Nothing positive can be said about Jusuf Nurkic breaking his leg last night against the Nets. The injury will go down as one of the worst days of Nurkic’s career and torpedoes the Blazers 2019 playoff chances. All we can do is try not to cry.
With that said, there is some light at the end of the very long tunnel. Initial reports paint a picture of an injury that is career-altering — NOT career-defining — for Nurkic and not franchise-altering for the Blazers. If all goes well, Nurkic will recover and return to form some time next season and this era of the franchise will continue.
In contrast, Greg Oden’s ruptured patellar tendon and Wes Matthews’ ruptured Achilles tendon fundamentally altered their playing styles and blew apart two promising would-be contending teams. With luck, Nurkic’s injury will have a comparatively smaller effect for both the player and the team.
(Yes, I’m aware that it’s the most Blazers thing ever to hope that a freaking compound fracture is comparatively “less bad” than other injuries in team history.)
Surgery was successful
It’s already been announced that Nurkic underwent successful surgery to repair the open fracture of his tibia and fibula. Importantly, he suffered no nerve or muscle damage, according to Yahoo’s Shams Charania:
Portland’s Jusuf Nurkic underwent season-ending surgery today on compound fractures, and some positive news: No nerve or muscle damage in his leg, league sources said. He is out indefinitely.— Shams Charania (@ShamsCharania) March 26, 2019
According to a write-up by Jeff Stotts of In Street Clothes about Paul George’s similar injury several years ago, this means Nurkic has cleared the first hurdle:
The bone pierced skin and muscle and the extent of the damage must be determined. Any punctured muscle will require additional treatment but a greater setback would be if any neighboring nerves were damaged. Nerve tissue takes a substantially longer time to recover and would require an extended time off to combat any associated loss of function or muscle atrophy.
Stotts writes that another likely complication of a tibia/fibula fracture would be ligament damage:
Fractures to the distal tib-fib area are often complicated because they include the supportive structure of the ankle while proximal fractures can involve the ligaments of the knee. Ligaments do not heal as fast as bone tissue and often fail to reach their initial strength. The sliver of good news here is that George’s fracture appeared to be closer to the midshaft of the bones, just above the ankle joint and below the knee, and no ligament damage is currently being reported.
Like George, there’s been no report that Nurkic suffered ligament damage.
Prognosis is good?
George and former NCAA player Kevin Ware, who also suffered an open tibia fracture during a game in March 2013, are the two most obvious comparisons to Nurkic. The good news is that both returned to basketball after recovery.
George was injured on Aug. 1, 2014 and played his next NBA game on April 5, 2015 — almost exactly eight months after the injury. George went on to win player of the month for Nov. 2015 and was named to All-NBA and All-Defense teams in his first full season back from injury. He’s played in 70 or more games every season since returning.
Similarly, Ware returned several months later and played nine games during the 2013-14 season and is still playing professionally in Canada as of this season.
The cases of George and Ware are a reminder that open fractures are traumatic for fans but they’re routine for medical professionals and do not preclude successful recovery:
“The injury just looked really dramatic on high-def television, but we see these kinds of injuries all the time in our practice,” says orthopedic surgeon Fred Azar, a team doctor for the NBA’s Memphis Grizzlies. “It was a compound fracture, and they all heal really well.”
GRAPHIC:— David J. Chao, MD (@ProFootballDoc) March 26, 2019
By video appears to suffer tibia and fibula fracture, possible open fracture with bone inside out thru skin. Surgery with rod but should have good outcome like #PaulGeorge. https://t.co/oVE0vqjNig
Stotts again, form In Street Clothes:
An injury of this magnitude is gruesome to watch but actually can heal relatively smoothly. ...The rod will fortify the area and insure both bones properly align. Doing so allows the healing process to occur in the best possible environment and helps the bone return to its original strength.
Former Blazers center Mychal Thompson also has positive experience to offer:
He WILL be back...I broke mine...He’ll be back— Mychal Thompson (@champagnennuts) March 26, 2019
Thompson missed the entire 1979-80 season with a broken leg but fully recovered to play multiple seasons without major injury.
The medical literature supports the expert opinions listed above; a 2016 review published in the journal of Sports Health found that 92 percent of people treated surgically returned to sport and many were back within a year, depending on the surgical technique:
For the different surgical techniques, IM nailing demonstrated a high return rate (88%) with favorable return times (mean, 41 weeks). ORIF demonstrated a high return rate (100%) yet with prolonged return times (mean, 52 weeks). External frame fixation demonstrated further prolonged return times (mean, 55 weeks).
(Note that not all of the injuries documented would be exactly like Nurkic’s and most people in these studies are not professional athletes. The main takeaway is that there is evidence people can generally recover from this type of injury, not that the findings are exactly translateable to each individual case.)
A case study also documented a college soccer player with a tibia/fibula fracture returning to play despite a complex rehabilitation process.
Something else to keep in mind is that Nurkic’s injury looked like a freak accident. Unfortunately, there is not much that can be done to eliminate awkward landings on another player’s shoe.
The Blazers, however, have focused on avoiding preventable injuries in recent years. The team drastically changed their training philosophy when they hired Chris Stackpole as Director of Player Health and Performance in 2013; Stackpole instituted state-of-the-art techniques aimed at detecting and correcting movement and/or musculoskeletal problems before injuries occurred. Jesse Elis, Stackpole’s replacement and current head of the medical staff, has continued to focus on injury prevention in recent seasons, to great success:
Portland leads the NBA for fewest games lost to injury with 34, followed closely by Charlotte. Indiana, Sacramento, and Phoenix round out the top five.— Jeff Stotts (@InStreetClothes) February 20, 2019
The Portland Trail Blazers lost the fewest number of games to injury during the regular season with the Pelicans surrending the most.— Jeff Stotts (@InStreetClothes) April 13, 2018
(Over the last five seasons only two other NBA teams have lost fewer games to injury than the Blazers, as of the start of this season.)
Until last night, even Nurkic had been healthy in Portland, missing only four games over the last two seasons despite suffering a myriad of injuries before joining the Blazers. This string of good “luck” coincided with his first offseason with Elis and the Blazers.
Unfortunately, no amount of preventative exercises will be able to stop all freak accidents, but that does not negate the excellent track record the Blazers have had with injuries in recent seasons. There’s little reason to doubt that Elis and his staff will correctly handle Nurkic’s rehab and return to play, and the fact that Nurkic has avoided non-freak-accident injuries the last two years provides hope that he will be a healthy player in the future.
Nurkic is motivated
Nurkic signed a 4-year, $48 million contract this summer and proceeded to put up the best numbers of his career. He showed massive growth this season as a player and would merit all-star buzz next season, if not for the injury.
I won’t belabor the point, but given the effort he showed this season there’s basically no reason to suspect he’ll be anything but 100 percent motivated to recover, which should help the rehab process.
Blazers long-term outlook does not change
Here’s the hard part: Nurkic’s injury pretty much ends the season for the Blazers. Anyone who has watched closely knows that the Bosnian Beast has been the team’s second best player and easily their best defender.
Fun fact: Nurkic is No. 2 in the entire western conference in net rating this season. Behind only Steph Curry.— Eric Griffith (@EricG_NBA) March 26, 2019
If Pascal Siakam didn't exist, Nurk would be a sneaky Most Improved Player candidate. It's hard to overstate how far he's come.
Damian Lillard and co. have survived CJ McCollum’s recent injury partially because Rodney Hood and Seth Curry can replicate a lot of McCollum’s skills (and because Dame has been playing out of his mind).
But there’s nobody on the roster who can replace Nurkic on both ends of the court. The Blazers will still be able to win games against lesser opponents, but in the playoffs they will suffer without Nurkic’s impact. Before Nurk went down the Blazers first round outcome likely would have come down to a coin-toss — now it will take a great deal of luck to win more than a game or two.
With that said, the long-term outlook for the team does not change. Enes Kanter, Rodney Hood, and Seth Curry will all still be difficult to re-sign this summer. Al-Farouq Aminu will still be an unrestricted free agent, but the Blazers will control his Bird Rights. Lillard, McCollum, and Nurkic are still locked in for several season.
General Manager Neil Olshey will still need to work to improve the team around the margins with limited resources to bump the Blazers up from “maybe can win a series” to “legitimate contender for the Western Conference Finals.”
If you’re happy with the direction the team is headed with the current core then Nurkic’s injury should not damper that enthusiasm in the big picture. And if you wish the team was more aggressive with its personnel moves, Nurkic’s injury should not convince you they’re better off standing pat.
Nothing about the Blazers priorities this summer have fundamentally changed, unlike when injuries to Matthews and Oden threw the franchise’s entire competitive timeline into turmoil and prompted the departure of several major players.
To put it crudely, LaMarcus Aldride left when Matthews’ achilles exploded, but Dame’s not going anywhere (...neither is the luxury tax bill, though). Nurkic missing half-ish of next season is not going to force a major pivot in front office strategy.
Nurkic’s injury sucks. So much. Nurk’s emergence gave us a glimmer of hope that the Blazers could be Western Conference finalists. Now, almost certainly, the season will end with another first round disappointment.
But, unlike with previous injuries in franchise history, Nurkic’s broken leg does not portend doom in the long-term. There is reason to hope he will successfully recover, and Olshey does not need to significantly alter the the franchise’s long-term strategy. If all goes well with rehab, in ten years Nurkic’s injury will remind us more of Mychal Thompson than Wes Matthews or Greg Oden.