Bone-mending advances could speed Cutler's healing

Bone-mending advances could speed Cutler's healing
Doctors rely on cutting-edge tools, techniques to shorten patients' recovery times

By Cynthia Dizikes, Chicago Tribune reporter

November 23, 2011

timelines: how long it will take the quarterback to heal versus the number of weeks left in the season.

Over the last several decades, doctors and scientists have built an arsenal of cutting-edge tools to help speed recovery time, which could allow a professional quarterback to use his throwing hand just weeks after breaking a thumb.

Cutler suffered a Bennett's fracture, a break in the metacarpal bone where the thumb meets the wrist, according to an NFL source. He is scheduled to undergo surgery Wednesday morning in Vail, Colo., according to sources.

Exactly what treatment he will get is not known, but doctors have an array of high-tech techniques at their disposal.

Tiny metal screws and molded plates are now able to squeeze and hold tiny bone fragments together. Compresses transmit ultrasonic waves to injured areas, which some think aids in healing. New bone-building protein and plasma treatments also are said to quicken recovery.

"Years ago, this would have been season-ending," said Dr. Neal ElAttrache, an orthopedic surgeon and sports medicine specialist at Kerlan-Jobe Orthopaedic Clinic in Los Angeles who reconstructed the knee of New England Patriots quarterback Tom Brady. "Now, they will likely have him moving it within a couple of weeks."

The NFL source who identified Cutler's break as a Bennett's fracture said a four-week recovery might be possible. There are six weeks left in the NFL regular season.

Other orthopedic surgeons, none involved in treating Cutler, said such a break typically takes six to eight weeks to mend.

In decades past it might have taken months to recover from that type of break, ElAttrache said.

Sixty years ago, orthopedics had a reputation for being one of the crudest and most limited of surgical professions. Doctors would immobilize a fracture by wrapping the break in tape, a splint or a cast. For extreme cases, such as a splintered femur, the preferred treatment was traction.

But the field blossomed during the Vietnam War, when doctors started using different limb-salvaging techniques like microsurgery and skeletal fixation. In the 1970s and 1980s, advances in fiber optics popularized arthroscopy, a minimally invasive procedure that allowed doctors to fix damaged tissue.

Each succeeding decade brought further technological leaps, either in detection, through the use of MRIs and CT scans, or in the engineering and manufacturing of screws, plates and other pieces of fracture-stabilizing hardware.

"I don't think it is overly dramatic to say the advances in orthopedics in recent decades have been on par with the introduction of antibiotics to treat bacterial infections," ElAttrache said.

While the technologies have changed, the biology of bone healing remains the same.

When bones fracture, the embedded blood vessels tear, creating a blood clot. That hematoma accumulates specialized cells, which begin to build delicate bridges of cartilage and woven bone between the pieces of broken bone. Eventually that bridge will become as hard as the original bone.

Doctors still use splints, casts and pins, but depending on the type and location of the break, metal screws and plates are also a common option.

Most of that hardware used to be made from stainless steel. Now doctors also use different types of metals, such as titanium, which more closely mimics the rigidity of bone. Doctors also have the choice of using smaller screws, some only 1 millimeter wide, and plates that have been molded to fit specific bones.

For athletes, the tailored fit allows for greater mobility throughout recovery, diminishing rehabilitation time.

"It is only in the last several years that we have had very small, effective screws that are used to fix small hand bones," said Dr. Mark Cohen, a Midwest Orthopaedics at Rush surgeon who is director of hand and elbow surgery at Rush University Medical Center. "We need these small implants, especially in injuries like Jay Cutler's."

Jay Cutler's broken thumb treatment - chicagotribune.com