Explaining Tua Tagovailoa’s right hip posterior dislocation-fracture, surgery, and career outlook

Explaining Tua Tagovailoa’s right hip posterior dislocation-fracture, surgery, and career outlook


Hey everyone, it’s Raj from 3CB Performance. Alabama QB and potential #1 draft pick Tua
Tagavailoa suffered a devastating right hip posterior-dislocation fracture on November
16th against Mississippi State, in the waning minutes of the first half. In this video – for which I consulted very
closely with a trusted, sports minded orthopedic surgeon – I detailed the injury, the surgery,
and Tua’s career outlook including potential risks and key challenges of rehab. The hip joint – known as the femoroacetabular
(FA) joint – is a “ball and socket joint” that consists of the head of the femur (upper
leg bone) and socket of the hip (acetabulum). It’s a unique joint in that it combines
both mobility – it has the second highest mobility of any joint in the body, second
only to the shoulder joint – and strength – it’s the strongest, highest force-bearing
joint in the body. A posterior hip dislocation-fracture is when
the femoral head (“the ball”) is forcibly ejected posteriorly (backwards) out of the
acetabulum (“the hip socket”), with an associated fracture to the surrounding wall
of the socket. It’s an extremely serious, high force injury
that’s typically only seen in young individuals due to motor vehicle or motorcycle accidents
and falls from height. It’s an injury handled by trauma surgeons rather than sports orthopedic
surgeons which speaks directly to just how serious this injury is for Tua. While still at the stadium, the medical staff
“anatomically reduced” Tua’s hip, meaning the hip was set back into place. This takes
stress off the neurovascular bundle (nerves and blood vessels) and reduces the risk of
post traumatic arthritis. More on both in the “Risks” section. After the joint is reduced, the surgical course
of action depends primarily on the extent of the posterior wall fracture. Typically, if less than 20% of the posterior
wall is fractured, the surgical team will perform an exam under anaesthesia (EUA) to
stress the joint and check for hip stability. If the hip isn’t stable, you proceed with
surgery. If the posterior wall is greater than 20%
fractured in the first place, immediate surgery is indicated. The approach is called a “posterior approach”
– the same as used for hip replacements – in which the surgeon enters into the joint from
behind. The fractured posterior wall is typically repaired and stabilized by using a few “spring
plates” over the fracture site and a “recon plate” that’s bent to act as a buttress. It’s a very involved surgery and part of
the reason why we have specialized 2+ year trauma surgery fellowships that focus on these
types of injuries. Considering the rare nature of this injury
in sport, there’s not much definitive research out there on return to play timelines. What
I was told is to expect at least six months before Tua’s back out on the field and it
could be up to one year before he’s cleared to return. That significant variance speaks to the severity
of the injury, the huge demands on the hip joint during football, and multiple variables
related to the potential risks and rehab. The greatest risk factor is known as “post
traumatic arthritis”. The hip dislocation can result in damage to femoral head and acetabular
cartilage and start a cascade of degeneration that leads to early onset arthritis. Avascular necrosis is when bone begins to
die because its blood supply is impaired. With hip dislocations, there’s an inherent
risk for AVN to develop in the femoral head which would then require a hip replacement.
That’s what happened to Bo Jackson and essentially ended his career. Numerous steps are taken to reduce AVN risk,
particularly one during surgery in which – unlike a hip replacement – the shorter hip external
rotator muscles are specifically re-attached at least 2cm away from their normal insertion (end point) on the femur (upper leg bone) to avoid damaging the blood supply to the
femoral head. Heterotopic ossification is when bone tissue
develops outside the normal skeleton and can lead to functional deficits such as a loss
in hip range of motion. It’s a key consideration after traumatic lower body injuries and typically
guarded against by administering certain medications or, in some cases, low level radiation is
actually used. The research shows that roughly 13% of posterior
wall hip fractures have an associated nerve injury, with a 2 to 10% rate of foot drop.
The trauma surgeon can, arguably, mitigate against this by keeping a knee flexed and
hip extended position during the surgery. The high level of demands placed on the hip
during football – especially for a mobile QB in Tua – in combination with the hip’s
unique level of mobility and strength, can make rehab a slow, grind it out process. You have to focus on maintaining hip mobility
early and then methodically build up strength and function, particularly in the hip abductors
and external rotators. It’s a frustrating process full of hills and valleys. That frustration is why the mental challenge
of rehab may be the largest hurdle for Tua to overcome in his journey back to the playing
field. For example, the research shows that oftentimes the last hurdle to be cleared after
a major injury is overcoming fear of movement or re-injury, known as kinesiophobia. Additionally, the spectre and daily life of
an extended rehab process that often finds you isolated and with the same one to two
people every day can wear on athletes and affect their motivation, attitude, and recovery. For that reason, Tua viewing the injury and
recovery through a “growth mindset” lens that paints it as a challenge rather than
as a defeat will be critical for him. We’re seeing more and more tangible research showing
how a positive, growth mindset can positively influence outcomes. Former Tide QB Greg McElroy spoke directly
on that in regards to Tua, stating: “So much about overcoming an injury is about your
attitude, and if there’s one thing I know about Tua, he’s going to have a remarkably
positive attitude in the approach to the rehab and everything that’s going to go along
with it.” Look, there’s no denying that this is a
brutal, extremely serious injury wrought with landmines of risk and highly variable timelines. Fortunately, Tua does have access to the highest
quality of medical care – from surgery through rehab to strength & conditioning – and by
numerous accounts has a very positive mindset. Each of these bodes well in his recovery and
potentially getting back on the field at a high level but there’s simply a lot of uncertainty
moving forward and this is truly a case of “only time will tell”. That’s a wrap for this video. Thanks for
watching. My goal is to provide you with in-depth, evidence based, narrative free analysis and
you can always find me on IG and Twitter @3CBPerformance. Make sure to sub to the channel for the latest
updates. 3CB out.


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