Breaking Down the Details of Rob Gronkowski's Injury

Dave Siebert, M.D.@DaveMSiebertFeatured ColumnistJanuary 15, 2013

FOXBORO, MA - DECEMBER 30: Rob Gronkowski #87 of the New England Patriots warms up prior to the game against the Miami Dolphins during the game at Gillette Stadium on December 30, 2012 in Foxboro, Massachusetts. (Photo by Jared Wickerham/Getty Images)
Jared Wickerham/Getty Images

Though the New England Patriots appear as dominant as ever, the effects of Rob Gronkowski's injury will only become more and more apparent as the competition continues to gets tougher.

The Patriots tight end originally fractured his forearm on an extra point play toward the end of a blowout win over the Indianapolis Colts back in November.

At this point, whether or not Bill Belichick should have rested his starters toward the end of that 59-24 victory is moot.

However, at the time of Gronkowski's Week 17 return, the hope around New England was that the Patriots avoided any serious complications due to the injury.

Unfortunately, that did not turn out to be the case.

Gronkowski suffered a second forearm fracture to the same arm on Sunday during the Patriots' divisional playoff victory over the Houston Texans.  He will miss the rest of the postseason as a result.

When the news surfaced that Gronkowski broke his forearm for a second time, many across the country immediately wondered the following:

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  • Is the fracture in the same location as the first?
  • Did the Patriots rush Gronkowski back?

The answer to both of those questions is a near-definitive no.

To understand why, let's take a closer look at both injuries.

There are two bones in the forearm—the radius and ulna.  With the palm facing up, the radius runs from the elbow to the wrist on the outside of the forearm, and the ulna does the same along the inside.  In fact, when someone leans with their elbows on the table, they are actually leaning on one of the ends of the ulna.

It is unclear which bone—or bones—Gronkowski first broke Week 11.  It is also unclear where, exactly, the fracture or fractures occurred.

However, given the fact that, according to Tom E. Curran of Comcast Sports Net, Gronkowski had a metal plate surgically placed after his first fracture, it is reasonable to assume the first break occurred in the shaft—the long, middle portion—of one of the bones rather than at one of the ends.

It is also safe to assume that doctors determined Gronkowski's fracture to be significantly "displaced," meaning the fracture caused the two pieces of bone to no longer be properly aligned.

For a better picture of a displaced fracture, imagine a broken toothpick.  The toothpick—representing the bone—is broken, and the shape of the bone is also altered.

In contrast, a "non-displaced" fracture is better represented by a bent drinking straw that has been re-straightened.  The straw is deformed, but the overall shape of the straw remains the same.

When a fracture is indeed displaced, the primary goal of treatment is to avoid what are called "malunion" and "nonunion."  In malunion, the broken toothpick reconnects itself but remains permanently deformed.  In the dreaded nonunion, the bone does not reconnect itself at all.

That is where Gronkowski's metal plate comes in.

Once X-rays confirmed a displaced fracture, Gronkowski underwent surgery on his forearm to directly visualize the fracture, manually realign the bone into its proper anatomical position and use metal screws to attach the plate to the bone in order to reinforce that position.

In other words, the metal plate holds the broken bone together—in a straight line—until Gronkowski's body heals the break on its own.

Nevertheless, as Gronkowski and Patriots fans everywhere now know, the metal plate does not come without risks.

Along with ensuring proper bone realignment, the metal plate collects outside forces applied to its center—and thus the fracture site—and redistributes them to its ends.  By doing so, it channels those forces from a relatively large area of bone and unleashes them on a much smaller one.  If they overwhelm that smaller portion of bone, a new break results.

As Curran's report discusses, that appears to be exactly what happened to Gronkowski.

During his leap and direct fall onto his forearm, Gronkowski placed the entirety of his body weight onto the healed fracture and metal plate.  The healthy part of his bone at the end of the plate therefore felt an unusually large portion of that blow and broke.

Though Mark Daniels of the Boston Herald reports that there are a number of differing opinions throughout the medical community, Gronkowski likely could have re-injured his arm in this manner at anytime.  It just so happened to occur mere weeks after the original break.

That said, as Daniels' column also mentions, it is possible that the bone was still weaker than normal from the first break and thus contributed to the second.  However, given the fact that Gronkowski received medical clearance to return to play, that contribution was likely minimal, if anything at all.

Regardless of the exact cause, the result remains the same, and Gronkowski will not see any meaningful on-field action until the start of the 2013 season, as according to the Associated Press (via Fox Sports), he underwent season-ending surgery on Monday.

Details around the second surgery are scarce, yet surgeons likely once again visualized the new break, realigned the bone and revised the plate and screws as necessary to ensure proper healing.  It is also possible additional screws or plates were added.

These manipulations likely mean Gronkowski must wear a cast for some time as he allows his body to slowly heal the new break.

Despite these developments, if there is a team that can successfully absorb a little bit of bad luck, it is the Patriots.

With so many solid receiving options, highlighted by Shane Vereen's breakout performance on Sunday, Tom Brady will likely be able to adapt to missing his superstar tight end once again.

Additionally, there is no doubt that Gronkowski will be be fully healed by the beginning of next season.  However, it is possible he will be at increased risk for more, similar forearm fractures in the future.

Only time will tell.

Dave Siebert is a medical/injury Featured Columnist for Bleacher Report who will graduate from medical school in June.  He plans to specialize in both Family Medicine and Primary Care (non-operative) Sports Medicine.  Injury and anatomical information discussed above is based on his own knowledge.

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