Wednesday, February 19, 2014

Mats Zuccarello's hand injury worse than previously thought

Mats Zuccarello has been an important player for the New York Rangers this season, scoring 43 points in 58 games for the club looking to make the playoffs for the fourth straight season. Zuccarello was named to Team Norway at the Sochi Winter Olympics and was the only NHL player on their roster.

In a game against Austria on the 16th, Zuccarello was injured blocking a shot, the puck injuring his left hand. Zuccarello was able to finish the game against the Austrians, however, missed yesterday's game against Russia due to his injured hand. Originally, Zuccarello's hand injury was considered minor, with only some bruising and swelling. Zuccarello was also noted as having trouble gripping his stick, so he didn't play. However, it was revealed today in the Norwegian media that Zuccarello has a small non-displaced fracture in his left hand. The news was confirmed by NY Post writer Brett Cyrgalis:

The Norwegian news source stated that while Zuccarello is hurt, he should be ready to play when the Rangers return to NHL action on the 27th of February. The bad news is that this is a hand (left) that Zuccarello has previously broken in 2011 while with the Connecticut Whale.

As I wrote in my previous post on hand fractures, hand injuries are fickle and fairly common in the sport of hockey. The most important factor in a hand injury is the location of the fracture. You need to make sure important tissues and ligaments aren't damaged. However, since the fracture is non-displaced, the chances of that are quite slim.

Non-displaced fractures do not require surgery. However, they do produce pain, swelling, bruising, difficultly with movement and grip and also sometimes deformity. Zuccarello's fracture was diagnosed with an x-ray. A regular x-ray is shown below which includes the bone anatomy:

As stated in my previous article, there are four basic types of [hand] fractures:
  • Displaced: the bone breaks into two or more pieces and becomes misaligned. There is a separation between the two fracture faces or the faces are no longer lined up. 
  • Nondisplaced: the bone cracks or breaks but doesn't move and maintains its proper alignment and position (The two fracture surfaces have not moved relative to each other).
  • Comminuted: the bone is broken in several pieces in different places.
  • Open fracture: the bone breaks through the skin (closed is when the bone breaks but there is no puncture or open wound). 
An x-ray showing a displaced fracture of the 2nd, 3rd, and 4th metacarpals. 

The x-ray image below shows a nondisplaced fracture of the 5th (pinky) metacarpal. The dark line (which is circled), is the fracture. This is the best picture of a nondisplaced fracture I can find. 

The good news for Rangers fans again is that Zuccarello's fracture is nondisplaced and will not require surgery. In cases like this when the bone fragments of the fracture haven't displaced much, or if the break is located in the middle (shaft) of the bone, a specially designed cast (or splint) will be used to hold the bone fragments in place and allow them to heal. Follow-up x-rays will be ordered to ensure that the bone is healing in a good position and hasn't slipped out of alignment. The length of immobilization and healing time depends on several factors (location of the fracture, depth of the fracture, possible injury to the surrounding soft/connective tissue and/or ligaments).

Unfortunately, the quick, less than two-week return for Zuccarello honestly seems unlikely. Hand fractures usually take 3-4 weeks to heal at the very least. On top of that, Zuccarello has broken his left hand previously which is not good news. His previous fracture was fairly serious, and finished his season, sidelining him for 4-6 weeks and not letting him participate in the 2011 World Championships for Norway.

Nondisplaced fractures are a common injury and not too complicated. Zuccarello will fly home and probably see a hand specialist after seeing the Rangers doctor. A cast will be placed (if it already hasn't been), and Zuccarello will rest until fully healed.