Garrison Hearst, Running Back for the San Francisco 49ers

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NAME: Garrison Hearst
TEAM: San Francisco 49ers
POSITION: Running back
INJURY: Original broken fibula, possible necrosis.

OTHER ATHLETES AFFECTED

Necrosis: Bo Jackson (hip), pro football and baseball

HOW IT HAPPENED

Hearst broke the fibula bone in his left leg on the first play from scrimmage in the NFC divisional playoff game against the Atlanta Falcons in January 1999. Hearst caught his left cleat in the turf after being spun around by Falcons defensive end Chuck Smith following a seven-yard run in the first quarter.

Hearst's recovery from surgery progressed slowly because of circulatory complications preventing sufficient blood flow to the damaged area and to the ankle and foot. In July 1999, orthopaedist Michael Mont, MD, performed surgery to try to stimulate the flow of blood to Hearst's foot, causing him to miss the entire 1999-2000 season.

PLAYER BIO

Hearst was the third overall pick in the 1993 draft out of the University of Georgia. He rushed for more than 1,000 yards for the Arizona Cardinals in 1995. San Francisco signed Hearst as an unrestricted free agent in 1997. Despite playing in just 13 games in his first season with the 49ers, Hearst rushed for 1,019 yards. He missed four games, including a playoff win over the Minnesota Vikings, with a broken collarbone.

Following the 1997 season, the 49ers tore up Hearst's two-year contract and signed him to a new five-year deal worth $15.1 million through 2002. Hearst finished the 1998-1999 season second in the NFC in rushing (behind Atlanta's Jamal Anderson) with a career-high 1,570 yards.

WHAT'S INVOLVED IN A BROKEN FIBULA?

The two bones of the lower leg are the tibia (shin bone) and the fibula. The fibula is a thin bone on the outside of the shin bone and, like the shin bone, goes from the knee to the ankle. The smaller fibula gets broken more often. Both lower leg bones are vulnerable to being broken in that they're close to the surface and force directly impacts the bone. Also, there are not a lot of protective soft tissues around them.

There are always concerns about the possibility of associated damage to blood vessels and nerves surrounding lower-leg fractures. If a large blood vessel is compromised, it can cause necrosis -- the death of tissue and bone. In this case, the injury can become limb-threatening.

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DIAGNOSIS

After his injury, Hearst was carted off the field; X-rays revealed the fractured bone. An MRI later revealed the circulation problems. MRI scans use magnetic waves to take pictures that look like slices through the foot. The MRI scan is useful because it shows not only the bones of the foot, but also the soft tissues of the foot and ankle -- the tendons, ligaments, and cartilage surfaces.

Club officials, during a break in the second round of the NFL draft on April 16, disclosed the setback in the 29-year-old player's rehab.

TREATMENT

Hearst' first surgery called for stabilizing the leg, setting it in place, bracing it, and allowing it to heal while not compromising circulation. Generally, the more limited the blood supply is, the longer the injury takes to heal. Sometimes broken leg bones require fixation of the fracture with a rod down the middle of the bone. Once healed, the athlete can gradually start building strength in the affected area.

Team physician Michael Dillingham, MD, noted problems in Hearst's ankle after the running back underwent an MRI in early April of this year. "The MRI we conducted on Garrison's ankle showed that the injury is healing slowly, but the healing is not complete," Dillingham said in a statement. "We feel an additional surgery is necessary to speed up the healing process to give him a chance to play this season." The additional surgery has not yet been scheduled.

PREVENTION

The original injury was considered a freak incident, and there was no way for it to be prevented. His slow recovery is also unusual.

RECOVERY

During recovery, the muscles of the leg may become smaller and weaker, and weight-bearing exercises during rehab will be difficult. San Francisco coach Steve Mariucci has said that Hearst, who has been in various phases of rehabilitation for 16 months, still is not able to run at full speed. He has already been ruled out of San Francisco's minicamp at the end of April.

Dillingham says there's a 70% chance Hearst could play sometime during the 2000-2001 season, but 49ers general manager Bill Walsh sees Hearst's chances of returning as no better than 50-50.

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LONG-TERM OUTLOOK

Player personnel director Terry Donahue said during a press conference that he has some real concerns about Hearst and his future health: "There's not a tougher guy in the world than Garrison, but the reality of it is there are some concerns about Garrison and how soon he'll be back. We really felt that at some juncture in the draft we had to take a look at a running back."

It's feared the bones in Hearst's foot will become susceptible to avascular necrosis, the bone-dying condition that developed in Bo Jackson's hip after an injury, forcing him to retire from football.

According to the National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse, avascular necrosis is a disease resulting from the temporary or permanent loss of the blood supply to the bones. Without blood, the bone tissue dies and causes the bone to collapse. If the process involves the bones near a joint -- like an ankle -- it often leads to collapse of the joint surface. This disease is also known as osteonecrosis, aseptic necrosis, and ischemic bone necrosis.

WebMD Feature

Sources

Medical information provided by Lyman Scott-William Smith, MD, team physician for the Carolina Hurricanes; Sports, Orthopaedic and Rehabilitation Medicine Associates; SOAR Medical & Rehabilitation Medical Associates (Dillingham); and the National Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse.

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