Like a great fighter, Dr. Steven Sanders is always thinking two steps ahead. So when one of those great fighters, Anderson Silva, fell to the canvas in pain after breaking his leg in his UFC 168 bout against Chris Weidman last Saturday, the UFC’s orthopedic surgeon wasn’t gasping or staring in shock.
“I have been taking trauma calls at the hospital (University Medical Center) since I moved to Las Vegas in 1991,” said Sanders on a media teleconference Monday, “so when the injury occurred, seeing it, the only question I had in my mind was ‘how low down on the leg was the fracture?’ Because depending on the level of the fracture, influences my thinking as to what type of orthopedic device I’m going to need to fix it. But the minute it occurred, I’m sitting there going ‘that’s fixable.’”
And after successful surgery Saturday night to repair Silva’s tibia and fibula in his left leg, the next step is healing, then rehabilitation. But the former middleweight champion and future Hall of Famer, wasn’t interested in such details before surgery. He only had one question for Sanders:
“When can I train again?”
It’s the mark of a competitor and the best to ever strap on the gloves in a mixed martial arts fight, but after the injury, which took place when Silva threw a kick which Weidman checked, not many were optimistic about the Brazilian icon ever entering the Octagon again, especially considering that he is 38 years old and facing approximately a three to six month healing process before even rehabbing his leg. But as Sanders points out, whether 18, 28, or 38, Silva shouldn’t take any longer to get back on his feet.
“His age does not play a role in the fracture healing,” he said. “There are other external factors that can affect a fracture healing, but in this case, not his age.”
In surgery, a titanium rod was inserted in Silva’s left tibia from below the knee joint to above the ankle, with three screws securing it. The fibula was stabilized, but without a rod.
“There were several reasons not to do individual surgery or fixation of that bone,” said Sanders. “First and foremost, the nature of the injury involved internal damage – stretching, stripping if you will, of the tissues around and attached to the bone. If the separate bone were to have been fixed, it would have involved an incision at the site of the break. And I did not want to expose the environment of the fracture to the environment of the operating room. That could increase his risk of infection. The second reason was, in terms of getting the leg to heal, the most important thing is to have compression where the bones meet. If one were to fix the fibula, that might pull the tibia apart and in fact then act as a strut, keeping the bone from compressing. And the third reason, is that although it is not perfectly lined up, nor did I attempt to get it perfectly lined up, it still has the potential to heal on its own.”
And even though the injury was severe, it could have been a lot worse, with two keys to it being manageable due to the bone not breaking the skin and the quick attention Silva received in the Octagon and on the way to the hospital, which is a Level 1 trauma center.
The most important thing in terms of minimizing damage or preventing any new damage once the injury occurred was how quickly he was attended to in the Octagon. The limb was stabilized (by Dr. Anthony Ruggeroli), it was lined up, and despite the fact that he was in horrific pain, his leg was maintained as rock solid as they could by holding it steady that there would be no further inadvertent injury. That was really the most important phase right there. The next phase of getting him to the ambulance and the hospital is important because right then and there you have someone in horrific pain, you don’t want someone going into shock, and you need to start getting them some pain medication under a monitored setting. So those are the two first immediate triage things that need to be done, and fortunately, as I was standing right outside the Octagon, were done.”
The subsequent hour-long surgery was followed by 15-30 minutes of closing Silva’s wounds, putting on a dressing, and applying a plaster splint. Remarkably, after less than 48 hours, Silva is already up and about on crutches and still asking when he can train again. That may not happen for six to nine months, but the good news is, with the proper healing, he can.
“Once the fracture is healed, it doesn’t concern me regarding repeat fracture,” said Sanders. “What we’ll have to see over time is how the soft tissues regenerate to be able to handle that kind of contact. That’s more of a variable than the bone.”
Stay tuned. The last chapter of the Anderson Silva as an active fighter story may not have been written yet.