Manchester United defender Luke Shaw is facing a long road to recovery after suffering a double leg fracture during his side's 2-1 Champions League defeat against PSV Eindhoven last week.
The 20-year-old, who had been enjoying a promising start to his second season at Old Trafford following his £24 million move from Southampton in 2014, writhed in agony on the floor following a heavy challenge after 15 minutes from PSV defender Hector Moreno, who faced no punishment from referee Nicola Rizzoli.
“I called him last night,“ Manchester United boss Louis van Gaal said on Thursday. "He sounds very strong, which was amazing for me – a big surprise. It is a good signal, but he knows he has a long way to go and it is not easy.
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“His family is there, we have sent people with him and he will come back when he is prepared. Maybe tomorrow. He will have a long period of rehabilitation and he has a long way to go.”
Shaw is now back in the UK after being taken to St Anna Ziekenhuis hospital in Eindhoven having undergone surgery. He faces a battle to be back in time before the Premier League season ends in May.
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"There are two bones in the lower leg, one is the tibia which is the bigger one and the one is the fibula. At the point of injury, Shaw’s tibia has a slight bend in it so it looks as though there was a sideways blow to that, and there was a bit of rotation as well," Specialist Sports Doctor Kalpesh Parmar of Pure Sports Medicine tells GiveMeSport.
"Without seeing the X-rays, I don’t know whether it’s in two or multiple bits, but from what I’ve seen it looks like a clean break, which means it’s snapped in two. It’s called a double leg fracture because the two bones in the leg tend to break at the same time."
It appears as though Shaw's recovery has been far from straight forward so far. Sky Sports reported earlier this week that his return to the UK was delayed because of fears amongst medical staff in Eindhoven over an infection to his wounds.
The former Southampton ace is also believed to have undergone a second procedure having had a metal rod inserted to stabilise the injury, although Manchester United have refused to comment so far. "From looking at the picture Shaw posted online, I think he may have had a complication called compartment syndrome, where there’s a lot of swelling in the lower leg and compartments of the leg are so tight that they start cutting off the circulation," explains Dr. Parmar.
"So what the surgeons would have had to have done is re-open the scars and let the pressure escape. Then they would have sewn the leg back up in stages so that it doesn't swell up again. That’s probably why he went back to theatre."
Six months is the standard recovery time for a double fracture like Shaw suffered, which would put him in contention to return for Manchester United by March, although it's unclear how any complications he may have suffered impact upon that. The Express say his spell on the sidelines could extend to a total of nine months.
Since returning to the UK, Shaw has been recovering in a Manchester United hospital, which he was discharged from yesterday. He now faces four weeks in a boot with crutches, and it will be up to eight more weeks before the bone is healed sufficiently to begin the next phase; rehabilitation.
"For the bone to heal it will take about six to eight weeks, and then the same amount of time for the rehabilitation process because he will be quite deconditioned, and the muscles in the leg will be deconditioned," explains Dr. Parmar.
"Then you need to start returning back to impact activity, so you start off on the bike and then in the pool or on an anti-gravity treadmill. Then he’ll be doing full impact running, then sprint work, twist and turns and then sports-specific rehabilitation, so work with a football. Then he’ll be doing controlled training with the team before full training, and all that takes time. But the medical department at Manchester United is world class so he’s in the best hands."
The good news for Shaw is that once back, he's not more at risk of suffering a relapse. But while a clean break like the one suffered by the Manchester United defender is easier to deal with than a broken leg with small fragments of bone, he still isn't out of the woods yet.
Dr. Parmar says: "It’s about making sure the bone heals fully first of all. It may take longer than you might think. If it all goes well - and he’s in the best hands - they’ll monitor the healing process closely and liaise with specialists - then it should be fine.
"But it can be prone to not healing correctly which is called a ‘non-union’ and there can be other complications like infections or compartment syndrome. The immediate post-operative period is the most dangerous in terms of complications. Any problems with delayed healing will only become apparent at about six weeks."
Shaw will hope that he's had more than his fair share of bad luck and embark on a problem-free recovery that will allow him back on the field as soon as possible. Euro 2016 remains a viable target for the England international although Manchester United will not rush him back into action.
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