Will Tiger Woods Play Golf Again? Doctors Predict Difficult Recovery

The severe lower leg injuries Tiger Woods sustained in a car accident on Tuesday typically lead to a long and dangerous recovery, questioning his ability to return to professional golf , said medical experts who have treated similar injuries.

Athletes with serious leg injuries who are believed to be career-ruining have managed to return – quarterback Alex Smith returned to football last season after a horrific leg fracture and golfer Ben Hogan returned decades ago suffered after a car accident.

But Woods' injuries are more extensive, and his road to recovery is riddled with serious obstacles. Infections, insufficient bone healing and, in Woods's case, previous injuries and chronic back pain can make a months or even years of recovery even more difficult, and can reduce the chance that he will play again.

In an accident near Los Angeles, Woods' right lower leg was crushed and his right foot seriously injured, and his leg muscles swelled so much that surgeons had to cut open the tissue covering them to To ease the pressure, says Dr.-UCLA Medical Center, where Woods, 45, was treated, wrote in a Twitter post on Woods's account.

Doctors also inserted a rod into Woods's shin and screws and pins in his foot and ankle. Doctors familiar with these types of injuries describe the complications they typically cause.

The injuries are often seen in motorists involved in car accidents, said Dr. R. Malcolm Smith, chief of the Massachusetts General Orthopedic Trauma Unit. Hospital in Boston. Typically, they occur when the driver frantically presses the brakes while a car gets out of control.

When the front of the car is destroyed, tremendous force is transferred to the driver's right leg and right foot. "This happens every day with car accidents in this country," said Dr. Smith.

Such lower leg fractures sometimes involve "massive disability" and other serious consequences, said Dr. Smith. "A very rough estimate is that there is a 70 percent chance that it will be completely cured," he added.

The crash caused a cascade of injuries. It destroyed Woods' shin bones, with primary fractures in the top and bottom of the bones and a scattering of bone fragments. When the bones in Woods' shin shattered, they damaged muscles and tendons; pieces sticking out of his skin.

The trauma caused bleeding and swelling in his leg, threatening his muscles. Surgeons had to quickly cut into the layer of thick tissue covering his leg muscles to relieve the swelling. If they hadn't, the tissue covering the swelling muscles would have acted like a tourniquet, restricting blood flow. The muscle can die in four to six hours.

It is possible that a muscle died after all, between the accident and the surgery, Dr. Smith said, "Once you lose it, you can't get it back."

Patients undergoing this procedure should remain in the hospital until the muscle swelling subsides. That can take a week or more. Sometimes, even after a few weeks, the swelling has not decreased enough to close the wound, so surgeons have to transplant skin over the opening.

Dr. Kyle Eberlin, a reconstructive surgeon at Massachusetts General Hospital, said doctors often need to transplant the skin of the thigh or back to plug the holes where bones protrude from the skin, a procedure called a free flap. They cut pieces of skin the size of a football and carefully connect tiny blood vessels – about a millimeter in diameter – from the skin graft to the blood vessels near the wounds using a microscope.

Infection is a risk with fractures breaking through the skin and following surgery to insert rods and pins into bones, with amputation in the worst case, Dr. Smith said. The likelihood of infection depends on the degree of contamination and the size of the wound.

In car accidents, gravel and sometimes dirt can get into the wounds, increasing the likelihood of infection, said Dr. Eberlin.

And opening the covering of muscles can increase the risk of infection, said Dr. Reza Firoozabadi, an orthopedic trauma surgeon at Harborview Medical Center in Seattle.

In large trauma centers such as Massachusetts General or U.C.L.A. free flap procedures are performed within 48 hours. But it is more common to operate within a week of the injury, said Dr. Eberlin.

Rehabilitation will be long and arduous. If Woods needed a free fap – which, according to trauma surgeons, seems likely – "it will be months and months before he can bear weight on his leg again," said Dr. Eberlin.

Woods also risks fractures that will not heal or that will grow together very slowly, said Dr. Firoozabadi. "To heal things, you need good blood flow," he said. "With an injury like this, the blood flow is disrupted."

As a result, he said, it may take five to fourteen months for Woods' lower legs to grow together, assuming they do at all.

The biggest hurdle will be his foot and ankle injuries, said Dr. Firoozabadi and others. It can take from three months to a year to regain freedom of movement and strength. Depending on the extent of those injuries, Woods can barely walk even after rehab.

His rehabilitation may be complicated by back surgery in December. Woods has also gone to rehab for an addiction to painkillers; Pain management during his recovery can now be difficult.

Still, some athletes have returned from serious injuries. Smith, the Washington Football Team quarterback, suffered a similar injury to his leg and returned to play in October. But it took two years and 17 surgeries, and along the way he developed an infection of the wounds and sepsis, a life-threatening condition. And Smith had no injuries to his foot and ankle.

Golfer Ben Hogan fractured his collarbone, pelvis, left ankle and a rib. The injuries were serious, but not comparable to Woods's injuries.

With his foot and ankle injuries and the serious injuries to his leg, Woods "may never play golf again," said Dr. Smith.