Derek Jeter wasn't the only one stunned to discover that his most recent CT scan showed a new crack, albeit small, in the area of his previously fractured left ankle. When apprised of Jeter's case, without examining him firsthand, other doctors believed it to be an extraordinary circumstance.
"Having a new fracture, to me, is unusual," said Dr. Matthew M. Roberts, who specializes in foot and ankle injuries at the Hospital for Special Surgery in Manhattan. "In a nutshell, I would have expected him to be back already, and so what's happening to him now, I can't explain."
That was the impression the Yankees got, as well.
"Unusual and surprising, yes,' general manager Brian Cashman said Friday. When asked if the club would now be more conservative with Jeter's rehab, the GM deferred to those in charge of the shortstop's recovery. "We're amateurs at this," Cashman said. "We're just going by what the specialists say. Just have to let the bone heal and you go from there."
The Hospital for Special Surgery, or HSS, is world-renowned for its orthopedic care and used by many professional teams, including the Yankees. Dr. Roberts is not involved with Jeter's surgery or rehabilitation; the shortstop was operated on by the highly respected Charlotte-based orthopedist Robert Anderson, who also is consulted by many athletes in various sports.
But Jeter had a similar reaction to Dr. Roberts when talking about this setback during an April 25 news conference at Yankee Stadium. In trying to pinpoint when and how he suffered this new fracture, the shortstop could not.
"I don't know what happened," Jeter said that day. "I wish I could explain it. No one can really give me a definite explanation for it. I don't think I pushed it too hard. Maybe I did, maybe I didn't."
Dr. Ken Mroczek, chief of the foot and ankle division at NYU Hospital for Joint Diseases, has some ideas about Jeter's setback, based only on the details provided publicly by the player and the team. Though the expected prognosis for a bone to heal usually is from six to eight weeks, other issues could have influenced Jeter's rehab, right up to the point when he had to be shut down for a second time last month.
"In the absence of new trauma -- he didn't have a twisting injury or nothing new -- I think two things could have happened," Dr. Mroczek said. "One, you can get a fracture near the plate, where there is a point of bone stress near the plate.
"Or, with the mechanics of the ankle, if one part of the ankle is sort of weak, and you're compensating, sometimes you'll load the ankle on the other side and you'll develop sort of a stress reaction or stress fracture on the other side. This [situation] implies that it may have been just altered mechanics."
After this startling development, the Yankees are in no rush to activate Jeter, and have set an ambiguous return date as some time after the All-Star break, which is more like late July, at the earliest. By all accounts, this "small fracture" -- as Cashman characterized it -- should heal in another six to eight weeks, with maybe another month of baseball-related rehab to follow.
But the how and why of Jeter's latest setback takes on greater significance because it could happen again or be more of a lingering problem when he returns to playing. Jeter acknowledged that the injured spot is a "tough area because not a lot of blood flow goes to that particular bone" and he is currently getting stimulation treatment.
"I would be surprised if there was a problem with the bone in general because he's a healthy person," Dr. Roberts said. "Derek may be older for a baseball player in the major leagues, but he's still a young person, and there's no reason to think that he has any problem like osteoporosis or any kind of issue with the bone.
"But you can get some situations when you haven't used the bone for a while that it does become relatively weak, just from the disuse. And it is possible to go out too hard, too fast. The rehab for any kind of fracture requires you to use the bone, and bone is dynamic in that it gets stronger as you use it. Some achy soreness is expected, but you shouldn't have sharp pain. It should be getting better each week -- not linger."
Jeter's history of playing through varying degrees of discomfort suggests he probably treated this round of rehab in much the same fashion. It's also what eventually led to the ankle fracture in the first place. Dr. Mroczek was at Yankee Stadium, as a spectator, the night Jeter was hurt in Game 1 of the ALCS and was surprised by the severity of the injury on a play that "wasn't particularly violent."
Only later did Jeter, who loathes talking about injuries, admit that he most likely pushed his pre-existing bone bruise to the point where the ankle ultimately cracked. The decision for surgery was made quickly back then, but it has not been raised at all in the wake of this second fracture.
"The only time for more surgery would be a stability issue and a healing issue," Dr. Mroczek said. "Clearly, they deem that he doesn't have a stability issue and they're going to give his fracture a chance to heal."
The thought now is to have Jeter in a walking boot for the foreseeable future, with close attention to the new problem area. Before this, Jeter had two CT scans that showed the bone had healed, so the Yankees expect this break to mend on the usual timetable -- despite the unusual circumstances. Even with this unexpected wrinkle, there seems to be no reason to worry excessively about Jeter's recovery, as delayed as it might be.
"Once the bone has healed, it should be good," Dr. Roberts said. "A bone should heal 100 percent. The process of being non-weight bearing leads to some atrophy of the muscles and some weakness, and you certainly do need to rehab that and get things strong again. But you would expect a full recovery."