It was not the debut that Julius Randle or the Los Angeles Lakers wanted. Instead of celebrating his first NBA game, Randle, the seventh overall pick in the June draft, was carried out of the Staples Center with his worried mother looking over him. The Lakers later confirmed that Randle had fractured his tibia, the larger of the two bones of the lower leg.
The 6'9", 250-pound rookie had high expectations coming into this season, one that may have ended as his leg gave way. The injury mechanism for a fracture like this is unusual in that it is normally a traumatic injury, where the bone itself is overloaded and snaps under the pressure. The extreme, but apt, comparison is to Paul George, who fractured both his tibia and fibula in a freak accident earlier this year after awkwardly landing on the basket stanchion during a U.S. national team exhibition.
Instead, Randle's leg appeared to simply give as he pushed off it going up to the rimmidway through the fourth quarter of L.A.'s season-opening loss to the Rockets. There was some contact in the moments immediately preceding the injury, but none that appeared to have sufficient force to cause a fracture. Randle hopped once on his left leg and went to the ground. It was not immediately clear where on the bone the fracture is, though the ankle shifted as he went up, which is an indication that the fracture is nearer the foot than the knee.
One study done by the Society of American Engineers showed that a normal male tibia fractures under a load of 260 foot-pounds of force. Dr. David Chao, the former team physician for the San Diego Chargers, tweeted that this type of fracture was atypical and "low energy":
Julius Randle @Lakers with likely tibia stress fracture that now is displaced. Will need surgery (rod). Low energy fracture.— David J. Chao, MD (@ProFootballDoc) October 29, 2014
It's easier to understand why George's leg couldn't handle the extreme and unusual loading of his body flying through the air and landing oddly than it is Randle's leg just snapping, which does imply some sort of underlying weakness. However, it does not appear that Randle had any sign of this prior to the injury.
Sources tell me that Randle, 19, had no unusual issues with his lower body during camp and was receiving no special treatments. The team was monitoring the rookie closely, including his previous foot injury, but there was no concern or complaint before Tuesday night's incident. Young players in their first year with an organization are routinely watched more closely as the team and medical staff learn how a player responds to the physical stresses of the game.
While it is likely that Randle's injury is what would commonly be referred to as a stress fracture, it does raise questions that Randle had some sort of weakness leading up to the injury. Randle showed no apparent issue when he came into the game in the first quarter. He ran with no visible limp or gait issues and had no known injury problems during his first training camp.
The likely treatment for this type of fracture is surgical. A metal rod is inserted near the bone and screwed into place to fixate the bone and strengthen it while it heals. In most cases, the rod is left in place and causes no issues in play. The normal rehab for this is around four to six months. Research from Jeff Stotts last year indicated that players missed 22 games on average after similar injuries, though that average would be skewed by longer rehab times last season.
While Randle's mechanism of injury was atypical, the injury itself is not unusual for NBA players. Aside from Paul George, several others have had similar issues. The most similar occurred to Jrue Holiday last season. Holliday missed 48 games after he was diagnosed with a stress fracture in his tibia in January. JaVale McGee also had a tibial stress fracture last season, missing all but five games after he was diagnosed with the issue in November. Manu Ginobli played through an incomplete stress fracture in the Spurs' championship season as well.
Lakers fans might recall that Kobe Bryant missed much of the second half of last season with a tibia fracture, though Bryant's was at the very top of the bone, just below the knee. His tibial plateau fracture was the same bone, but involved a very different mechanism and healing process. Going further back, the Lakers lost another promising player in his rookie season to a fractured tibia, but James Worthy came back pretty well. The old school footage here shows Worthy landing awkwardly after a dunk attempt.
Despite the level of care and the normal healing timeline, there are a few factors that could extend this. NBA teams have shown a high level of conservatism with young players and injuries, such as sitting top picks Nerlens Noel and Anthony Davis well after their normal timelines, as well as an extended absence expected from this year's No. 3 pick, Joel Embiid. The Lakers could simply elect to let Randle "redshirt" his rookie season and come back with a full offseason and camp.
Randle also has a significant medical history. He had a screw put in his foot during his senior year in high school. He had no problems in his year at Kentucky, but reports surfaced that the bone had not healed properly during the leadup to the NBA draft. The Lakers showed no real concern and denied that Randle would need corrective surgery.
If there is any further concern about the foot, now would be a perfect time to go in and have the surgery, putting the healing concurrent to that of his leg. Both injuries are on the right side and have similar timelines, so it wouldn't necessarily slow the progress of either. Again, Randle denied that the foot is a problem.
Assuming the healing time is normal, that there is no involvement of cartilage or other soft tissue and that the foot is not a complicating factor, there is no reason to believe that Julius Randle will have any difficulty returning to his normal level. The injury is painful and disappointing, but there's no impact beyond the immediate.