Best-Case, Worst-Case Scenarios for Jake Locker's Heartbreaking Hip Injury

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Best-Case, Worst-Case Scenarios for Jake Locker's Heartbreaking Hip Injury
Frederick Breedon/Getty Images

Another sickening silence overtook the NFL community on Sunday when Tennessee Titans quarterback Jake Locker went down with a right hip injury. A gif of the injury is below, courtesy of @CJZero.

According to Teresa M. Walker of the Associated Press, trainers carted Locker off the field with his leg immobilized. Doctors later admitted the former Husky to St. Thomas Midtown Hospital to undergo further testing.

Immediately following the injury, not much was known. However, a number of different scenarios can play out after such an injury mechanism. Let's take a look at a few, all the while hoping Locker's version turns out to lie on the minor end of the spectrum.

 

Overview of Hip Anatomy

The hip consists of the joint where the femur—the thigh bone—meets the pelvis. Specifically, the rounded head of the femur sits within a socket in the pelvis called the acetabulum.

For a clearer picture, imagine a beach ball sitting inside an inner tube. The beach ball represents the femoral head, and the inner tube represents the acetabulum.

This X-ray shows the head of the femur—represented by a yellow circle—sitting within a red cup, representing the acetabulum. Photo from Wikimedia Commons and edited by the author.

The acetabular labrum—a ring of supportive cartilage—surrounds the rim of the acetabulum itself, deepening the pocket and providing more stability to the femur as it moves within the joint.

Unfortunately, just as an outside hit can knock a beach ball out of an inner tube—or a golf ball from a tee, for another example—the femur can separate from the acetabular socket if a tackle applies enough force.

A hip dislocation occurs when the femur falls entirely out of the socket. On the other hand, a hip subluxation is only a partial separation.

The surrounding labral cartilage can also tear with or without either above injury, as can other soft tissues in and around the joint.

 

Best-Case Scenario: Subluxation, Labral Tear or Soft Tissue Injury

Young quarterbacks are not supposed to leave games on carts, and when Locker departed from the field, all watching could only begin to hope.

Unfortunately, a review of the video makes it clear that even the optimal scenario is still also likely a troubling one.

After receiving one hit from New York Jets defender Muhammad Wilkerson, Locker falls into a second Jets defender, Quinton Coples.

The hit from Coples causes Locker to fall inward to his left while his right leg remains planted on the ground. As a result, his right hip sharply internally rotates.

Locker's fall forced his right hip into significant internal rotation, as seen in the above freeze frame.

Normally, hips can internally rotate to about 30 to 40 degrees. However, Locker's weight and downward momentum forced his lower leg outward much further, thereby pushing his femoral head past its limits.

Forced internal rotation can cause the femur to slip out of the acetabulum in the backward direction—a posterior hip subluxation or dislocation.

This video shows the basic anatomy of the hip.

Fortunately, Locker's thigh stayed directly underneath his torso, a mechanism of injury associated with dislocations not usually accompanied by fractures.

In the best-case scenario, the fall forced Locker's femur only partially out of his socket and did not significantly damage any surrounding tissue, blood vessels, bones or nerves. A subluxation can also pop back into the acetabulum on its own and without any intervention.

Regrettably, such an injury could still cost significant time—possibly approaching one to two or more months. However, two months is much better than some of the alternatives.

Then again, it is also possible Locker remains hospitalized simply for intravenous narcotics to adequately control his pain while doctors evaluate an otherwise-milder injury—relatively speaking, at least. A need for IV pain medication is a very common reason to stay overnight in a hospital.

 

Worst-Case Scenario: Hip Dislocation with Other Associated Injuries

Posterior hip dislocations can threaten the sciatic nerve. Photo courtesy of www.healthcentral.com.

As always, exact medical details are unavailable to the public.

Nevertheless, a full hip dislocation could prove devastating.

Whenever a bone moves into an abnormal position, the risk of damage to other muscles, tissues and nerves arises.

In the case of the hip, posterior dislocations can damage the sciatic nerve—one of the main nerves of the leg. The leg's blood supply is also at risk—though this occurs more frequently with anterior dislocations.

Nerve or blood vessel damage can pose an immediate threat to the viability of the affected limb—not to mention an athlete's season or career.

Furthermore, certain types of femur fractures can interrupt the blood supply of the bone itself, potentially leading to serious downstream consequences.

Thankfully, no reports of emergency surgery to correct a vascular or nerve defect yet exist. Additionally, according to NFL.com's Ian Rapoport, early tests do not show did not show a hip dislocation—at least at the time of examination, that is.

 

Bottom Line

Can the Titans make the playoffs without Locker?

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To understand Locker's road ahead, keep a look out for the diagnosis itself, his projected length of hospital stay and any need for surgery.

A subluxation—or even a complete dislocation—does not necessarily threaten his career. However, associated nerve or vessel injuries could.

That said, in the end, Locker's health and well-being are all that matters, and the thoughts of the NFL community are certainly with him as he begins to move forward from a night that surely changed his life.

 

Dr. Dave Siebert is a resident physician at the University of Washington. Information discussed above is based on his own knowledge and experience in a level-one trauma center.


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