FanPost

Questioning the Management of Derrick Rose's Orbital Fracture Saga

On September 29th, Derrick Rose suffered his latest setback in what has been a career once destined for greatness now defined by freak injuries. This time, however, neither of his knees were the problem. On the very first day of team practice for the 2015-16 season, Taj Gibson inadvertently elbowed Rose in the face and fractured his left orbital. While the Bulls and their fans collectively exclaimed "not again!", there wasn't much concern at first given the reputation the injury carried in NBA circles. While everybody that receives surgery for such an injury is expected to miss at least a few games, many stars don't even opt for surgery and choose to play through the injury. Even then, the window of recovery for such an injury isn't more than about six weeks in the worst of circumstances, so most shrugged off the injury as a non-concern given Rose would probably miss only the preseason barring any setbacks.

But now six full weeks removed from surgery, Rose is posting worse shooting numbers than ever through nine games and routinely stating after contests that he is still experiences discomfort and diplopia (double vision). The Bulls have never been completely forthcoming regarding medical details of their players, and Rose certainly isn't an exception to this. Rather, he is probably the Bulls' poster child for it. So given the lack of information the Bulls provided regarding this issue, I decided to do some internet digging to see if I could uncover anything that could call their management of this situation into question. You will find, as I did, that there are some disturbing and substantial lapses in judgement regarding this issue.

The first part of this article will briefly overview orbital fractures as well as the possible post-surgery symptoms associated with them. The second half will detail how the Oklahoma City Thunder handled Russell Westbrook's own facial-skeleton fracture last season in comparison to the Bulls' handling of Derrick Rose's.

Part One: Orbital Fractures for Dummies

[Medical information and images in this section courtesy of Jeff Stotts of In Street Clothes (certified athletic trainer) and Cat Nguyen Burkat of EyeWiki (board-certified ophthalmologist)]

Face Bone Chart

Although the most frequently injured part of the human face is actually the nasal bone, one of the most common areas for fracture-related injury in the NBA in recent seasons has been the orbital/eye socket. The human orbital is comprised of seven unique bones in various areas of the skull that are prone to fracture when directly contacted with substantial force (such as an elbow from a perennially pissed-off sixth man). These include, but are not limited to, the frontal bone (forehead area), the maxilla (upper part of the jaw connected to the nose and eye socket), and the zygomatic bone (also known as the cheek bone). The degree of injury with fractures in these areas usually depends on factors such as crack size/severity, potential muscle/tissue involvement or damage, and the displacement of bone(s). Surgery is usually only required if the latter is present or if the eye itself also suffered damage, and recovery time directly correlates to whether or not doctors performed surgery. Regardless, even in the most ambiguous and unfortunate of situations, players aren't expected to ever miss more than six weeks of action.

Below is a list of notable players that suffered facial fractures/injuries prior to All Star Weekend 2015, along with the type of injury they suffered, whether or not they required surgery, and the number of games they missed. Again, this is courtesy of Jeff Stotts:

Complete Orbital Fractures

Rose missing the preseason as opposed to the regular season makes it a bit tricky to nail down how many games he actually missed, but if we assume an NBA team averages roughly three to four games per week and note Rose missed about three weeks of action, then we can ballpark estimate that Rose would have missed between nine and twelve regular season games before returning to normal health. When comparing this number to the number of games missed by other players that received surgery, the total missed is higher than normal but not at all alarming. However, what is alarming is that now six weeks removed from surgery (which equates to roughly 20 regular season games when you add the actual number of games the Bulls have played thus far), Rose still clearly has not recovered from his injury. The only cases above that lasted longer in terms of recovery time were that of Etan Thomas in 2003 and Larry Sanders in 2014, both of whom missed a full six weeks before they returned to action. Given all of this, I don't think it's entirely ridiculous to declare that Rose came back too early from his surgery and is now quite clearly feeling the consequences in his play.

Here's where it gets substantially worse. One of the most common complications following orbital fracture surgery revolves around the pre-surgery timeline and diplopia. In several instances, double vision as a side-effect often resolves itself in roughly two or three weeks or becomes a non-factor in the grand scheme of the patient's vision depending on their habits and activities. However, operating too early can complicate this side effect, and that is why it is usually recommended that patients are observed for a period of one or two weeks before a decision is made regarding surgery. Derrick Rose suffered his orbital fracture on September 29th and subsequently had surgery the next day. Six weeks removed from his operation, Rose claims he is still suffering from double vision. Although there is barely any information available regarding the specifics of Rose's injury, Bulls management can do nothing to obscure Rose's timetable regarding this issue, nor can they obscure publicly available medical facts. I found this information roughly twenty seconds after I googled "orbital fracture post-surgery complications." I find it incredibly disturbing that no one on the Bulls' management or medical staff was aware of the complications that can arise from rushing this type of surgery despite how easily available such information is. Even more disturbing is the possibility that Bulls' management and/or the medical staff green-lighted surgery while aware of this information because of a desire to get him back on the court before the regular season began. Either way, the negligence in this situation is clear, and the blame lies squarely on those tasked with making such decisions.

Part II: The Case of Russell Westbrook

On February 27th, Russell Westbrook suffered a particularly unsightly facial fracture after being inadvertently kneed in the face by teammate Andre Roberson at the end of a game. Because Westbrook did not report any significant side-effects, he underwent surgery the next day and returned roughly four days later to continue his rampage across the NBA to the tune of a 49/15/10 triple-double against the Sixers in an overtime win. If you watched him that night, it was almost impossible to imagine that the guy doing stuff like this had doctors prying open and fixing his face not even a week prior. There may not be a more impressive physical specimen in the entire NBA.

I bring Westbrook into this discussion not because his injury is somewhat similar to Derrick Rose's, but because the method in which it was handled stands in stark contrast to how those responsible managed Rose's case. Yes, both players received their surgeries the day immediately following their respective injuries, but the people performing those surgeries and the respective organizations' willingness to be forthcoming about the facts surrounding it couldn't have been more different.

Let's start with Russell Westbrook's doctors. Rather than have the surgery performed in Oklahoma City, Westbrook flew out to Los Angeles to have his procedure done by the Osborne Head & Neck Institute. There were two doctors that performed Westbrook's surgery while the Thunder medical staff stood by in attendance: Dr. John Joseph Rehm and Dr. Jason S. Hamilton. Rehm is the Facial Plastic Surgery Consultant for a variety of Los Angeles sports teams including the Dodgers, Kings, Lakers, and Sparks. Hamilton is widely known as the doctor that performed emergency reconstructive surgery on former USC running back Stafon Johnson after his infamous catastrophic weightlifting accident that made national headlines in 2009, and his actions subsequently allowed Johnson a chance at an NFL career. Thunder management did not leave anyone in the dark with how they would be handling their superstar athletic specimen point guard. Instead, they went out and got two of the most respected doctors in sports to fix up Westbrook and make sure he would come back healthy without any setbacks, which he quite clearly did.

Now compare that to how Bulls' management handled Rose's case. As of today, we still have no idea who actually performed Rose's surgery. In fact, the only information made available to the public was that Rose's surgery was done at Rush University Medical Center. Although Rush is without question a revered medical institution (not to mention the largest non-government employer in West Chicago) and the 2010 U.S. News & World Report indicates that Rush is one of the top hospitals in eleven different fields, ophthalmology is not one of their strengths. Further complicating this is that Rush has fourteen different ophthalmologists on staff, which means Rose's surgery could have been performed by just about any of them.

See the disparity here? The Thunder sent Westbrook to one of the very best institutions in the country to have two of the most respected experts in the field as it applies to sports handle the situation, and as a result Russell Westbrook clearly returned to an elite level of play immediately. The Bulls sent Rose to a revered medical institution but not one that specialized in the injury Rose faced, and clearly did not feel as if the procedure went well enough to merit releasing the name of the doctor that operated on him. Now Rose is somehow shooting even worse than last season and is still dealing with repercussions from the injury a full six weeks removed from the surgery and the injury incident itself. Somehow, an organization that observed what some would call over-extreme caution regarding Rose's previous health problems decided that it would be okay to rush him through the entire process of dealing with an orbital fracture if it meant getting him back before the season began. As the same organization that fired Tom Thibodeau for caring way too much about the regular season (among other things), the irony here is remarkable.

THE BOTTOM LINE

Remember when you were a kid and your parents told you to take good care of your toys or maybe your pets? And when they broke or they were sick how you wanted to ensure they got the very best care possible because you felt somewhat responsible? The behavior of Bulls management in this situation has been akin to that of a spoiled kid from the North Shore that breaks their cell phone or loses their dental retainer and immediately demands another one instead of learning to take care of their possessions. Rather than take the time to ensure Rose's health would finally normalize, the organization got tired of waiting and instead decided to push for the method that got them Rose back as quickly as possible (i.e. "DADDY BUY ME A NEW ONE NOOOOOOOOWWWWWWWW"). I cannot even for the life of me begin to fathom how the Bulls' concluded that the best option for Rose would be to immediately send him to surgery despite public medical knowledge that doing so could cause complications. Furthermore, that they concluded rushing him back from a surgery that itself was rushed (and performed at Rush) would be the best course of action for his future is even more perplexing.

I wish I had more information, but even with what is available it is easy to see that the Bulls clearly did not handle this situation with enough care and consideration. As a result, we have seen the most watered-down version of Derrick Rose in recent memory, and nobody quite knows if or when Rose will start playing more efficient basketball again. What I do know is that Rose once again had his injury situation critically and laughably mismanaged by all involved in the Bulls' organization, and someone has to be held responsible.

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