Just about 7 hours ago, MMA fans were treated to a gut wrenching, horrific end to the main event at UFC 168. Former Middleweight champion, Anderson Silva escaped the onslaught of punches and elbows from the first round that opponent, Chris Weidman was raining down on him, and appeared ready, willing and able when they returned from their corners for the start of the second round. Anderson has been known to take some punishment in the first round of several of his fights, only to come back and beat the tar out of his opponents. It appeared that this might be the way things would go this time, as well. Then, the unthinkable happened.

He threw a kick, and Weidman, who had not checked any kicks in their first bout, reacted by bringing his leg up and checking the kick. Silva's lower leg snapped and nearly wrapped itself around Weidman's leg. To make matters worse, Anderson stumbled back and actually lowered the injured leg to the ground and put pressure on it in a reflex action that was undoubtedly to maintain his balance.

Silva went down immediately, grabbing his injured leg, and screaming out in the excruciating pain he was most likely suffering. The fight was stopped, and Weidman retained his belt via TKO. It's a victory nobody likes to see, but in the immortal words of Gus Johnson, ‘These things happen in MMA' and we've seen it on more than one occasion. Just seven months ago, former UFC middleweight star, Phil Baroni suffered an almost identical injury.

To better educate our readers on the medical implications of Silva's injury, I reached out to my good friend and orthopaedic surgeon, Dr. Steve Mora. Some of you may remember my interview with him from earlier this year, and you can find his impressive list of credentials there, as well. He was able to give his initial thoughts on what the nature of the injury was, the extent of the damage, the complications that might potentially arise, the course of treatment, the projected recovery time and the possibilities for Silva's continued future in MMA.

*All X-Ray images were provided by Dr. Mora to illustrate subject content. They are not Anderson Silva's X-Rays.*

Possible Diagnosis

That was a pretty grotesque injury, and I feel so bad for him. From what I could see, it looked like a distal tibia fracture. That means that it was a break towards the end of the shin bone. The medical diagnosis was probably a distal tib/fib fracture, or maybe a distal third, as in the lower third of the shin.

In this case, there's going to be a heavy amount of soft tissue injury, because Silva's leg almost wrapped around Weidman's leg. That means that it was significantly angulated and displaced. Then, he put his weight on it, when he tried to stand. What normally happens in situations like these, is the sharp, fractured ends of the bone will cause damage to the surrounding muscles and tendons, and sometimes to the nerves or arteries.

The other thing I noticed is when he was down, there was a little bit of puckering, right where the fracture was at. It looked like the fractured bone end was almost coming out of his skin. I don't think that it did, but it was pretty close. I also noticed that the ring doctor was putting some pressure there, near the spike, probably to keep it from coming out.





Treatment

The usual treatment for unstable tibia fracture is something called an intra medullary nail. It's a rod about as thick as your pinky finger that's inserted through the upper part of the bone and passed through the medullary canal of the broken bone. Once it's across the fracture, the rod maintains the bone in a straightened position, which keeps it from rotating. The rod is affixed with screws that go above and below the fracture. It's almost like you're shish-kabobbing the fracture. That rod will provide support long enough for the bone to fill in the cracks and heal. Once the fracture is healed, then the person is allowed to be active again.

The question that comes up often, is whether or not to remove the rod. The reason is, when you have metal on a bone that has been exposed to trauma, you can get a fracture right around the rod. The metal stiffens the bone, but it only does that in the immediate area that the rod is placed. The adjacent areas are not stiff, and are susceptible to additional fractures. In my experience, combat athletes benefit from having the rod removed. If you do remove it, you have to wait longer to fight because there will be screw holes and tunnels that will have to fill in and heal. If Anderson gets rod placement, and he takes 4-5 months to heal, and then elects to have the rod removed, that will add several more months to his hiatus, not to mention rehab. If it's really close to his ankle, it might not be rodded, they may choose to use a plate and screws.





Complications

One of the side effects of a tibia fracture is excessive swelling. The bone will get fixed but the leg will continue to swell for the next couple of hours because of the bleeding and the surgery. The leg has to be elevated and closely monitored for what's called compartment syndrome. This occurs when there is excessive bleeding, usually because the fracture spike damaged the muscle or because of the initial trauma. With Anderson, this trauma could have happened twice; the first time when their legs impacted and his sort of wrapped around Chris' leg, and again when he tried to stand on it.

That causes bleeding, and the surgery, especially if there is rod placement, will cause bleeding. All the blood accumulate within the space in or around the muscle compartment. It will continue until the muscle compartment or envelope cannot expand any more. When it cannot expand any more, the swelling puts pressure on the artery, causing the artery to collapse. Then there is a loss of oxygen to the extremity that can lead to necrosis.

To make sure this doesn't occur, you monitor the patient's pain and palpate the area. If the tissue is rock hard and the pain level is elevated, then they may have compartment syndrome. In that case, another surgery is performed to relieve the pressure. That is basically where you open up the muscle compartment by making long incisions. The patient will stay in the hospital for a few more days, then the wounds will have to be closed up. The key is identifying the problem and acting on it rapidly.

MMA Future

His age is not a big contributing factor. 38 is not old when it comes to this injury. As far as this injury healing properly, he should have an excellent chance, if it's an uncomplicated fracture without nerve damage. He's a healthy man, so the bone should heal properly. The people that have problems with healing fractures are the elderly or people with major health problems. How long is it going to take to heal? The injury could take 3-6 months to heal, and then to be recovered enough to get back to fighting, it could take a year, not because of age, but because of the nature of the fracture. They tend to be stubborn to heal in everybody. I think there's a very good chance that he heals and recovers sufficiently to get back to his fighting career. That's obviously if he wants to. He'll have to get over some hurdles, but it's quite possible that he can.

*It should be noted that Dr. Mora specializes in sports injury and frequently treats MMA athletes*

You can follow Dr. Mora via his Twitter account, @myorthodoc