This article is part of our NBA Injury Analysis series.
Sprains and strains occur more frequently in the NBA, but bone injuries are on the rise in the first part of the season. Multiple players have suffered bone-related problems, including bone contusions, fractures and stress fractures that have resulted in missed time. Last week, three more players were added to the list, as Houston Rockets center Clint Capela and Cleveland Cavaliers guard J.R. Smith sustained bone fractures, and Los Angeles Lakers forward Larry Nance Jr. suffered a bone contusion. However, not all bone injuries are identical and can vary in mechanism of injury, amount of damage and subsequent treatment.
In Houston, Capela suffered a fractured fibula, one of the two bones of the lower leg, in a collision with Minnesota's Karl-Anthony Towns on December 17. The fibula, in conjunction with the tibia, runs from the knee to the ankle, playing a role in both joints. It sits on the lateral or outside portion of the leg and serves as an anchor site for multiple muscles and ligament. The fibula is smaller than the tibia and is not considered a major weight bearing bone. However, its positioning does complicate recovery as the stability of both the knee and ankle have to be closely monitored during the recovery process. Additionally, the fibula sits in close proximity to multiple nerves, and a fracture in a certain area can result in nerve damage. During the 2012-13 season former MVP point guard Steve Nash suffered a fibula fracture that involved a nearby nerve,
Sprains and strains occur more frequently in the NBA, but bone injuries are on the rise in the first part of the season. Multiple players have suffered bone-related problems, including bone contusions, fractures and stress fractures that have resulted in missed time. Last week, three more players were added to the list, as Houston Rockets center Clint Capela and Cleveland Cavaliers guard J.R. Smith sustained bone fractures, and Los Angeles Lakers forward Larry Nance Jr. suffered a bone contusion. However, not all bone injuries are identical and can vary in mechanism of injury, amount of damage and subsequent treatment.
In Houston, Capela suffered a fractured fibula, one of the two bones of the lower leg, in a collision with Minnesota's Karl-Anthony Towns on December 17. The fibula, in conjunction with the tibia, runs from the knee to the ankle, playing a role in both joints. It sits on the lateral or outside portion of the leg and serves as an anchor site for multiple muscles and ligament. The fibula is smaller than the tibia and is not considered a major weight bearing bone. However, its positioning does complicate recovery as the stability of both the knee and ankle have to be closely monitored during the recovery process. Additionally, the fibula sits in close proximity to multiple nerves, and a fracture in a certain area can result in nerve damage. During the 2012-13 season former MVP point guard Steve Nash suffered a fibula fracture that involved a nearby nerve, and the resulting effects lingered throughout the season and into the following year.
Fortunately, Capela's fracture is reportedly small, and no ligament or nerve involvement has been cited. Furthermore, the injury won't require surgery, suggesting the fracture is a nondisplaced injury. Instead, Capela will rest the area and depend on the body's natural healing response to mend the area effectively and appropriately. For this process to occur, specialized cells known as osteoblasts and chondroblasts are required. Together they form and lay down new cartilage and bony tissue at the fracture site, forming a mass of healing tissue known as a callus. The callus tissue will gradually be incorporated into the bone and further fortified with additional bone tissue. Following complete ossification, the bone is considered healed, though the final remodeling phase will continue in the following months as the area is shaped by the various stresses placed on and through the bone.
Capela will be allowed to return when ossification is complete, somewhere in a four-to-six week window. Looking back on other cases of fibula fractures suggests this is a fair timeline, as the last nine NBA players to suffer a nonsurgically treated fibula fracture during the season missed an average of 19 games. Pelicans forward Dante Cunningham improved those numbers when he missed 12 games earlier this season with a nondisplaced fibula fracture.
Veteran big man Nene and second-year forward Montrezl Harrell will help fill the void left by Capela. Harrell has started Houston's last two outings and averaged a respectable 16.5 points, 5.5 rebounds and 1.5 blocks in 27.9 minutes of action. He's worth a roster spot in most formats.
Smith's injury isn't quite as simple, as his thumb injury was reportedly a "complex fracture." The break, suffered when he swatted at the ball in the hands of Milwaukee's Giannis Antetokounmpo, required surgery and is expected to keep him out 12 to 14 weeks.
The thumb is made up of three individual bones, the proximal and distal phalanges and the first metacarpal. These three bones form three joints, the carpometacarpal (CMC) joint, the metacarpophalangeal (MCP) joint and the interphalangeal (IP) joint. The CMC is the bridge between the bones of the wrist and the thumb. The MCP joint is formed from the first phalanx and the first metacarpal while the IP joint is formed by both phalanges and makes up the tip of the thumb. These joints allow for a high degree of movement but are intricately designed and stabilized by a specialized system of ligaments and tendons.
Since the 2005-06 season NBA players who suffer thumb fractures that necessitate surgery have previously missed an average of 23.3 games (roughly 6 weeks). However, recovery is widely varied and depends on the type of break and other soft tissue involvement. Based on the provided information and the lengthy estimated time of recovery, it's clear Smith's break was significant and likely involved multiple ligaments and/or tendons.
Smith was struggling before the injury occurred but fantasy owners hoping for a rebound can now effectively move on. The Cavaliers have plugged DeAndre Liggins into the starting lineup but his contributions on the court aren't exactly fantasy friendly. The same can be said for veterans Richard Jefferson and Iman Shumpert.
Larry Nance Jr.
Nance's injury isn't as extensive as Smith's or even Capela's, but it still carries a similar timeline. Nance is expected to miss the next four weeks with a bone contusion in his left knee. The reason for the extended absence is due to the fact that a bone contusion is actually more like a microfracture with tiny cracks developing in the outer layer of bone. The body repairs this damage just as it would a complete break, filling in the gaps with new bone tissue. Furthermore, Nance's injury could require a bit more time, as the biomechanical properties of the knee can delay the recovery process. Thomas Robinson has been the biggest beneficiary of Nance's absence, averaging just over 17 minutes of court time in three straight games after four straight DNP-CDs. Luol Deng has also emerged as a legitimate fantasy option after a rough start to the year.
Fast Breaks
Damian Lillard: Lillard is considered questionable for Monday's contest against the Raptors with a left ankle sprain. He rolled the ankle in the fourth quarter of the team's loss to the Spurs on Friday but later admitted he's turned it several times prior to this incident. The All-Star guard insists he won't miss time, but it likely won't be entirely up to him. The Trail Blazers medical team is one of the best in the league and knows the benefit of letting a seemingly minor injury heal to prevent it from becoming a chronic issue. Tread cautiously here for the week ahead.
Dirk Nowitzki: Dallas' all-time leader in just about every statistic possible returned to the court after missing 14 straight games with an Achilles injury. He played 15 first half minutes in a win over the Clippers, scoring 17 points on seven of 12 shooting, including two of three from beyond the arc. He's under a tight minutes restriction and it wouldn't be surprising to see him sit one of the games in both of Dallas' back-to-backs this week.
Chris Paul: The Clippers point guard has missed back-to-back outings with a mild left hamstring strain. The injury doesn't seem overly concerning though he does have a history of hamstring problems. Paul missed five games in the 2011-12 season with a left hamstring strain and two more during the 2015 postseason. He appeared to be close to playing in Sunday's Christmas day loss to the Lakers but opted to manage the injury a bit more conservatively and now plans on sitting Monday as well. The Clippers do have a four game slate this week making it easier to stomach Monday's missed game though playing CP3 in weekly formats will be a calculated risk.
