Dez Bryant's Broken Finger: Risks of Delaying Surgery

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Dez Bryant's Broken Finger: Risks of Delaying Surgery
Wesley Hitt/Getty Images

Dez Bryant's broken finger has added yet another storyline to the Dallas Cowboys' (7-6) already emotional, dramatic, last-second 20-19 victory over the Cincinnati Bengals (7-6) in Week 14.

After all, a wide receiver in the NFL certainly can't play with a broken left index finger, right?

Wrong.

According to Ed Werder of ESPN.com, Bryant has elected to delay the surgery that was recommended to him by a hand specialist, or an orthopaedic surgeon specializing in hand surgeries.

Attempting to play through the injury for a Cowboys team that is making a desperate playoff push is an admirable move by the third-year wide receiver out of Oklahoma State University.

It is also quite risky.

As Werder mentions in his report, "If Bryant reinjures the finger, it could cause permanent stiffness, which would minimize his ability to catch passes."

Normal left hand X-ray. The finger that Dez Bryant broke, the left index finger, is highlighted by a yellow circle. It is made up of a total of three bones. Photo from Wikimedia Commons and edited by the author.

Why is that the case?

Simply put, finger fractures can be tricky.

A finger fracture can be classified as either "non-displaced" or "displaced."

A non-displaced fracture has occurred when one of the bones in the finger has been broken but not moved out of place.

Imagine bending and re-straightening a drinking straw.  The straw is clearly deformed, but its overall shape remains the same.

In contrast, a displaced fracture is better represented by a broken toothpick.

The toothpick is broken, and in addition, the shape of the toothpick is permanently altered.

Nevertheless, the human body is an amazing machine.  It will heal the vast majority of both non-displaced and displaced fractures on its own.

The difference lies in how well it does so.

In most cases, a non-displaced fracture will heal essentially perfectly without any intervention.  The healing process will take out the bend in the straw, so to speak, and after a few weeks, the bone will look entirely normal.

However, a healed displaced fracture will not.

X-ray of a broken hand (not Dez Bryant's) after wires have been surgically placed to re-align a displaced fifth metacrapal fracture. The wires can be seen as the white criss-crossing lines toward the top of the X-ray. NOTE: this is (likely) not the same bone that Dez Bryant broke. Photo from Wikimedia Commons.

In a healed displaced fracture, the break in the toothpick has been re-connected by the body, but the figurative "bend in the toothpick" remains.  This process is called "malunion."

The purpose of surgery following a displaced finger fracture is to re-align the bone before healing has taken place in order to prevent malunion.

That is where the risk in delaying surgery lies for Bryant.

As always, exact medical details are unavailable to the public.  However, speculation suggests that because surgery was recommended, Bryant's left index finger fracture is displaced to at least some degree.

That said, it is likely only minimally displaced.  If the fracture was more severely displaced, it is a safe bet that Bryant would have already been ruled out for Week 15 in favor of undergoing surgery.

In other words, doctors are probably not terribly concerned about the possibility of malunion at this point.

However, the risks do not end there.

As Werder also mentions, the "Cowboys' medical staff will attempt to devise a means of protecting the finger that also enables Bryant to function as a wide receiver."

Video by Dr. Nabil Ebraheim, Chairman, University of Toledo Department of Orthopedic Surgery, describing finger malrotation, one of the possible complications of a finger fracture.

The rationale behind protecting a broken finger lies in the fact that while a fracture is healing, the bone is quite weak.

As a result, less force to the finger is needed to cause more damage.

While playing with a known fracture, hits to Bryant's hand that would not have previously caused harm may now cause further injury, including a more severely displaced fracture.

Also, if a fracture is dramatic enough, surgical re-alignment may not be able to completely restore normal anatomy, and malunion can result.

In the worst case scenario, nonunion, where the bone never reconnects itself at all, is possible.

Malunion or nonunion can lead to decreased finger range of motion, stiffness and permanent deformity.

Any of those complications would make life as a wide receiver in the NFL extremely difficult, if not impossible.

All of that said, the Cowboys' team physicians are not going to mess around.

Bryant will certainly wear added protection on his finger this Sunday, and at the first sign of any further injury, he will likely be removed from the game.

Hopefully that does not come to pass, for both Bryant's sake and for the Cowboys'.

Streeter Lecka/Getty Images

Tony Romo certainly needs as many receiving options available as possible for this week's contest against the visiting Pittsburgh Steelers (7-6).

With both teams desperate for a win, each will be definitely be pulling out all the stops.

For now, it appears that Dez Bryant will be, too.

 

Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will be graduating from medical school in June, 2013.  He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine.  The injury information discussed above is based on Dave's own anatomical and clinical knowledge and can be supplemented by Medscape's article on finger fractures that can be found here.

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