DeMarco Murray delivered yet another terrific performance Sunday night as the Dallas Cowboys defeated the Philadelphia Eagles, but he paid the price with an injury, suffering a broken bone in his left hand.
Specifically, Murray fractured the fourth metacarpal in his left hand, according to ESPN.com’s Todd Archer. The fourth metacarpal is the long bone that runs from the base of the ring finger to the wrist.
By the time the injury news was announced, Murray was undergoing surgery to stabilize the fracture. The team left open the possibility that Murray could return this weekend by stating he had not been ruled out of Sunday's game against the Indianapolis Colts. But is it really possible that he could return less than a week after undergoing surgery?
Yes, actually, it is possible.
The implantation of hardware during surgery provides a construct in the hand that offers immediate stability and helps ensure proper alignment of the bone. While the bone itself takes at least four to six weeks to heal, the surgical stabilization permits sooner range of motion activities (sooner than if there were no surgery) and potentially less soft tissue adhesions or scarring. The return-to-play criteria then comes down to pain tolerance and the return of functional range of motion and strength.
In a study presented at the 2014 American Orthopaedic Society for Sports Medicine meeting, a group of in-season elite football players who had undergone surgery to repair metacarpal fractures were able to return to play, on average, in less than a week. The study, conducted by physicians at the American Sports Medicine Institute in Birmingham, Alabama, included high school and collegiate football players; the average return-to-play time for the collegiate players was 2.8 days. There were no reported complications following surgery and, most importantly, no incidence of re-fractures.
One college player in this study who suffered this injury and returned to play less than a week after surgery was then-Alabama wide receiver (now Atlanta Falcons star) Julio Jones. He fractured a metacarpal in his left hand in the first half against South Carolina in October 2010. After undergoing surgery the next day, Jones returned to practice late in the week and played the team’s next game against Mississippi. During my visit to Falcons training camp in August to see Jones, who was preparing to return from a second foot surgery, I referenced the scar on his hand and asked how he was able to return to action so quickly following that injury. He told me that once he caught the first few balls in practice, he knew his hand was solid and he just mentally made the decision he would be ready to play. He has had no setbacks with his hand since the surgery.
Most athletes cited in the study were either wide receivers or defensive backs and the sample size is relatively small, but Dr. Lyle Cain, orthopedic surgeon, University of Alabama team physician and one of the study’s authors, notes there have been several other players since that data was collected -- including running backs and offensive linemen -- who have returned to play in under a week. The study results demonstrate that a return to playing football at a high level less than a week after surgery to repair a metacarpal fracture is possible. But is it probable?
Not necessarily. It’s important to remember, above all, that individuals heal at different rates. Each injury has its own unique presentation, and there may be other factors that influence how quickly a player is allowed to progress through the rehab process and onto the playing field.
Cain says there are two primary considerations when evaluating whether an athlete can return to play within days following this type of injury and surgery: surgical fixation and functionality. Most of the fractures that occur in these athletes are clean breaks in the middle of the bone that are easily stabilized; fractures that result in multiple fragments are more complex and would not fall into this category.
“Once you get good fixation with the hardware in there, it appears the repaired metacarpal may even be stronger than the native metacarpals around it," Cain said. “Then you need to make sure the athlete has enough strength in the intrinsics [small muscles of the hand] to control the ball and to do what he needs to do on the field with minimal discomfort.”
As a running back, Murray needs to not only carry the ball effectively (which he does primarily with his right hand; the injury is to his left), but he also needs to be able to catch the ball and block effectively. Murray would be expected to be wearing some type of protective equipment on his surgically repaired hand and would need to demonstrate that he could still carry out his responsibilities uncompromised (or at least minimally compromised). As ESPN’s Ed Werder reported, the Cowboys athletic training staff that cared for Emmitt Smith as he returned from a similar injury is unchanged, which benefits Murray.
When he spoke to reporters Monday, coach Jason Garrett laid out what will be the determinants of whether Murray plays this week. Garrett's words seemed to reflect what the team’s medical personnel will also be evaluating.
“The biggest question we have to ask ourselves is: Is he functional to do his job?" Garrett said. "Can he hold the football? Can he carry it under duress? Can he block? Can he do the things necessary to play the position?”
All football players who undergo surgery to repair a metacarpal fracture will have a few things in common: They will all experience some degree of pain and limitation after the operation and will all require several weeks to heal completely. The timetable in which they return to competition, however, is based on the variables that make each of them and each of their injuries unique, particularly how fast they recover and how quickly they can return to form. The big question for the Cowboys will be whether they are comfortable enough with Murray’s progress as of Sunday to expose him to game conditions.
While recent examples provide evidence that elite football players can return to competition quickly following this type of surgery, given the uncertainty that surrounds how any player recovers from injury, it shouldn’t come as a surprise if Murray’s status remains in question until game day approaches.