Predicting Joba’s prognosis

The ankle injury saga has been an interesting case study for how the media tend to respond to serious injuries (I’m going to ignore the excessive media moralizing about how trampolines are deathtraps, and therefore going on one is incredibly irresponsible).  The immediate reaction was that Joba’s injury was quite possibly life-threatening (due to major blood loss), and at minimum, career-threatening (due to possible risk of infection and other complications), which naturally sent Yankee fans into hysteria.  The media coverage of the injury largely seemed to largely focus on these worst-case scenarios, and there was not much discussion of the realistic timeframe for Joba’s return.

Recently, the news about Joba has been more positive.  While the open dislocation of Joba’s ankle is still an awful injury, the reports that there were no microfractures or infection so far are good signs for his prognosis.  This whole process of media reporting of injury prognoses made me curious about what the current medical literature had to say about this type of injury.

Since I had a little free time, I decided to poke around Medline and see what I could on the subject.  Important caveats: I am no expert on this topic, and the findings in the included studies may very well not be applicable to Joba’s case.  The vast majority of studies that I found were case reports, which mean that the sample size is by definition fairly small, especially since this is not an especially common injury.

The studies I examined all mentioned that fractures and infections were predictors of future complications associated with open ankle dislocations.  Both of these would increase the risk of developing avascular necrosis (bone death due to loss of blood supply) in the future.  Since Joba apparently escaped these adverse outcomes, the likelihood of long-term disability doesn’t seem to be very high.

As for when the victim is able to return to their pre-injury activity level, the evidence is less clear.  One case of a patient who suffered a similar injury to Joba saw a return to full activity within 6 months.  Another paper described the case of a 20 year-old college football player who suffered the dislocation along with a fractured fibula (which Joba did not have), and was 100% functional after 7 months.  Several other studies didn’t report when the patient was fully functional, but did report that they had no problems 2-3 years after the injury.

Unfortunately, none of the studies I found really had an analogous situation to Joba.  The college football player comes the closest in terms of the required performance levels, but his injury was likely more severe because he also had a fractured fibula.  Still, given the possible talk about a career-ending injury I think any of us would take a 7-month rehab period before Joba was 100%.  This more conservative timeline would end Joba’s season, but give him time to get healthy and in shape for the start of 2013.

Given that Joba is an exceptional athlete (compared to the average American) and will be receiving the best medical care and rehab possible, it wouldn’t be unreasonable to imagine an accelerated recovery timeline.  This leaves hope that he will see Joba at the end of 2012, even if it is just in September.  However, Joba is not out of the woods yet, and the possibility of infection or setbacks could complicate matters.  Regardless of what happens, however, Joba Chamberlain will likely be back in the Yankee bullpen in 2013 assuming there are no setbacks (and he doesn’t have the audacity to play with his child again).