Welcome back everybody i’m, dr brian suter – and this is your number one source for learning about the unique medical side of the world of sports. This photo’s not fake. This is what happened when jeremy lane not only broke his arm in super bowl 49, but also tore his acl in this video we’ll. Take a look at not only what happened, but how it happened. As always, if you enjoyed learning about this unique set of sports, please consider subscribing to my channel and let’s get started. We’Ll talk first about the forum, injury, and this was the play as lane was returning. This interception we see julian edelman come in to make the tackle, hits him there on the left, lower leg, which is really important and we’ll get to later on, for the injury that this caused, but the nas lane is falling to the ground. He has something called a foosh injury or a foosh mechanism stands for fall on an outstretched hand. Now, for how this happens, we have to pay attention to the fact that, when he lands, his elbow is locked, in extension, meaning it’s completely straight, and his body is essentially rotating. He has this sort of angular momentum, that’s going to impart this torsional stress down through his arm into the forearm contributing to the fracture now here we can see it a little bit in this view. You can see the pretty obvious deformity here in the forearm from when the fracture occurs, but again pay attention to how basically his arm is absorbing all that impact, while his body is simultaneously twisting imparting this torsional load through his arm.

We can see it here again in this view, as he’s falling to the ground, that left arm is going to land and so right here, he’s falling on that outstretched left arm and then, as his momentum carries him through with that torsional component. That imparts this twist down through the forearm and that’s, where we can ultimately see the fracture, occur down in that middle portion of his forearm we’ll. Take a look next at our biodigital anatomy tool here and what i want to point out are the two bones of the forearm that lane broke we’re looking here at a left arm, and so this is going to be the outside of the arm, and this is Going to be the inside and this bone highlighted is the radius it’s on the thumb side of the arm, and then the one on the inside is going to be. The ulna lane reportedly broke both of these bones and it was something called a compound fracture, meaning the bone actually came through the skin, which imparts all kinds of additional risk of infection, in particular, something which elaine as we’ll talk about actually dealt with now. Technically, when we think about the bones of the wrist, the radius and the ulna are going to comprise some of that wrist joint. But then we also have all of our small little carpal bones that sit more in the wrist itself. Now the important things to understand with the biomechanics of the elbow joint are number one: the basic bony morphology of the ulna and the radius sort of determine how they’re gon na move this bump back here is the olecranon process it’s this hard bump.

You can feel in the back of your elbow and essentially our ulna rotates in flexion and extension about the humerus in this humeral ulnar joint. So, whenever we flex and extend that’s purely movement of the ulna flexing and extending off of the humerus now, our radius is also going to flex and extend off of the humerus, but it gets involved with something called pronation and supination. So if you hold your elbow fixed when i have my palm up that’s supination and then when i turn my palm down, that’s going to be pronation. So whenever i make this motion, what’s happening is the radius. Here is basically spinning on the side of the ulna, allowing you to turn your wrist up and down. This picture really says it all, because here we can see that elbow is completely extended, meaning the arm is locked straight and so you’re not going to be able to absorb as much of that impact through flexing the elbow up and through the muscles it’s all going To go directly through the bones of that arm. The other thing too, of course, because of this foosh position, where he’s landing on this outstretched extended wrist. All of that axial load from the ground is going to be transferred directly up through his forearm. Putting those two bones: we talked about in a severe amount of compression, but then that component, where his body is rotating about his arm imparts additional torsion and our bones – are not very strong with that.

Torsional component, specifically too, because his hand is extended like this and locked on the ground, that’s going to even make it harder for him to rotate and sort of compensate, as opposed to say if it might have just been his fist. Or you know if his wrist would have been flexed or not extended, so this is just a terribly unlucky position for him to be in where you see this, just imperfect some of these forces that are enough to break both of those bones. This would be almost nearly impossible to actually replicate it’s, just one of those terrible bad luck, things that happened in sports now, the seahawks medical staff was extremely prompt to get there to evaluate him, and the first thing you can see i’m doing here is basically stabilizing The fracture you want to make sure you get it as supported and stable as possible so that you don’t result in any more injury to those soft tissues like the muscles, the nerves, the blood vessels, and then here, of course, we can see. Now he has this cast, or this splint on his entire arm, helping to keep that fracture stabilized, so let’s walk through the form fracture one more time here. Lane is running down the sideline he gets hit and as he goes to brace for his impact, he extends that arm. He extends that wrist, causing this foosh mechanism, where all this axial load from his body wave falling, is going to be transmitted up through the ulna up through the radius, combined with this rotational component from how his upper body and his legs are spinning around that’s.

Going to impart torsion down through his forearm, which ultimately is going to result in that break, it’s, also, no surprise that this was a compound fracture. This much body weight on an arm. That’S completely broken like this. I don’t know how you wouldn’t. Have the bones go through the skin and so that part of it isn’t surprising at all, just seeing how severe it was now. Perhaps the craziest part of this whole story was that lane didn’t even realize until afterwards that he had also torn his acl on this play now in a severe trauma like this, when the surgeons are paying attention to the obvious compound fracture in his arm, you can Understand how they might miss looking at the rest of his joints, he was reportedly in a grocery store when his knee just buckled and that prompted an mri that showed his acl was torn and, in fact, when we look back at the play, it’s really easy to See when his acl got injured the first view here we can see when edelman comes in. He imparts this valgus directed load from the outside inward onto lane’s left knee now from this angle. It might not look like much but as we’ll look in a second here. This was a significant amount of impact, and lane’s foot is anchored onto the ground when that load comes in. If that impact had come in when his foot would have been off the ground, he probably wouldn’t have torn his acl.

But now, if we look from this back view, we can clearly see when the acl got injured. So here edelman’s, coming in to make impact on that outer or lateral portion of lane’s left knee and here as lane’s leg is planted. Edelman basically drives that knee inward imparting that severe valgus load onto his knee, which is classic for a contact. Acl tear also the fact that lane’s body is tilted so far over that left side causes even more of a moment to be distributed down through the knee to cause it to swing inward and put stress and pressure on that acl leading to the rupture. The other thing too, as we play this through here when lane, is actually on the ground and kind of comes back up. This position right here is not going to be good for his knee either. You can tell that he’s, basically still kind of rolled up on his knee bent over to the outside of it now with any flex that’s not going to put as much stress on the acl, but certainly this can injure the mcl. This can cause some more meniscus damage, so two kind of instances, but clearly we can see from that initial hit by edelman that the acl would have been injured as well now to make things even more complicated lane had to deal with infection from his forearm fracture Surgery that extended his absence, but it was really the acl terror that caused him to miss so much time now he was able to return to the field.

So this didn’t end his career, but you can’t doubt the amount of just mental stress that would come along with this and just having the confidence to go back out and make big plays. So this is an injury that i hope we never see again. Nonetheless, i hope it was educational to take a look at some of that anatomy, with the forearm some of the specific movements and breakdown. Why exactly something so severe like this happened? A lot of these types of bad injuries really come down to just pure bad luck. In the sense of forces, imperfectly lining up at just the right time to cause a bad injury, there’s, nothing about mechanics that are going to change this or lower the risk, it’s, just terrible luck that happens when you’re playing in a contact sport. Thank you, as always for watching. Everybody, though, enjoy the super bowl this weekend.

https://www.youtube.com/watch?v=2whA2pVO6W8