With titanium plates, Crosby's jaw expected to heal quickly
April 2, 2013 8:00 AM
Penguins trainer Chris Stewart helps center Sidney Crosby after taking a slap shot to the face.
By Sean D. Hamill Pittsburgh Post-Gazette
The type of jaw surgery that Sidney Crosby endured last weekend after being hit in the face with a puck should, at the latest, allow him to return to game action by the time the playoffs begin in a month, experts say.
"As long as he keeps his nourishment up -- and he should since he's not wired shut -- he should be good to go in three to four weeks," said David Dattilo, director of oral and maxillofacial surgery for West Penn Allegheny Health System.
The timing and the jaw injury itself appear to be similar to what Steelers quarterback Ben Roethlisberger experienced in 2006 when his motorcycle collided with a car whose driver failed to yield and turned left in front of him. The accident occurred a month before preseason camp was to begin.
Mr. Roethlisberger, who was not wearing a helmet, also did not have his jaw wired shut and was in camp on time that year.
If all goes well in three to four weeks, Dr. Dattilo said, Mr. Crosby won't even necessarily need special headgear to protect his jaw "because his jaw will be just as strong as before, and probably stronger because it will be metal-reinforced."
UPMC spokesman Chuck Finder said UPMC's contract with the Penguins, as well as with the Steelers, prohibits UPMC doctors from talking to anyone about any medical procedures involving players unless the teams authorize them. The Penguins are not allowing UPMC's doctors to talk about Mr. Crosby's surgery.
The "plating" technique surgeons used to repair Mr. Crosby's jaw -- as well as Mr. Roethlisberger's -- is the dominant form of mandible fracture surgery these days and helps shorten recovery time and potential problems over wiring a jaw shut, said Robert Kellman, a surgeon at the State University of New York's Upstate Medical University in Syracuse.
Plating involves holding the fracture together with small, 1-millimeter thick titanium plates that are bent to follow the contours of the jaw bone. The plates then are screwed -- with four or six screws per plate -- into the bone in a way that pulls the fracture together.
Titanium is the metal of choice because it's strong, light and because titanium is "very biocompatible with human bone," Dr. Kellman said, and, depending on the injury, the plates are often left in place even after the fracture heals.
Wiring jaws shut was done to use the upper and lower jaw bones as a splint to hold the fractured bone in place, he said.
"We have moved away from" wiring jaws shut, said Dr. Kellman, who has done plating surgeries more than 1,000 times. "The plating technique has evolved significantly over the last two decades."
Dr. Kellman said he repaired a Syracuse Crunch minor league hockey player's jaw using plates a couple of years ago, and the player was back on the ice a day later wearing a special modified helmet.
Surgeons typically can do the surgery from inside the mouth, cutting through the mucous membrane to get to the bone. The membrane quickly heals and the thin metal is almost unnoticeable within a few weeks.
The goal -- as it is with wiring the jaw shut -- is to get "rigid fixation" of the jaw. It will heal better and more quickly if the fractured jaw bone does not move at all, particularly during the first few weeks.
Improper alignment, or even micro-movements during healing, can cause a variety of problems down the road, including temporal mandibular joint, or TMJ issues, that can cause pain, earaches and headaches, Dr. Kellman said.
How soon a hockey player gets back on the ice and tries to compete is based on "choices that people make," Dr. Kellman said. "How much risk are they willing to take?"
Dr. Dattilo, who has done hundreds of similar "plating" surgeries like Mr. Crosby's, said Mr. Crosby could be back on the ice doing moderate workouts early this week.
But he would not advise end-to-end skating for a few days while swelling from both the puck and surgery heals.
Strenuous activity increases blood pressure, which can add to swelling, which results in loosened sutures, Dr. Dattilo said, and "you want the body to heal well."
"You want the bones to mend properly so you don't get a non-union of a fracture that could cause lots of problems and keep him out the rest of the year," he said.
Like Mr. Roethlisberger before him, Mr. Crosby will have to be on a soft-food diet -- mashed potatoes, scrambled eggs, high-protein and high-carbohydrate shakes and other foods -- for three to four weeks to help ensure that there is no movement of the fractured bones. If he follows the right diet, he should be able to keep his weight on.
On top of all of that is just a degree of patience that the Penguins and Mr. Crosby have been through before with his concussion and neck injuries from two years ago.
Dr. Dattilo, who follows the Penguins, says the current state of the team might be most helpful of all to Mr. Crosby's recovery.
"The Penguins are doing so well," he said, noting the current 15-game winning streak and return of Evgeni Malkin and signing of Jarome Iginla. "There's really no reason to put him in too soon, which helps."