00:00This is the Injury Report, presented by NYU Langone Health.
00:05Mets interim manager Andy Green said pitcher Clay Holmes is inching closer to going out to an affiliate and pitching
00:12in a rehab assignment.
00:13He's been out with a non-displaced fibula injury.
00:17So in today's Injury Report, we're bringing back Dr. Leith Jazrawi, orthopedic surgeon at NYU Langone,
00:24to see when Clay is going to come home, or when Holmes is going to come home.
00:28Doc, appreciate you hopping on with us.
00:31You, as an orthopedic surgeon, well-respected in your field.
00:34You're the guy to talk to about this.
00:37Can you walk us through what a non-displaced fibula fracture actually is,
00:43and what's the difference between displaced versus non-displaced?
00:49All right, that's a great question.
00:51So let's get down to, well, what's the fibula?
00:55Fibula is one of the bones in the lower leg.
00:58It starts at the ankle joint, goes all the way up to the knee.
01:01It marries with the tibia.
01:03So those two work hand in hand.
01:06Now, part of a whole bunch of ankle fractures, you can get a fibula fracture combined with it.
01:12Clay's injury is a little different.
01:14It was a foul ball that hit directly on his fibula, causing it to crack or break.
01:20Okay, that's a lot different than some of these horrible twisting injuries you see at the ankle,
01:27where the force is like a spiral and breaks both the tibia and the fibula.
01:32So direct contact.
01:35He's a young guy.
01:36This is going to heal.
01:38Now, he's a professional athlete.
01:40So in this case, whether it was displaced or not displaced, since it was a direct contact,
01:47these have a very high likelihood of healing without surgical intervention.
01:51But we always talk about surgical intervention potentially getting athletes back quicker
01:59and they could weight bear on it.
02:00But here's the great thing about ankles.
02:03With this isolated fibula fracture, really, the only thing that's holding him back is pain.
02:09So if his pain is okay, he can go back because it's a stable injury.
02:15So if he can get wrapped up and play even with the fracture and doesn't have pain,
02:21he's okay to play because he's not going to hurt himself.
02:24Now, realistically, you need some healing to occur there before they can feel comfortable going out there.
02:32So what's my timeline on this?
02:35Typically, these bones take about four to six weeks to heal.
02:37So my guess is that he'll start feeling better by that by four weeks and then start throwing.
02:44Yeah, I'm looking at anywhere between six and eight weeks to get back.
02:47But like I said, it's a stable injury.
02:50If he feels up to it, you can play on these things with a broken bone because of the nature
02:57of this type of injury.
02:58Okay, so he's already been cleared to throw and he's progressed to mound work.
03:03So that's some good news.
03:05So what does that return to pitching progression look like from here on out?
03:09Like, is it just bullpen sessions?
03:11Do you ramp it up to live batting practice?
03:14And then you throw him into a rehab assignment?
03:16What do you think their course of action is going to be for Klay's timeline?
03:21They're going to do both simultaneously, right?
03:25Throwing program, rehab program.
03:28But realistically, they're testing him out to see if it hurts him.
03:31Because it's a stable injury, he can throw on it if he can tolerate it.
03:36So they're going to gradually build him up and see what he can tolerate.
03:39That's the beauty of this injury.
03:42It's really whatever he can tolerate.
03:45Now, look, at the pro level, a lot of stress.
03:47Big guy, big legs, a lot of stress on the ankle.
03:51It may hurt him.
03:52So he's going to do a gradual buildup.
03:54Maybe first time he goes out, throw one or two innings and see how he feels.
03:59But the great news for Mets fans is that this is a minor thing, you know.
04:04And depending on the nature of the fracture, you know, when you say non-displaced, it could
04:09be a little crack there where the bones are aligned perfectly.
04:12And it doesn't matter.
04:14It's just going to heal on its own with very little pain.
04:17So, you know, there's a lot of promising things in what we're hearing and how he's progressing.
04:24I think he's going to be back in four to six weeks, meaning throwing off the mound in a game.
04:29You said something I haven't heard all summer or all season.
04:34Great news for Mets fans.
04:35I think we need to cut that and print that as our social clip.
04:41You talked about him kind of just seeing what the pain is going to be like.
04:45And he's going to recover, but we're talking about the Mets where we're not worried about
04:49a deep postseason run.
04:51So what are the chances of re-injury once he's back on the mound?
04:56I mean, unless he gets hit again with the ball.
04:59No, it's not like that.
05:01So I'm not concerned about that.
05:03Once it heals, it heals.
05:05And if they have setbacks, they have setbacks.
05:08But it's really, this is a thing you just push forward with and he'll get better.
05:13Let's say a non-pro athlete, though, comes into your office.
05:18Obviously, they want the top care.
05:20They have a non-displaced fibula fracture, just like Clay.
05:25Would their treatment options in rehab differ?
05:30No.
05:31So the only thing that's different is the access to care that these people have,
05:37meaning therapists, trainers, massage people.
05:40You know, at that level, that's what they get.
05:43But honestly, I have patients who've come in with this injury.
05:46They're able to hop on it.
05:48And I go, you're fine.
05:50I'll give you a little ankle brace.
05:52You go out, you do what you could tolerate.
05:53And I send them to therapy.
05:55So really, it's what they can tolerate.
05:57And the way I determine whether they can go back, some of the, you know,
06:01both the non-pro and the pro athletes, depending on the sport,
06:07if they can hop on it with one leg, they're cleared.
06:11That's my test.
06:12And that's a very common test that we'll use on the sideline.
06:16If you could hop on it on one leg or one foot, you're cleared to play.
06:22All right.
06:22I love it.
06:23Doc, appreciate you coming on with us.
06:25Enjoy your weekend.
06:26You got it.
06:27Enjoy the rest of the summer.
06:28Good catching up.
