Explaining Cowboys QB Dak Prescott’s compound fracture and ankle dislocation

Dallas Cowboys quarterback Dak Prescott was transported to a local hospital for surgery after suffering a compound fracture and dislocation of his right ankle during Sunday’s game against the New York Giants.

That Prescott was headed for immediate surgery indicates just how severe the injury is, according to the Mayo Clinic website.

Unlike more common fractures and broken bones, compound fractures or open fractures usually mean part of the bone broke through the skin at the moment of injury. Complicating matters, open fractures must be treated immediately because of the risk of infection to the open wound, according to the Mayo Clinic.

Prescott was treated with sterile dressing on site before surgery to wash the wound and fix the fracture. The injury will likely end his season, according to Cowboys head coach Mike McCarthy.

Cowboys quarterback Dak Prescott leaves the field on a cart in the third quarter against the New York Giants Sunday after his serious ankle injury. (Photo: Tim Heitman, USA TODAY Sports)

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Prescott’s injury brings back fresh memories of the gruesome injury Washington quarterback Alex Smith suffered on Nov. 18, 2018 – although Smith’s injury was complicated by a serious infection. Prescott’s injury is also similar to the one Boston Celtics forward Gordon Hayward suffered on Oct. 17, 2017. Hayward was diagnosed with a dislocated ankle and fractured tibia.

Understanding the injury

The ankle joint, according to the Hospital for Special Surgery website, is composed of the tibia, fibula and talus bones. The talus (or "ankle bone") connects your leg to your foot.

Doctors think of the ankle as having three sides and a "roof," and fractures can occur in each of these areas or in combination. The lower portion of the tibia forms the roof and medial (inside) of the ankle, while the lower portion of the fibula forms the lateral (outside) and posterior (back) of the ankle.

In Prescott’s case, we do not know what specific bone was fractured or if there were more than one.

There could also be ligament damage associated with the fracture since ligaments connect bone to bone to provide stability of the joints. Soft tissue may have also been damaged, depending on the severity of the fracture and dislocation.

Explaining the surgery

A compound fracture almost always requires reduction, a process where the bones are manipulated back into place and set so the ankle and leg can heal correctly, according to the Hospital for Special Surgery. The goal is to have the bones heal as closely to perfect as possible to prevent any residual instability or malalignment of the bone.

If the fracture is serious enough and future mobility could be cause for concern, pins, screws, rods or plates could also be inserted to maintain proper positions of bone and provide stability.

Recovery time

Following surgery, restricting movement is critical to proper healing, so a hard or soft cast, splint or walking boot is usually prescribed. Keeping weight off the ankle is also crucial, which can necessitate the use of crutches or a cane.

For most people, immobilization can last anywhere from four to eight weeks, depending on the severity of the injury. Once X-rays determine that the injury is healing correctly, patients could start weightbearing and begin physical therapy, which could take another six to eight weeks.

In terms of his future with the team, he and the Cowboys failed to reach an agreement on a long-term deal so Prescott is playing under the franchise tag for $31.4 million guaranteed this season and does not have a contract for 2021.

He could sign a long-term deal after the season or become a free agent in March or go back on the franchise tag.  

In early September, Prescott said he anticipates being in Dallas “for the long haul.”

Sunday night, owner Jerry Jones released a statement:

"We are all heartbroken for Dak and this very disappointing injury. … He has all of our love and support. And we have no doubt that he will return to the position of leadership and purpose that he brings to our team."

Contributing: Jori Epstein

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