University of Louisville guard Kevin Ware's horrific leg break is so unusual, Tampa orthopedic surgeon and sports medicine specialist Seth Gasser says he's never seen one quite like it in his 20 years of practice.
But it's likely, Gasser said, that Ware had already damaged his leg, and landing hard on it as he did in Sunday's NCAA Tournament victory over Duke was enough to cause bones to snap and protrude through his skin.
"A bone that breaks in that way is not normal bone,'' said Gasser, who was watching the game with his son when Ware went down. "It has sustained some prior injury or damage.''
Gasser's son cringed when he saw the break. The surgeon remembers looking at his son and saying, matter-of-factly, "He just broke his fibula and tibia."
Gasser, whose patients include basketball players for the University of Tampa and USF, says he'll see one or two athletes with stress fractures each season.
"It's quite common for basketball players in particular to have small stress fractures on their tibia. It comes from all the running, jumping that their legs take. It's the repetitive nature of the pounding their bones withstand in basketball that puts them at risk for these fractures.
"They may not even know they are there. Or it may cause some shin pain, and when they stop playing for a while, it heals,'' said Gasser, who is with Florida Orthopaedic Institute in Tampa.
"Think of it this way: You know how a bag of chips has a little tear at the top of the bag so you can open it more easily? A stress fracture is that kind of little nick that can lead to a major break. It's a point of weakness in the bone that can snap during a stressful landing.''
That's why Gasser says that when he sees an athlete with shin pain, he orders X-rays, and if they show no damage, he'll then get an MRI exam to be certain there are no stress fractures.
"You have to stop the activity and in Ware's case, put a rod in the leg so it can heal. It is notorious for being slow to heal. It can take months.''
He said Florida Orthopaedic Institute cared for a high school basketball player from Clearwater about 15 years ago who had repetitive stress fractures in his tibia. Surgeons put a rod in his leg to prevent the kind of fracture Ware suffered.
"Sports was his ticket to a higher education, so recovery was important to him. He went on to play college basketball. Without the surgery, he wouldn't have gone on to college (to play),'' Gasser said.
Ware had successful surgery Sunday night after sustaining the fracture in the first half of the Midwest Region final. Leaping to block a 3-pointer, Ware broke his lower leg in two places when he landed. Teammates who heard the bones snap and saw them protrude from Ware's skin openly wept.
Ware urged his coach and teammates to go on and win the game.
"He was groggy, in good spirits. He saw us win the trophy and was crying and said it was all worthwhile," coach Rick Pitino told the Associated Press after visiting Ware in the hospital. "We didn't cut down the net, but I left him the trophy."
School officials said doctors reset the bone and inserted a rod into the tibia during the two-hour procedure.
Louisville trainer Fred Hina told Pitino it was the same injury that derailed the Heisman Trophy hopes of running back Michael Bush, who also played at Louisville. Bush recovered from the injury and has had a productive NFL career with Oakland and Chicago.
As it turned out, he was watching.
"I just cried," he wrote on Twitter. "I feel so bad. Flashback of myself. Anyone if he needs anything please let me know."
Dr. Reed Estes, assistant professor of orthopedic surgery at the University of Alabama at Birmingham, and team physician for the UAB football team, also said basketball players are prone to stress fractures in the tibia, the larger of the two lower leg bones, and that can weaken them.
"If these are not detected they can result in a full fracture, particularly if the landing mechanics are just right" after a jump, Estes said. Surgery to stabilize the bones is usually successful, and Ware should be fine to play next season, he said.
Dr. Frederick Azar, head of the Campbell Clinic in Memphis, Tenn., and a spokesman for the American Academy of Orthopaedic Surgeons, said Ware "jumped pretty far horizontally and vertically, and he landed with a twist," which puts so much torsion and stress on the bones they could have just snapped. He agreed with Gasser and Estes' assessment that a stress fracture could have made Ware more prone to such an injury.
Louisville, the top overall seed in the tourney, missed four of its next five shots but regained its composure to take a 35-32 halftime lead and went on to an 85-63 victory.
"We won this for him," Pitino said. "We were all choked up with emotion for him. We'll get him back to normal. We've got great doctors, great trainers. We talked about it every timeout, 'Get Kevin home.' "
Information from the Associated Press was used in this report.