Re: Today
I'm a general surgeon trained in trauma management and can comment a bit on Mr. Russell's condition, my only information being what I've read on MO. Of course all of what I write is speculation; short of examining Mr. Russell myself or speaking to his physicians I can only really guess.
With a severe crush injury and open fracture to his leg (and arm?) the likelihood of Mr. Russell racing again this season is pretty much nil. From what I can gather from these updates he is not even "out of the woods" yet, (as he is still a resident of the ICU and in "critical" condition). Loss of a limb or even his life to complications must be considered in an individual with injuries this severe.
"Compartment syndrome" may develop in a severly damaged extremity, and it sounds like it did so in Mr. Russell's case. Extensive tissue damage (due to crush injury in this example) causes such marked swelling in the muscles and other soft tissues in the leg that the resultant pressure can actually impede blood flow, threatening the viability of the extremity. Part of the treatment consists of incising open the various muscle compartments allowing them to "bulge" and relieve some of the pressure to improve circulation.
The fluid which drains out of the open extremity is primarily serum which is no longer contained by the skin. Some ongoing bloodloss may also be occuring, but is probably fairly minimal by this point. It is actually too soon for "pus" to be draining from the injured leg, as it takes several days for the bacteria that have been introduced into the wound at the time of injury to multiply and lead to the development of pus. Infection of the extremity is actually one of the most significant risks for Mr. Russell right now; it threatens the limb itself, and upon spread to the bloodstream is lifethreatening also. Maintiaining the best circulation of blood to the extremity is among the highest priorities, along with powerful antibiotics, adequate nutrition, and local wound cleansing. Response to these treatments and healing will depend largely upon the viability of the tissue, and only a bit more time will tell how much tissue death has occured from the injury.
If surface tissue loss has left his extremity with significant areas missing skin, then grafting skin from elsewhere on the body, (or from cadavers), may speed the healing. A wound which would have taken 8 to 12 weeks to grow new skin over it may now heal over in 3 or 4 (or perhaps less).
Assuming all of the above goes well, a patient with injuries as described above will require considerable rehabilitation. Physical therapy will be arduous and extensive. In someone as young and otherwise healthy as Mr. Russell, assuming joint function is well preserved, a complete recovery with return of all mobility is possible. Limitations in the flexibility, strength, and sensation of the limb are also quite possible.
Only time will tell, and Mr. Russell's motivation to be well can not be underestimated as a significant variable. Support from his family, friends, and fans can make a big difference in maintaining that motivation, so keep the kind words heading his way!
James D. Bove III, D.O.
Associate Professor of Surgery
Ohio University
I'm a general surgeon trained in trauma management and can comment a bit on Mr. Russell's condition, my only information being what I've read on MO. Of course all of what I write is speculation; short of examining Mr. Russell myself or speaking to his physicians I can only really guess.
With a severe crush injury and open fracture to his leg (and arm?) the likelihood of Mr. Russell racing again this season is pretty much nil. From what I can gather from these updates he is not even "out of the woods" yet, (as he is still a resident of the ICU and in "critical" condition). Loss of a limb or even his life to complications must be considered in an individual with injuries this severe.
"Compartment syndrome" may develop in a severly damaged extremity, and it sounds like it did so in Mr. Russell's case. Extensive tissue damage (due to crush injury in this example) causes such marked swelling in the muscles and other soft tissues in the leg that the resultant pressure can actually impede blood flow, threatening the viability of the extremity. Part of the treatment consists of incising open the various muscle compartments allowing them to "bulge" and relieve some of the pressure to improve circulation.
The fluid which drains out of the open extremity is primarily serum which is no longer contained by the skin. Some ongoing bloodloss may also be occuring, but is probably fairly minimal by this point. It is actually too soon for "pus" to be draining from the injured leg, as it takes several days for the bacteria that have been introduced into the wound at the time of injury to multiply and lead to the development of pus. Infection of the extremity is actually one of the most significant risks for Mr. Russell right now; it threatens the limb itself, and upon spread to the bloodstream is lifethreatening also. Maintiaining the best circulation of blood to the extremity is among the highest priorities, along with powerful antibiotics, adequate nutrition, and local wound cleansing. Response to these treatments and healing will depend largely upon the viability of the tissue, and only a bit more time will tell how much tissue death has occured from the injury.
If surface tissue loss has left his extremity with significant areas missing skin, then grafting skin from elsewhere on the body, (or from cadavers), may speed the healing. A wound which would have taken 8 to 12 weeks to grow new skin over it may now heal over in 3 or 4 (or perhaps less).
Assuming all of the above goes well, a patient with injuries as described above will require considerable rehabilitation. Physical therapy will be arduous and extensive. In someone as young and otherwise healthy as Mr. Russell, assuming joint function is well preserved, a complete recovery with return of all mobility is possible. Limitations in the flexibility, strength, and sensation of the limb are also quite possible.
Only time will tell, and Mr. Russell's motivation to be well can not be underestimated as a significant variable. Support from his family, friends, and fans can make a big difference in maintaining that motivation, so keep the kind words heading his way!
James D. Bove III, D.O.
Associate Professor of Surgery
Ohio University
