The Dynasty Doctor: Rookie Injury Concerns

Scott Peak Posted On May 7, 2014

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Editor’s Note: Dr. Scott Peak is an ABPN board certified neurologist and neuro-oncologist. He is also a dynasty football addict and huge friend of Dynasty League Football. He’s excited to lend his expertise in medicine with hopes he may help the DLF Team and its followers better understand medical conditions and injuries that may impact NFL players and dynasty football owners. If you have a question for The Dynasty Doctor, just click here. Please remember The Dynasty Doctor is geared towards questions regarding medical science, injuries to players and their collective impact in fantasy football.

With the draft just hours away, we take a moment to review some important injury news so you can make educated decisions during your rookie drafts. Let’s review a few significant medical issues that have crept up in recent weeks.

Tre Mason, RB AUB

Mason reportedly has a scaphoid wrist fracture sustained last year, and it has created some concern amongst his future owners (NFL and dynasty players). The fracture has been slow to heal and questions have been raised about how this could impact his dynasty value. At DLF, we think discussing this injury, with a particular focus on dynasty value, is important and we will review it now.

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The scaphoid is a wrist bone that articulates with several other small bones in the wrist, and also with a much larger bone in the forearm, the radius. It is commonly fractured in athletes when using an outstretched hand to break a fall. When the wrist is extended, like holding up your hands to tell an oncoming car to stop, the force of impact is felt at the base of the palm/wrist, and a scaphoid fracture can occur.

The scaphoid bone has a limited blood supply to the part closest to the radius and it can take longer to heal. It appears Mason may have a chronic scaphoid fracture with bone not completely healed. This is not an unusual injury, but can have long-term complications if not treated effectively. The injury can often occur a long time before it is diagnosed and may initially be diagnosed as a sprain. Persistent pain usually leads to the discovery of the injury. Non-union of bone can occur in up to 15% of athletes with a non-displaced scaphoid fracture.¹

Treatment can be conservative with casting for 6 to 12 weeks. Distal fractures (the front part of the bone) can heal in 90-95% of cases with a cast, helped in part by a good blood supply to this part of the scaphoid. For proximal parts of the scaphoid (back part of the bone), poor blood flow might make casting less likely to work and surgery may be required. Internal fixation of the fracture with a small screw can help compress the fracture and facilitate healing, and a bone graft might also be used to promote bone fusion. It is important to address non-union of a scaphoid fracture, as this can result in long-term arthritis. It can take 3 to 6 months or longer for the bone to heal, worst case scenario, if surgery with a bone graft is needed to address non-union of bone.²

There are case reports of scaphoid fractures with non-union of bone treated successfully with surgery, including one report of 15 such patients all with healing an average of 14 weeks after surgery.³If a bone graft is necessary to heal non-union of a scaphoid fracture, most authors report successful union of bone in 75 to 100% of cases, an average of 16 weeks after surgery.³

Mason has denied he needs surgery, but most authors recommend surgery for scaphoid fractures that have not healed with conservative measures, so that might be why NFL medical providers reportedly think surgery will be needed. It has been reported Mason played through the injury and, if true, that would suggest it could be a small, non-displaced fracture, and therefore more likely to have a successful outcome. NFL medical providers reportedly feel the injury won’t be a long-term issue for Mason, again suggesting this could be a less severe fracture. The worst-case scenario is long-term arthritis and problems with grip strength. For an NFL running back, grip strength is obviously a concern.

I think Mason has a good chance to return to play and I think his long-term outlook in dynasty is still fairly good. In fact, news of this injury might turn Mason into a bargain in rookie drafts, and if he falls into the mid-to-late second round, I wouldn’t hesitate to grab him at that valuation.

References

Geissler, WB. Arthroscopic Management of Scaphoid Fractures in Athletes. Hand Clinics (2009); volume 25(3): 359-369.
Belsky MR, Leibman, MI, and Ruchelsman, DE. Scaphoid Fracture in the Elite Athlete. Hand Clinics (2012); volume 28(3): 269-278.
Wolfe SW, Hotchkiss RN, Pederson WC, et al. Green’s Operative Hand Surgery, Sixth Edition (2011). Chapter 18: 639-707.

Austin Seferian-Jenkins, TE WAS

Seferian-Jenkins’ foot fracture seems to be coming along well. He underwent surgery for a stress fracture in his left foot in February and he recovered well-enough to run a reported 4.56 40-yard dash during a workout with the New York Jets. Seferian-Jenkins has declared himself fully healed, so that’s good news. Foot fractures are a concern in an NFL athlete, but I’m not moving Seferian-Jenkins down my board based on a single stress fracture.

Marcus Lattimore, RB SF

While obviously not a rookie, Lattimore’s case always bears watching, so we added it in today as a bonus.

Lattimore recently admitted lacking burst and explosiveness and not being mentally or physically recovered yet. This isn’t surprising, and at DLF we’ve said expectations should be tempered on Lattimore since last year. Lattimore has a total knee dislocation in the right knee, and an ACL rupture in the left knee. Athletes with total knee dislocations return to sport in 79% of cases, but only 33% return to their previous performance.¹ A second study showed only two out of nine competitive athletes returned to their pre-injury level of play (22%).²I’m rooting for Lattimore, as he seems to be a great person, but I’m pessimistic on his long-term productivity in dynasty formats.

References

Peskun CH, Levy BA, Fanelli GC, et al. Diagnosis and Management of Knee Dislocations. The Physician and Sportsmedicine (December 2010); Volume 38(4): 101-111.
Eranki V, Begg C and Wallace B. Outcomes of Operatively Treated Acute Knee Dislocations. The Open Orthopaedics Journal (2010); Volume 4: 22-30.

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