Friday, April 25, 2008

Jimmy Rollins 'Fracture' Unfounded

Jeff Erickson, senior editor of Rotowire and the host of "The Rotowire Fantasy Baseball Show" on XM 175 (weekdays at noon ET) recently advanced the notion that Phillies MVP shortstop Jimmy Rollins' stint on the disabled list (ankle sprain) is worth investigating as to whether the injury is due to a fracture.

We don't know how this cockamamie rumor got started but we intend to put the brakes on it right now. Jimmy Rollins has a soft tissue injury of his ankle. He's working it, he's rehabbing, he is taking batting practice, and prior to being backdated on the DL, he pinch hit at least twice.

What may have happened is this: some Phillies medical brainiac -- despite an appropriate clinical examination and negative plain radiographs of the injured extremity -- decides, just to make sure, and just because Rollins is a multimillion-dollar MLB stud, blah, blah, blah -- that Rollins should undergo computerized tomography or magnetic resonance imaging ostensibly to illuminate occult fractures.

This is common practice in circles where expensive and medically unindicated tests are performed "just to be on the safe side." Every doctor's office and emergency room does it -- even to ordinary people -- because...well...they can. The subsequent fees help pay for the equipment and the doctor's kid's braces.

Anyway, it's important to recognize that the "gold standard" for diagnosing a fracture clinically is an appropriate medical history for mechanism of injury and examination of bony tenderness when a clinician pushes on the site (on the bone, not on the soft tissue).

Generally, an X-ray is then obtained to prove or rule-out bony injury. If the x-ray is negative, there is no fracture. But from time to time, a medical practitioner is convinced that the X-ray is wrong and goes on to more exotic (and expensive) imaging techniques (CT and/or MRI) and viola -- an "occult" fracture is realized.

Unfortunately -- arguably with select exceptions -- the nonplain film identified fracture outcome is exactly the same as if the fracture was never identified. Imagine, if every time somebody fell down resulting in an X-ray to rule-out fracture, and the X-ray was negative, all those people receiving a CT -- "just to be on the side" (and pay a few bills). Imagine the magnitude of that practice inflicted across the population. The unnecessary expense would probably rival the gross national product of Canada, and the superfluous radiation exposure would not do anyone any good either.

We are convinced that Rollins is fine, and he will be clubbing the ball and tearing up the base paths precisely three weeks from his original point of injury. You can bank on it.