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The Doctor Is In: Pouncey’s Season Ain’t Over Yet

Like the great Yogi Berra always said, “it ain’t over ’til it’s over.” And in my medical opinion, Pittsburgh Steelers All-Pro center Maurkice Pouncey may very well make it back in time to snap the ball to quarterback Ben Roethlisberger this season.

(All the usual disclaimers: I am not Maurkice Pouncey’s physician, I have not reviewed any of his medical records or Xrays, and all you will read is based on the information available to the general public)

As we all know and some of us would like to forget, Pouncey sustained a broken left fibula in a preseason game versus the Green Bay Packers on August 23rd. He was placed on Injured Reserve/Designated to Return, which means that he could not practice with the team for 6 weeks and could not play in a game until 8 weeks after the date of being placed on IR. So it was a considerable loss. As always, the standard is the standard, though, and the team has moved on with back-up center Cody Wallace, with the hope and expectation that their true starting center would reclaim his rightful place on schedule.

This week, however, that plan changed. One week before he possibly planned to return to practice, Pouncey reportedly developed an infection in his leg and subsequently underwent a second surgery to have a plate removed. Reports today suggest that he will see a surgeon in North Carolina for a second opinion.

Ed Bouchette of the Pittsburgh Post-Gazette is already painting a gloomy picture for Steelers fans and believes Pouncey may be done for the year.

Bouchette clearly has the inside track when it comes to reliable sources, but I wouldn’t rule out Pouncey just yet. It really depends on whether his fracture has healed, and I doubt that anyone outside the Steelers inner santum has that information yet. So let’s look at what we do know.

The fibula is the smaller of the two bones between the knee and the ankle. Unlike the tibia, it does not bear any significant body weight. The fibula forms the outer or lateral part of the ankle and provides stability to the ankle joint as well as a point of attachment for muscles and ligaments. Here’s an Xray of a typical fibula fracture:

 Fibula fx xray

Fortunately, Pouncey did not also have a fracture of his tibia, which would have required a more complicated repair and a longer recovery. He reportedly only required an Open Reduction and Internal Fixation (ORIF) of the fibula…otherwise known and going to the OR and screwing a plate across the broken part:

fib2

Here’s an animated video that shows the repair if you want to totally geek out. Basically, the surgeon makes an incision down the side of the lower leg, exposes the bone, and secures a long plate with multiple holes along the length of the bone with screws.

It sounds like Pouncey was recovering well, and all signs pointed to his return to practice until he was found to have an infection. If the infection had only been in the skin or soft tissue, antibiotics would probably have resolved it. Typically, if even intravenous antibiotics don’t clear the infection, the next step is to remove the hardware. Unlike human tissue, any man-made or foreign material in the body will not respond to antibiotic therapy once it is contaminated by bacteria. Until that foreign body is removed, the infection will persist, even become chronic for months or years.  I have to assume that Pouncey received some pretty strong antibiotics before it got to the point where he went back under the knife.

The key at this point is whether the fracture has healed. If it has, than Pouncey will need to recover from his recent surgery and have his infection treated completely, but he will likely be back.  How soon? Tough to predict, but it is entirely possible that he could be back on the practice field in as little as a month. That would be just before the bye week, giving him 2 weeks of practice before the Steelers face the Seattle Seahawks in Week 12 on November 29th.

If the fracture hasn’t healed, that presents a more challenging problem. With an infection still present, he cannot have new hardware put in his ankle or it will also get contaminated and he will be right back where he started. In that case, he might be treated with a bone graft from a different part of his body or external fixation with a cast. And his recovery would depend on what choice his surgeon makes. In that scenario, unfortunately, I think that the Steelers will have to depend on the next man up for the duration of the season. Then again, if they make it deep into the post-season, Maurkice Pouncey has a chance to line up with his fellow offensive linemen before the story of the 2015 season is in the books.

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