ANATOMY OF A BAD BREAK : Bone in Dravecky’s Left Arm Was Weakened by Operation

His first comeback has been called a miracle. Will there be a second miracle for Dave Dravecky?

That’s what some orthopedic specialists and other doctors think the 33-year-old left-hander for the San Francisco Giants will need to return to the mound, after suffering a broken bone in his throwing arm Tuesday night in a game at Montreal.

That was the fifth time that Dravecky had pitched since his seemingly impossible return to baseball after recovering from a rare form of muscle cancer, which nearly destroyed his pitching arm last year. But it was only his second start since rejoining the Giants last week after a rehabilitation stint in the minors.

After the operation last fall, doctors gave him virtually no hope of ever playing ball again, except maybe with his kids in the back yard.

The left-hander was warned that the particular type of operation required to remove the cancerous tumor would render his arm fragile and susceptible to fracture. But he came back anyway.

Now Dravecky has entered something of a medical no-man’s-land.

“We’re basically in uncharted territory here,” said Robert Chandler, an orthopedic surgeon in Los Angeles.

Dravecky is certainly not the first major league player to come back from a severe arm injury. One of the most famous cases involved Ted Williams, the Boston Red Sox star who suffered a shattered elbow in the 1950 All-Star game and made it back to the playing field. Another medical miracle involved the rebuilding of Tommy John’s pitching arm.

But few pitchers have ever had serious fractures in their pitching arms, and the Giants seem to have a disproportionate share of them. Terry Mulholland, another San Francisco pitcher, was put on the 60-day disabled list last August when his left forearm was broken by a line drive.

There are few cases of major league pitchers making comebacks from broken arms, simply because so few suffer fractures in the first place.

“Major league pitchers simply don’t break their arms,” said Chandler, a surgeon at the Kerlan-Jobe Orthopedic Clinic in Inglewood, one of the country’s leading sports-medicine facilities. “Guys come in all the time with broken arms they get playing ball in the back yard. But major league pitchers don’t. Their bones are too well-conditioned.”

When doctors discovered that Dravecky had cancer, they warned him that he had little, if any, chance of resuming a career in the majors.

The problem was not the cancer alone, but the operation as well.

The form of cancer that struck Dravecky in the biceps of his pitching arm was a malignancy known as a “desmoid tumor” or “aggressive fibromatosis.”

Basically, according to physicians, it is a nearly benign form of cancer called a “low-grade malignant tumor,” which typically does not metastasize--spread to other parts of the body--but in many instances, somewhere between 30% and 70% of cases, recurs in the spot where it developed.

Dravecky returned to his home state, Ohio, for the surgery.

There, a Cleveland orthopedic cancer surgeon in one of the state’s largest and most highly respected medical practices set about removing the growth, which had grown to about half the size of a golf ball, only months after Dravecky and his wife had noticed it. They had assumed it was scar tissue left over from earlier surgery to correct arm problems.

According to Donald Morton, a UCLA surgeon and cancer specialist, the typical surgery involves removing the cancer, along with some of the surrounding muscle tissue and even a portion of the adjoining bone. The missing bone is then replaced with a type of cement.

Although Dr. George F. Muschler of the Cleveland Clinic removed some muscle tissue surgically, he did not cut out any bone. Rather, in a seven-hour operation, he used cryosurgery, a method of freezing malignant tissue so that it is destroyed.

Essentially, Muschler said, he had to freeze enough bone tissue adjacent to the muscle, destroying some cells, that the bone itself would surely be somewhat weakened.

Muschler said he had discussed the matter with Dravecky, warning the pitcher that for at least two years after the operation last Oct. 7, the bone would be susceptible to fracture.

But in some ways Muschler thought that was the least of the pitcher’s worries, for half of the deltoid muscle had been removed from the biceps, slightly below the shoulder. And that is a key muscle in lowering the arm, a motion that no pitcher can live without.

Though many fans were stunned by Dravecky’s latest injury, his physicians were relieved that it was no worse than it was.

The worst experts had envisioned when they saw the ballplayer slump to the ground on the pitcher’s mound Tuesday night was a career-ending tear of the shoulder muscle.

“I don’t want to understate the seriousness of this,” said Gordon Campbell of Palo Alto, a team physician for the Giants. “It’s bad. But I know Dave and I know the condition of his arm, and the two are compatible with returning next year.”

As it is, the early prognosis was that he would be able to begin rehabilitation again in six weeks, with the humerus bone in the upper arm healing fully early next year.

Asked at a press news conference if he thought he could pitch in the majors again, Dravecky, his arm in a padded sling, responded, said, “Only God can answer that question. But I hope so.”