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Saints CB Breaux out 4-6 weeks, 2 doctors fired for misdiagnosis

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Dome

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The New Orleans Saints have fired their two orthopedists, Dr. Deryk Jones and Dr. Misty Suri, according to a league source.

The decision follows a misdiagnosis of cornerback Delvin Breaux's injury. Breaux has missed the majority of training camp with what the team diagnosed as a leg contusion, but Breaux underwent X-rays on Monday that revealed a worse injury. He was seen in a walking boot and using crutches Monday afternoon at the team facility. 

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According to the source, Breaux suffered a fractured fibula that will keep him out for four to six weeks.

http://www.nola.com/saints/index.ssf/2017/08/saints_fire_two_orthopedists_a.html#incart_river_mobile_index

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TheVillain112

TheVillain112

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20 minutes ago, domepatrol91 said:

Sean Payton of owes Breaux an apology. He was openly frustrated with Breaux not returning to practice and didn't deny reports he was being shopped.

Curious if he actually does.  Coaches (mainly based on my experience with Marvin Lewis) I've seen generally don't take concussions/injuries seriously enough...

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sammymvpknight

sammymvpknight

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I'll leave this here. :)

 

IS KIKAHA'S KNEE A BIG DEAL? This is my post-draft analysis: If the Saints Sports Med staff cleared Kikaha is most certainly due to him having a normal knee exam and recent post-surgical MRI. Based on the objective measures that technology currently allows, his knee is stable.

But is he at a higher risk for reinjury now that he has had two ACL reconstructions on the same knee despite having a stable recent exam/MRI? The question can be answered by looking at the most recent pertinent medical literature. 

I am going to point you toward two landmark articles on the topic:
-Walden et al. High risk of new knee injuries in elite footballers with previous anterior cruciate ligament reconstruction. 2006.

-Wright et al. Increased re-injury risk after ACL reconstruction. 2011.

Walden et al looked at ACL graft injury rates at one year post-op reconstruction. They found that those with a prior ACL tear are at a 4-11 times greater risk of damaging the graft or tearing the ACL in contralateral knee as someone uninjured. Considering that Kikaha re-injured his graft within one year of his initial surgery, its easy to say in hindsight that he was high risk for re-injury at that time.

But considering that he Kikaha is now 4 years post-op, is he still at a higher risk of re-injury? That question can be answered by looking at the study performed by Wright et al. They looked at 5 year recurrence rates, and their findings were very interesting. The study found that the graft knee has a lower risk of re-injury (5.8%) than the contralateral knee (11.8%). Both numbers are HIGHER than the five year incidence of a similar population without a prior ACL tear.

So what do the findings mean? It means that Kikaha is at higher risk of ACL tear than the average population. It is interesting that the contralateral knee has a higher rate of injury than the grafted knee. A strong argument can be made that a grafted ACL is better than a normal ACL in a person with a contralateral ACL tear. Genetic predisposition is likely a big reason.

My post 3rd tear analysis: Yes...this is bad. I would say that the likelihood of a fourth ACL tear is pretty darn high. For an ACL tear to not take twice is uncommon. He better be going to James Andrews this time.


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MARSHON LATTIMORE: I like Lattimore...I think that he could be a good player. But I have concerns. Hamstring injuries are fickle, especially at the CB position that stresses the hamstrings more than any other position on the field. It is assuring that he has avoided recurrence in the last year, but it's something that he will have to contend with his entire career. He will need to have a very good strength and conditioning instruction. Lattimore hyperextended his knee while in training camp, which has resulted in missing pretty valuable playing time. There did not appear to be any significant structure damage and he looks to be on track to return to play without restrictions shortly. I do think that the loss of practice will set him back a bit, unfortunately...and boy do we need him to be a solid contributing with our CB corp that remains questionable at best.

THE EMBARRASSING #32 PICK SITUATION THAT PROBABLY TURNED INTO A BLESSING IN DISGUISE: The Saints wanted Foster. Foster was an undersized LB with personality concerns...but even more of concern was his injury history. He has a history of concussions and a playing style that leads to concussions, and has a bum shoulder. Somehow, someway, despite just about every other team not clearing Foster medically...the Saints cleared him...or did they? Clearly, the Saints were going to take him...but was he medically cleared by the Saints medical staff? Is the Saints medical staff competent? Or did the Saints medical staff NOT clear Foster, and Payton want to get him anyway? Any way you slice it...I have big concerns because this is a team that has been absolutely devastated by injury in the past few seasons. I suppose that shouldn't be surprised by the blunder that would have been if Foster would have lasted one more pick. It makes me question the Saints medical eval of Lattimore...along with many of their other draft selections. Medical is probably the most important part of the scouting process and the Saints simply don't appear to know what they are doing.

RYAN RAMCZYK: Ramczyk has had a torn hip labrum that was surgically repaired. The cause of the labrum is actually due to a structural abnormality of either the hip joint or the hip bone causing the labrum to be frayed in the process. The point of the surgery is to both fix the labrum and also correct the structural abnormality. Recurrence is about 5% after two years. In all likelihood, he's probably be good to go unless he has a contralateral hip structural abnormality, which unfortunately is very common. Ramczyk has been fighting through an undisclosed injury through camp. No details are available so my analysis stops there.

MARCUS WILLIAMS: No significant injury concerns and has been a healthy participant through camp. 

ALVIN KAMARA: Kamara does not have a significant injury history. He wasn't heavily utilized on Tennessee which brings into question whether he could be a bell-cow type RB...but he won't need to for the foreseeable future with Mark Ingram in town. Kamara is a talent. One doesn't need hundreds of hours of game film breakdown to figure that one out...pretty much only need one preseason game. The question is whether or not Kamara can handle a heavier load, because if he can...I strongly believe that this will be AP's last season as a Saint...because you just can't keep Kamara's talent off the field. 

ALEX ANZALONE: Looking at his injury history...he did have a labrum repair...but those are typically slam dunks if done by a decent Sports Med staff with a good rehab team. UF's medical team is one of the best in the south. He also had a broken arm last year. But it takes quite a bit for me to get worked up over a fracture. Does he have a mineral/vitamin deficiency? Does he had a medical condition that predisposes to fractures? Did he need internal fixation? What do his current x-ray's look like? I suspect that his prior arm fracture was a fluke and has a low likelihood of recurrence. The shoulder is a bit more of a concern...but again...I generally have quite a bit of trust in the UF staff. Though I don't completely trust the Saints evaluation of injuries...at least there's enough there for me to have some confidence that he will stay healthy. Anzalone has stayed healthy through training camp. He will likely be replacing Dannell Ellerbe, who was one of the more predictable medical busts in the Payton tenure. 

TREY HENDRICKSON: No significant injury history. Has missed a nice chunk of training camp due to an undisclosed injury. No other details to provide.

AL-QUADIN MUHAMMAD: Had a prior "minor" knee surgery a few years ago, which he revealed on social media post-operatively. Maybe not quite as dumb as Arian Foster revealing his MRI findings (including PPI) over social media...but it's still shows a bit of immaturity. The list of "minor" knee surgeries is pretty long but with common things being common...meniscal surgery probably tops the lists. Recurrance is always a possibility and there is a higher incidence of early osteoarthritis and early retirement from NFL play after an isolated meniscal repair. It certainly is NOT an ACL repair...but it's not probably a trivial thing. 

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THE ARGUMENT THAT SAINTS HAVE TAKEN RISKS WITH MEDICAL IN THE PAST WITH BIG BENEFITS:

I think that it is very important to consider the athlete, the surgeon, and the rehabilitation team in regards to injuries. Drew Brees had an absolutely BRUTAL SLAP (shoulder labrum) tear. 

But he did have a few things going for him. 

1) He is Drew Brees...clearly a pretty spectacular professional who worked his BUTT off in post-surgical rehab. He also keeps his body in excellent shape, so it definitely improved his post-surgical outcome. If it was just about any other QB in the NFL...I am willing to wager that the significant majority of QBs would have never returned from that injury.

2) James Andrews is one of the most gifted surgeons in the world. He essentially DEFINED the SLAP tear and created the procedure to fix it. If it just about any other orthopedic surgeon in the world that would have performed the procedure, Brees would have likely never returned to form.

3) The Andrews Institute is the best outpatient sports rehabilitation center in the world. The surgery is only as good as the rehabilitation that follows, and this is usually where things fall apart. 

Brees was a special athlete, he had a special surgeon, and he had a special rehabilitation team...and that is how he became Drew "frickin" Brees.

The big names in Sports Medicine know which players will have good outcomes. It depends SO much on the person that you are getting. 

I really liked Takk McKinley coming up to the draft. He's a guy who I felt had the potential to be an elite pass rusher. But then news of his shoulder came to light and I started digging into the personal make-up of Takk McKinley. There is no question that he is a hard work on the field...but he is dumb as a rock and I had BIG questions about his ability to be a professional note just on the field...but off the field. He is he going to have the insight to know how to rehab his shoulder? He could barely follow instructions at the NFL combine! It was an enormous red flag for me...and as a result I soured on him quite a bit entering the draft.

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NICK FAIRLEY: I'm going to stay as objective as possible. Fairley was signed to a large contract the offseason prior to him having been found to have a career threatening pre-existing condition. He was cleared medically before given the new contract. He's out for the year, and he will likely not play again. So the question is whether or not the contract could have been prevented. What led to the second and third opinions? Did Fairley develop symptoms after the contract was given. Did Fairley have concerning symptoms before the contract was handed and did not say anything and therefore made it through the initial screening? Was there a change on the medical team that led to a second set of eyes that found something concerning? 

We can speculate all day long on what happened that resulted in this debacle...but regardless of what happened, it doesn't reflect well on the the Saints medical team.

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MAX UNGER: Max Unger has had chronic foot issues before he was initially signed by the Saints. So when he had recurrence late last season, there should have been some sort of timetable on recovery. Though return to sport after surgery isn't an exact science, there is enough medical literature out there to give pretty good guidelines. I'm encouraged that Unger will probably only miss a few regular season games (at most), but I can't help to wonder if the surgery should have been done a bit earlier so that he had a chance to get in shape before the season starts. Unger is a veteran and doesn't necessarily need a ton of preseason games to get ready...but he does need conditioning to make it through the regular season to help he be the same caliber of player and also to help prevent injury. I don't know all the circumstances of his recovery, but his rehab timeline is a bit frustrating.

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ADRIAN PETERSON: Is AP a mutant? Is he a robot? Or is he human? That's a question that has been asked quite frequently in Sports Med circle and still is asked today after it took AP about 9 months to come back from an ACL reconstruction and then go on to rush for over 2,000. The truth is that as mentioned previously in my discussion of Drew Brees...it takes THREE THINGS to come back from a catastrophic injury. 1) A MOTIVATED, GENETICALLY SUPERIOR PLAYER, 2) A VERY GOOD SURGEON, 3) A VERY GOOD REHAB TEAM. James Andrews did his procedure and his rehab was top notch. And of course...AP is one of the most dedicated players you will find. But as a common rule in surgery..."you can't do better than God." So how did AP get "better" shortly after an ACL reconstruction. The truth is that he wasn't better...he actually wasn't as physically gifted as he was before the surgery. But he was STILL good enough to be one of the best running backs in NFL history. Wrap your head around that! There are going to be lots of debates over who is the greatest RB of all-time...but AP's 2012 season is all I need to answer that question.

Dr. James Andrews' words, not mine: "The problem is he was a very special patient. He had the best rehabilitation in Houston and with his trainer in Minnesota. He had 24-hour-a-day care and his rehabilitation was the key. It wasn’t that I did anything special with the surgery. You’ve also got to realize what a unique individual he was for recovery."

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DELVIN BREAUX: Sean Payton is unhappy about Delvin Breaux's injury situation (knee bone contusion) and has placed him on the trade block. Sean Payton, the person who CONTINUALLY invests in injury prone players, is angry about an injury prone player getting injured? I can't be the only one rolling my eyes right now. Sean...you get what you pay for. In a bubble, Sean Payton should not be mad at Delvin Breaux right now. This is football...and players get injured...especially the ones with propensities to get injured in the past. And Delvin Breaux is a LOW-COST undrafted free agent. I think that things are starting to boil over and Payton is frustrated with what's happening on the injury front on his team, and that Breaux just happens to be at the wrong place at the wrong time. The problem is NOT Delvin Breaux...the problem is much bigger than that...and that is much more difficult for Payton to rationalize.

Update: It was a missed fracture on x-ray. A couple docs were fired. It's going to be interesting where they find a replacement. New Orleans exactly the Mecca of medicine. 

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cddolphin

cddolphin

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5 minutes ago, bananabucket said:

Why would it not be serious?  What doctor is never going to make a mistake?

I don't work in the medical field, but mistaking a fracture for a contusion sounds like a big mistake. These aren't you neighborhood doctors, these are guys who are responsible for accurately diagnosing and caring of mutli-million dollar assets.

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