Dr. Silverman is no stranger to breaking down the forces of nature that result in an athlete’s injury as well as their expected recovery protocol. He’s tackled the likes of Steph Curry, Julio Jones, Giannis Antetokoumpo and more, and unfortunately for Dak Prescott, we can now add his name to the list. Below, Dr. Silverman examines what occurred during Dak’s injury yesterday and what he can expect from his rehab.
Dak Prescott’s Fractured and Dislocated Ankle
Dak Prescott was injured midway through the third quarter as he scrambled to his left and was tackled awkwardly by a Giants defender. You can see a video of the play below before we dive into what we see based on the video and our decades of experience fixing ankles just like this one.
Oh damn. Dak Prescott. #cowboys #NYGvsDAL (WARNING GRAPHIC) pic.twitter.com/adhSjg5kHO
— Browns Rally Possum (@BrownsRally) October 11, 2020
Dak’s injury involved an external rotation and possible eversion injury at either the ankle joint (most likely) or the subtalar joint. The prominence of his medial malleolus over his shoe made it difficult to identify. It’s clear that he has an ankle fracture, but what’s unclear is whether or not he has a syndesmotic injury associated with it. (Syndesmosis is a fibrous joint in the area held together by ankle ligaments).
This type of ankle fracture is typically allowed early weight bearing within the first few weeks and the latest by four weeks. If he has the ankle fracture with the syndesmosis component, he will need an open reduction and internal fixation of both the fractured bones and the ligaments around the ankle. This has a very good prognosis for fractures, it is common, it will be reduced well and carefully monitored. Gentle training can begin once the bones have healed, however, he will not be doing any aggressive moves from an injury like this until at least three months from now.
If Dak is incredibly unfortunate and had a subtalar dislocation, this is likely a career ending injury. Subtalar dislocations, which can be reduced routinely, result in post traumatic arthrofibrosis (stiffness in the joint below the ankle joint). He will lose significant mobility and speed if he loses that joint mobility.
The Cowboys later tweeted out that Dak suffered a compound fracture and dislocation, which is a bit of a dated term in orthopedic circles. This suggests it was an open injury. In other words, the bone broke through he skin. Open fractures are the result of higher energy injuries, they have a higher risk of infection and they present with more potential post-traumatic problems. Because the bone breaks through the skin, there’s a greater risk of both bacterial infection and eventual arthritis onset. More scar tissue around the ankle joint also leads to greater mobility restriction and can even damage muscles in the area.
Not to be harsh, but the moment I saw him go down my heart sank knowing the truth of how long he was going to be out at a minimum. He’s got some of the world’s best doctors and experts helping him, but even if it heals as expected, I believe we’ll be able to see that he’s not the same player he was before the injury. We’ve seen how great athletes can mold their game to their abilities and their limitations, so hopefully Dak can do the same, because it’s unlikely he’ll ever have the same mobility or confidence in the ankle that he did prior to yesterday. We wish him the best in his recovery.