NFL Injuries

Should you draft Derek Carr with confidence this season?-Dr. Morse

Photographer: Scott Winters/Icon Sportswire

Derek Carr, the 26-year-old quarterback of the Oakland Raiders, soon to be Las Vegas Raiders, just signed a massive five-year $125 million contract extension through 2022 making him the highest paid player in NFL history. Carr suffered a significant leg injury, breaking his leg that ended his 2016 season prematurely. Carr suffered a broken fibula just before Christmas, during week 16 when Colts defensive end Trent Cole hit Carr just below his knee after beating left tackle Donald Penn on a sack in the fourth quarter. Carr had his foot planted on the ground and was then twisted during Cole’s tackle. Carr happened to be wearing a microphone that day, and after that hit he instantly screamed: “it broke, it broke.” Additionally Carr had suffered a broken 5th/pinky finger in week 12, which caused his pass completion percentage to drop nearly 11% after the injury.

The good news is that Carr managed to avoid any ligament damage during the fibular fracture. Unfortunately Carr needed to undergo surgery to reinforce the fibula bone, which he did in LA on December 27. The timetable for return is typically 6 to 8 weeks, so he should have been up and throwing by March with no issues, which he has been reportedly throwing without issues

What is a fracture of the fibula?

Let’s briefly talk about the fibula fracture. Fibula fractures are often combined with a fracture of the tibia, the larger bone of the lower leg, due to indirect violence and landing from a jump on a twisted foot. However, we know that Carr fractured just his fibula. While weight bearing is nearly impossible with a fractured tibia, weight bearing is still very possible with a fractured fibula, because typically humans do not put as much weight on the fibula as we do the tibia. An isolated fracture of the fibula may only exhibit local tenderness, unless it involves the ankle joint. Symptoms often include a sudden onset in pain with rapid swelling after the impact, collision or fall. As we witnessed with Carr, he was unable to place much weight on the actual leg.

The fibula bone is the smaller of the two lower leg bones, and runs on the outside of the lower leg. This bone connects to the bony prominence just below the knee on the top, and connects to the bony prominence on the ankle, known as the lateral malleolus. The fibula does not serve much purpose, providing mainly only support and attachments for muscles. On the other hand, the tibia, the larger bone of the lower leg, bears the majority of the body’s weight and is much more important for lower stability, strength and mobility.

Traumatic fractures of the fibula often occur after or during a severe ankle sprain. So it is important to carefully examine the ankle and knee joints to make sure there are no additional injuries besides the fractured fibula. It does not appear that Carr’s injury was of the open variety, which means that the bone would literally be sticking out of the skin.

What type of surgery did Carr have?

Despite limited details about the surgery, Carr likely underwent an open reduction and internal fixation (ORIF) surgery to help stabilize and heal the fractured fibula. Most people who have ORIF of their fibula do very well. There are multiple complications associated with this surgery, including nerve damage, infection, bleeding, bone misalignment, and blood clots. There is also the inherent risk that the fracture will not heal properly, leading to a second surgery.

It is unclear where exactly on the fibula Carr suffered the fracture, whether it was closer to the knee, in the middle of the shaft, or closer to its attachment at the ankle. The location is very important because if the fracture was closer to the knee, then this is very good news and should not impact him in terms of strength and mobility. However if the fracture is closer to his ankle, a very important joint in terms of mobility, then this could create some issues for Carr in the long run.

Are fibula fractures common in sports?

While fibula fractures are not very common in football, they are more common in sports like soccer, skiing and snowboarding. The average return to play for a soccer player with a fractured fibula is approximately 18 weeks, for reference sake. The difference is that soccer players rely on their lower legs for nearly everything they do on the field, cutting, dribbling, passing, planting their foot, and shooting. Quarterbacks rarely run and use their feet as much, so the return-to-play is much quicker.

Based on reports Carr will have a lot more freedom at the line of scrimmage this upcoming year under new offensive coordinator Todd Downing, more so than he had under former offensive coordinator Bill Musgrave. The Raiders have a top five O-line, and with most of their offensive weapons returning, Carr is a sure bet to either repeat or build on his 2016 stats.

My suspicion is that Carr will be completely fine this upcoming season, and to be able to move and mobilize when he needs to, particularly trying to avoid the pass rush. With the acquisition of Marshawn Lynch, and the return of their offensive weapons (Cooper, Crabtree, & Cook) I would be very surprised if Carr tried to rush. Rushing is simply too risky, as we have seen with Cam Newton. In 2016 Carr average 63.8% passing completion, just shy of 4000 passing yards, with 28 TDs and 6 INTs. Additionally Carr rushed 39 times for only 70 yards with no touchdowns, which is more like scrambling then actually running.

I personally believe that Carr will be equally as mobile as he was in his previous years, but will likely taking just as many, if not more snaps, from the shotgun to help avoid the risk of taking any further shots to the legs.

Fantasy Implications

Carr is currently being drafted as the 6th quarterback off the board, on average being taken in the 6th round with the 9th pick (6.09) in standard 12-team leagues and the 4th pick of the 7th round (7.04) in 12-team PPR leagues. Carr is being taken just after Matt Ryan and Andrew Luck, and right before Russell Wilson and Ben Roethlisberger. I think this is a really good spot for Carr, as he has much more potential than Wilson, Newton, and Cousins in my opinion with the weapons that he has at his disposal. My suspicion is that Carr will likely be slept on this year, as people will be concerned about his injury and how it could impact him. However I would not hold his injury from 2016 against him when drafting. Draft him with confidence, as the Raiders should be contenders in 2017 if everyone stays healthy.

This was written for the @TheFantasyDRS by Dr. Jesse Morse. I am a Board-Certified Family Medicine physician, and I am currently completing a Sports Medicine Fellowship at the University of South Florida in Tampa. If you have any questions or comments, you can contact me directly at @DrJesseMorse or visit my website at: Keep an eye out for my next article!

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