When Atlanta Braves first baseman Freddie Freeman left the May 17 game against the Toronto Blue Jays immediately after being hit on the wrist by an Aaron Loup 94 mph fastball, fans collectively held their breath.
After all, Freeman had been off to a hot start this season, so hot that at the time of his injury, he led the National League in home runs and ranked in the top five in four other hitting categories (runs scored, extra base hits, on-base percentage and slugging percentage). When news emerged that Freeman had fractured his wrist and would miss approximately 10 weeks, the fan base's much-hoped-for exhale of relief instead resembled more of an anguished slow leak from a tire, one that will need to be patched until Freeman is able to return.
Once the injury was defined, the big question became what to expect in terms of Freeman's recovery and return. Could he truly return to his prior level of function this season? And, could he do it in under three months?
Breaking the 'best possible' wrist bone
It always helps to start with the positives. First, no surgery is required. As the Braves noted in their news release, Freeman suffered a non-displaced fracture. Despite reports of the bone being broken in seven places, the term non-displaced indicates all fragments are aligned in proper position. Casting the wrist helps to prevent movement, and should allow for proper healing.
Although the Braves have not specified which bone was fractured, video replay of the injury shows Freeman is hit just as his wrists turn over when he swings the bat. At the moment of contact, the small bones of the wrist positioned between the inner (medial or ulnar) aspect of his forearm and the long bones of the hand are exposed. These small wrist (carpal) bones are surrounded by various soft tissue structures, primarily ligaments that interconnect the carpal bones and tendons that control movements of the wrist.
As Freeman noted, he was told by orthopedic hand surgeon Dr. Gary Lourie that of the eight bones in the wrist, he had broken the "best possible one." Ligaments in the area help stabilize the joint, thus eliminating the need for surgery in some cases, including Freeman's.
Another important structure in the area is the ulnar nerve, the nerve that sends the signals controlling sensation and muscle firing on the medial side of the hand. Had Freeman's fracture been displaced, such that some of the bone fragments moved out of alignment, the nerve could have potentially been compromised. The fact that surgery was not required in Freeman's case is a positive sign that the nerve was not involved.
The course of treatment is to initially cast the fracture site to allow the bones to heal. Freeman appeared at a news conference with his immobilization device on display, an emerald green short-arm cast running from his elbow to his wrist with an extension over the fourth and fifth fingers to keep them from bending and tugging at the fracture site. The design of the cast allows Freeman the use of certain fingers, but limits those that would pull on the area that must be kept still in order for the bones to remain in position.
The Braves stated Freeman will be in the cast for four weeks. Normally, imaging is conducted intermittently along the way to ensure healing is going as planned.
Then comes the fun part.
Rehabbing the wrist
After a period of immobilization to protect the bone, the process of regaining full range of motion and strength begins in order to eventually be able to grip and swing the bat. Not only is grip strength going to be challenged after the muscles have been on hiatus, but rolling over of the wrist to allow a natural swing will take work. The lack of movement is critical in the early days post-fracture to keep the bony fragments in alignment until they can heal. But that immobility results in soft tissues becoming stiff and tight, making it more difficult to then regain the motion necessary to function properly as a hitter. At age 27, Freeman is certainly capable of getting back to his prior form ... but when?
The Braves have projected an absence of approximately 10 weeks; if the healing process goes smoothly, this is a reasonable expectation. But will he be the Freeman who was having perhaps the best start to a season ever following a career year?
It certainly doesn't seem fair to expect him to vault back to that level of play immediately, given the typical ramp-up time to restore power commonly seen following wrist and hand injuries. Such ailments are not uncommon in baseball, and while the particular mechanism and location combination of Freeman's injury are unique, it doesn't mean there aren't reasonable comparisons to be made.
One particular wrist bone injury that is common in baseball -- common enough to provide data sampling -- is the hamate fracture. Most hamate fractures occur at a portion of the bone called the hook, and treatment involves surgical removal of the broken fragment. Despite the surgical approach for treating a hamate fracture, the remaining course of treatment is fairly similar to that in Freeman's case: Restore range of motion and strength to the point where swinging the bat is no longer an issue.
Most baseball players who sustain hamate fractures will miss between six to eight weeks of action, but their absence from the favored stats categories extends even longer. According to an article on beyondtheboxscore.com looking at return to power following hamate fracture, most baseball players in the study were able to ultimately return to their prior numbers post-injury. The catch? It took nearly a full season of at-bats for them to do so, an eternity in the world of baseball.
What to expect this season and next
It is often the case for players coming off an injury such as this one that they return to their numbers in a gradual fashion. Just as it's unfair to assume a player will return to action precisely where he left off, so is it to write someone off completely because of his injury. It's often the case that a player improves as he returns to play at the highest level of competition. Repetition of motion, progressive strengthening and translation to baseball activity are all ultimately part of the final phase of rehab that can only take place on the field.
Freeman is in the early stages of his recovery, but it will be interesting to see what the rest of 2017 has in store for him. After all, he missed 44 games in 2015 because of a right wrist problem, yet returned in 2016 to produce career numbers, despite a slow start. Freeman admitted that it took nearly seven months for the pain to go away with that condition, and it showed. With this latest injury, the diagnosis is clearer as is the treatment; presumably the pain will resolve more quickly as well.
Regardless of what he is able to do to round out the 2017 season following his return, Freeman may be even more productive next year, as he may just be hitting his stride. If history repeats itself, everyone had better be on the lookout for Freeman in 2018.