Fantasy football injury analysis from a certified athletic trainer

Dez Bryant

The most costly Week 1 injury likely occurred in Dallas when Bryant suffered a broken foot during the team's comeback win over the Giants. The injury was diagnosed as a fifth metatarsal fracture and surgery was performed late Monday evening.

However, the precedent set by other wideouts who have suffered the injury creates a bleak outlook for Bryant's recovery.

The metatarsals are the long bones that make up the length of the foot and bridge the tarsal bones of the midfoot to the individual bones of the toe. The fifth metatarsal sits on the outside of the foot at the base of the fifth toe, better known as the pinkie toe. The fifth metatarsal serves as an anchor for multiple muscles, including the tendons of the muscles responsible for moving the foot up and down.

Fifth metatarsal injuries can occur in multiple locations in a variety of ways. The aforementioned tendons can lead to avulsion fractures if they forcibly pull away a piece of bone. Stress fractures in the fifth metatarsal may also occur though these usually occur in the diaphysis, or shaft of the bone. The most serious of these breaks occurs when the proximal end (base) of the fracture breaks.

Bryant's injury, known as a Jones fracture, is difficult to manage because there is a minimal amount of blood in the area. As a result, medical personnel generally opt to treat a Jones fractures surgically to better reduce the odds of a delayed union or nonunion.

Regardless of location, surgery is far from a guarantee and the likelihood of a re-fracture or a follow-up surgery is surprisingly high. Problems following surgery generally are associated with the surgical hardware as the screw or pin can bend, fail or even break.

Jones fractures have gained notoriety in professional sports in the last year, largely in part to NBA All-Star Kevin Durant's well-documented struggles with the injury. Durant suffered the injury in preseason and has since undergone three surgeries, including a bone graft. While the injury appears more frequently in the NBA, NFL players including several notable receivers have endured the ailment. Atlanta's Julio Jones, Cincinnati's Marvin Jones and former Giants receiver Hakeem Nicks missed time with the injury the last few years.

Julio Jones broke his left fifth metatarsal during the 2011 scouting combine and wasn't cleared to run until 10 weeks after surgery. The foot was a non-factor for his first two seasons in the NFL, but his 2013 season ended after Week 5 when he re-broke the area and underwent a second surgery. Nicks broke his foot during OTA's in late May 2012 and spent the next 13 weeks recovering before returning for the final preseason game. Unfortunately, even then his foot remained an issue throughout the year, limiting his snaps in practice and games. Last season, Marvin Jones missed the entire year after suffering a fifth metatarsal fracture in preseason. (However, it is worth noting that Jones' return was complicated by an additional ankle injury that required another arthroscopic procedure.) More recently, rookie receiver DeVante Parker missed nearly three months of activity after the Dolphins opted to send him under the knife to address a hardware issue with a fifth metatarsal fracture repaired in college.

Looking at these players as well as others to suffer fifth metatarsal fractures, including Ahmad Bradshaw and Aaron Rodgers, it's hard to imagine a scenario where Bryant is back in the four-to-six week window that's been reported. Rushing things would only increase the risk involved especially when you factor in Bryant's surgically-repaired right fibula and his recent hamstring woes. He's too valuable to outright drop, but expecting him to be back quickly is not advised. Tight end Jason Witten and receiver Terrance Williams should benefit the most from Bryant's absence, though quarterback Tony Romo's value takes a hit.

Turf Burns

Andre Ellington: The Cardinals' running back suffered a posterior cruciate ligament (PCL) sprain in his right knee and could be shelved for multiple weeks. Not as well-known as its counterpart, the ACL, the stronger PCL sits behind the ACL and aids in knee stability. The ligament serves as the main axis for knee rotation and as a result must be stable to allow complete motion through the joint. Ellington's injury is considered minor, meaning the damage was limited to the microfibers of the connective tissue. Surgery will not be warranted and the Cardinals medical staff will focus on limiting the associated symptoms like pain and swelling. The injury allows an opportunity for veteran Chris Johnson to show if he has any fuel left in the tank this week against a Bears team that surrendered 133 yards against Green Bay in Week 1.

Mike Evans: The Buccaneers hoped Evans would play in Week 1, but his balky hamstring prevented him from dressing. The second-year receiver suffered a hamstring strain during preseason, and it was believed a conservative approach to treatment would allow him to be ready to start the regular season. That hasn't been the case, and the Bucs have already begun to speculate about a Week 2 absence, as well. Watch this situation throughout the week but make sure you have an insurance option readily available.

T.Y. Hilton: Another elite receiver went down in Week 1 as Hilton limped off the field with a knee injury. An MRI revealed all ligaments intact and Hilton was diagnosed with a knee bruise. While the severity of the injury has to be considered a win for the Colts, it could still cost him a week or two. Knee bruises can take a while to heal as the biomechanics of the joint are counterproductive to healing. When the kneecap bends it comes in contact with the bones of the lower leg, putting stress on and through the patella. Hilton admitted the joint had significant swelling and his availability for Week 2 is in doubt. Indianapolis plays on Monday Night Football this week, giving Hilton an extra day for treatment, though it also puts fantasy owners in a tight spot. If Hilton does miss time, second-year receiver Donte Moncrief likely will line up alongside veteran Andre Johnson with rookie Phillip Dorsett seeing more opportunities, as well.

DeSean Jackson: The Redskins' receiver will miss at least three weeks recovering from a moderate hamstring injury. Given the estimated time of recovery, it seems likely the injury was a Grade 2 hamstring strain. These types of injuries can take even longer to heal and can prove difficult to manage for a receiver dependent on his speed. Receivers Pierre Garcon and Andre Roberts as well as tight end Jordan Reed should see their roles expand but none are overly impressive.

Delanie Walker: Walker suffered an undisclosed hand injury in the team's win over the Buccaneers after hitting it on an opponent's helmet. The Titans ruled out a possible fracture, and coach Ken Whisenhunt expressed optimism about his Week 2 chances. He's day-to-day.

Stotts works as a Certified Athletic Trainer (MAT, ATC, PES, CES) and is a former winner of the Best Fantasy Football Article from the Fantasy Sports Trade Association.

Follow @RotowireATC on Twitter.

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