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Orthopaedics and Rehab

Too gruesome for video: The ‘high-energy’ injury of Dallas Cowboy Allen Hurns

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A collective horror rippled through the Metroplex during the NFC Wildcard playoff game on Jan. 5, 2019.

A collective horror rippled through the Metroplex during the NFC Wildcard playoff game on Jan. 5, 2019. On live television, Cowboys wide receiver Allen Hurns dislocated his left ankle and snapped his fibula in an injury so gruesome that the footage was deemed too disturbing to televise more than once.

I watched the game live and viewed the footage several times. Warning: The video is graphic. It’s available on SportsDay if you’re interested.

As Hurns was tackled, his left foot planted on the ground and his body continued to rotate around the stationary foot under the weight of a Seahawks player. The visual was nauseating; it was obvious that Hurns was in severe pain as medical trainers stabilized his ankle, removed him from the field, and rushed him to a nearby hospital for emergency surgery.  

We call this type of injury a high-energy orthopaedic trauma. I see similar injuries regularly in patients who survive vehicle crashes, falls, and cycling accidents, for example. As bad as Hurns’ injury looked, full recovery is common when patients can receive emergency surgery and participate in physical therapy after their injuries heal. 

Why Allen Hurns needed emergency surgery

Hurns’ dislocated ankle was the most grotesque factor of the injury, and it’s the reason he underwent emergency surgery. The dislocated joint compromised the skin because it increased pressure on the arteries and nerves, threatening circulation. Without the prompt care Hurns received, his bone might have protruded through the skin, increasing the risk of bleeding and severe tissue damage. 

Hurns’ broken bone – the fibula – is the smaller of the two bones in the calf, the other being the tibia. Between these bones and the ankle is the syndesmosis, a joint that connects to the other bones with ligaments. The rotation of Hurns’ leg also likely tore these ligaments, which normally provide stability in the ankle.

The athletic trainers and medical staff at the Cowboys game immobilized Hurns’ ankle, which was exactly what bystanders or first responders should do in the event of a severe ankle dislocation with a fractured fibula. The standard approach to address such an injury is to take X-rays, followed by closed reduction (setting the bones back to the proper alignment). Then, an orthopaedic surgeon would likely employ a plate and screws to fix the broken fibula, as well as repair the torn and injured ligaments. 

“As grotesque as Hurns’ injury looked, full recovery is common when patients can receive emergency surgery and participate in physical therapy after their injuries heal.”

– Dane K. Wukich, M.D.

Full recovery is possible for most patients

The day after the emergency surgery, Hurns spoke with the NFL Network and assured them he would play again next season. Hurns tweeted that he is “ready to attack this recovery process” and that he will come back “on a mission.” 

Most patients with high-energy injuries such as Hurns’ can fully recover within a year if they are nonsmokers, don’t have diabetes, and aren’t obese – all factors that affect how well the bones heal. For an elite athlete like Hurns, it’s not far-fetched that he could be playing again in August 2019.

However, Hurns has a long road of recovery ahead. He must allow his fractured fibula and torn ligaments to heal properly. The average patient can start physical therapy after six weeks in a splint, cast or removable boot without bearing weight on the injured limb. However, Hurns’ physical fitness and motivation likely will allow him to safely start physical therapy sooner, assuming that his surgical wounds heal properly. 

Hurns’ injury was horrifying for spectators and his fellow players to watch. But football fans – as well as patients who have suffered similar injuries – can expect a full recovery with guidance from an orthopaedic surgeon and specialized physical therapists.

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