Sano Heading to Surgery

[dbminn]

Well, not the best news of the day...

 

And from the Strib too.

 

Here's to a speedy recovery!

 

 

[D. Hocking]

I suppose better now than January or February.  Best wishes to him.

[gunnarthor]

Well hopefully he has a fast recovery but I think it means the Twins can't really plan on him being third this year.

[dbminn]

 

Well hopefully he has a fast recovery but I think it means the Twins can't really plan on him being third this year.

Everything could turn out fine for Sano but I think you're right. Could make the future of both Grossman and Vargas with the Twins less likely than before. Those decisions will be made long before Sano hits the field in the spring.

[Respy]

I wasn't aware that there was a surgery for shin stress reaction.  After some research, sounds like recovery is about 3-4 months.  So yes, it's good to do it now, and hope he's back for Spring Training.  I'd expect that this should solidify Escobar being tendered an arbitration contract, and I'd be surprised if the Twins sign a DH-type this offseason if they think Sano might need to spend extra time there next year.

[caninatl04]

I hope this doesn't impact his weight issue.

[diehardtwinsfan]

Well, if he's headed to surgery this month, 6-8 weeks puts him as resuming full activities sometime in January. I cannot imagine this type of surgery affecting anything other than some of his conditioning. He should be in playing shape by spring.

[70charger]

 

Well hopefully he has a fast recovery but I think it means the Twins can't really plan on him being third this year.

 

I think Escobar just got some job security. 

[Craig Arko]

Could be the worst fallout from this is that he could trigger the metal detectors in every airport he goes through.

[Mike Sixel]

Just another reminder we know nothing about their health, and we shouldn't question their heart so much, imo. Here is hoping for a speedy recovery!

[drjim]

This all feels very ominous. Makes concerns about his weight and position all the more relevant.

 

Certainly ends any thoughts of an extension and likely ends any possibility of trading an IF.

[Thrylos]

Wish him the best.  Better now and being ready next March, than losing time next season

[laloesch]

Titanium rod ?  What the heck?  Seems kinda extreme.

[Thrylos]

 

 

This all feels very ominous. Makes concerns about his weight and position all the more relevant.

 

Certainly ends any thoughts of an extension and likely ends any possibility of trading an IF.

 

I do not understand this logic at all.  He had a injury that was caused by a ball during a plate appearance.  Freak accident.  Nothing to do with his weight and position, and he is taking care of it during the off-season so he will be in playing shape by ST.

[USAFChief]

 

This all feels very ominous. Makes concerns about his weight and position all the more relevant.

 

Certainly ends any thoughts of an extension and likely ends any possibility of trading an IF.

concur.  

 

And strengthens worries about his conditioning...he can't really do that while this heals.

 

 

[drjim]

I do not understand this logic at all. He had a injury that was caused by a ball during a plate appearance. Freak accident. Nothing to do with his weight and position, and he is taking care of it during the off-season so he will be in playing shape by ST.

After normal offseasons he pushes the limit on his weight and he's already borderline on d. These facts almost certainly aren't going to be improved with 2 months of recovery from a rod being placed in his leg.

 

I would love to be wrong, but I wouldn't go into the spring counting on him doing anything in the field outside of a start or two a week at 1b.

[laloesch]

 

concur.  

 

And strengthens worries about his conditioning...he can't really do that while this heals.

 

If anything hopefully he comes out of this healthy but also raises his own awareness about his own health and conditioning.  I remember being in my early 20's, thought i was invincible. 

[tarheeltwinsfan]

This particular shin stress reaction is distressing to me...and it's only November 2nd.

[Halsey Hall]

I got a Stress  reaction watching the Astros and realizing how far the Twins are from that level. 

[Old Twins Cap]

Have to agree that all the clamor for Sano to be a 3B for the next 5 -7 years has got to be tamped down.

 

He will have a metal rod in his leg.  Logic would say, the less stress on that leg the better.

 

Hopefully he can play 1B.  He's young, with big strong bones.

 

I got metal hips at age 50 and life has never been better.

 

But, you still play odds so they favor the best outcome.

[Taildragger8791]

 

Could be the worst fallout from this is that he could trigger the metal detectors in every airport he goes through.

 

Titanium implants don't set off metal detectors unless you go the Wolverine route and replace all your bones with it. It's non-ferrous which is why it makes for a good implant, otherwise you'd have a real bad time in the MRI machine.

[Winston Smith]

I'm willing to accept, after reading the comments, that his Dr's probably know more about this than any of us. So I'll hope for a speedy recovery at wait until spring to worry about all the side stuff.  Good luck with this!

[Heezy1323]

It's a little difficult for me to make sense of this with the information available, but I'll offer my $0.02. 

 

I'm guessing that he had an initial injury with the foul ball that caused a bone contusion/bone bruise which really is similar to a stress reaction, though at the beginning it occurred in this case all at once rather than due to repetitive stress over time. If the injury is on the anterior edge of the tibia (nearest to the front of the leg), that is what we refer to as the 'tension' side of the bone- meaning with each step, that part of the bone has a tension/distraction force place across it. This can slow the healing process. From a biomechanical perspective, his weight would also play a role. 

 I can't remember if I've used the analogy here before, but I often discuss with patients who have this type of problem about the 'see-saw of bone metabolism.' On one side is 'bone build-up' and on the other is 'bone breakdown'. The body is always balancing these two for almost all of your bones (even if not injured). In cases of a stress fracture (or similar injury like this), the see-saw gets tipped in favor of 'bone breakdown' for any number of reasons. The things we can do to try to tip the see-saw back the other way include rest, vitamin D, smoking cessation, weight loss, activity modification, bone stimulators and others. I suspect all or most of these were tried with Sano (I am assuming he doesn't smoke). Most of the time, non-surgical treatment is successful. Sometimes, it is not. 

 The titanium rod is something we refer to as an intramedullary nail. Meaning, it is a rod that goes down the hollow center of the bone. For the tibia, it is introduced just below the knee.The canal of the bone is opened with a reamer. You then pass a rod down the center of the bone and ream the canal of the bone in 1/2 mm increments until you reach the correct size. You then pass the titanium rod down the center of the bone and place 1-2 'locking screws' at each end to prevent rotation of the rod or bone. 

 The idea is that the reaming process stimulates a stronger healing response at the site of the stress injury, and also that the added stiffness of the rod takes sufficient stress off the bone to allow the 'see-saw' to tip back to the 'build-up' side. 

 Because the rod is sitting essentially directly adjacent to the bone where the injury is, any follow up MRI's are difficult to interpret because you are going to get some 'scatter' artifact from the rod. As such, I would expect that the return to play is going to be based on symptoms more than follow-up imaging. 6-8 weeks seems very reasonable to me. I would think that this has a very high chance of solving this problem, but I am also on record saying that I think it is unlikely he will require surgery, so what do I know. Once the rod is in place and this area has 'healed', I would think it is extremely unlikely for it to recur due to the presence of the rod.

 
Sorry for the long post- it may have been more like $1.15...

 

[h2oface]

 

I suppose better now than January or February.  Best wishes to him.

 

....... but not better than in August or September..... regardless of the defense then, and coming, for again suggesting it should have been done right away, for Sano's sake and the Twins....

[h2oface]

I have an intramedullary rod/nail (it was called a rod then, now a nail) in my right tibia since 1991 (at 36). It was from a complete tib/fib break. Never set off a metal detector, but it does show up on the body scan. It wasn't a compound fracture, as the bones never came out of the skin, but it was quite severe, and the tibia was a clean complete cross sectional fracture, with the fibula a spiral fracture. The foot was twisted 180 degrees and pointed backwards. I was walking (kind of... the start of the rehab - bearing weight) in a week, and had a full leg cast for about 3 weeks, used crutches for a day, then one, then a cane, and was walking and rehabbing with no props in a month. It has never given me any problems, fully healed, and I was very active and a professional Hang Glider and Skydiver for years after, with no restrictions whatsoever. It surprises me that for a stress reaction this is being used, but it should have a relatively quick healing time, especially since Sano is under 26, and the osteoblast/osteoclast dance is more active, and the bones don't have to actually heal a severe break. The rod allows for weight bearing very quickly, and the weight bearing even helps it heal. The locking screws must be a newer addition, as I don't have them at all, and have not had any migration of the rod. Sano will be limited on cardio movements, for sure, and it will be a challenge to find a routine to keep toned and not gain weight, especially if he has not learned to eat a little less than he needs to maintain. If he lacks self control, and pigs out, he will skyrocket, as we all will.

[spinowner]

 

Titanium rod ?  What the heck?  Seems kinda extreme.

I believe almost all orthopedic bone implants are titanium. Strong, light, and unlikely to trigger an immune response.

[spinowner]

 

 

Sorry for the long post- it may have been more like $1.15...

Posts on the subject of orthopedic medicine by most of us: $.02.

Posts on the subject of orthopedic medicine by Heezy1323: priceless.

[Heezy1323]

 

I believe almost all orthopedic bone implants are titanium. Strong, light, and unlikely to trigger an immune response.

Many are. Stainless steel is also frequently used for many of the same reasons you list. The vast majority of hardware implants for fracture fixation are one of the two.

[Heezy1323]

 

It surprises me that for a stress reaction this is being used, but it should have a relatively quick healing time, especially since Sano is under 26, and the osteoblast/osteoclast dance is more active, and the bones don't have to actually heal a severe break.

 

Thanks for sharing. Mad props for throwing in 'osteoblast/osteoclast'. 

[diehardtwinsfan]

 

Posts on the subject of orthopedic medicine by most of us: $.02.

Posts on the subject of orthopedic medicine by Heezy1323: priceless.

 

Yeah, Heezy.... for the record, you should be on staff at TD. Your contributions here are invaluable.

 

Edit... yes, I know you probably make a lot more in your current role