Bateman, Kikau headline monster casualty ward
John Bateman required a trip to hospital on Sunday night after a heavy head collision with Viliame Kikau resulted in a concussion and suspected fractured eye socket.
The Raiders forward was initially removed from the field for a HIA, and on closer inspection there were real fears for a facial fracture.
After failing the HIA he was quickly taken to hospital for further assessment of his facial injuries.
If a fracture is confirmed, often at least 4 weeks recovery is required for adequate bone healing to allow a safe return to sport. Surgery can be required to insert a plate in order to stabilise the fracture and speed up early healing.
Time on the sideline can be extended to 10-12 weeks if the fracture is severe or requires significant surgery.
Best-case scenario there have been isolated minor eye socket fractures return in 2-3 weeks in the NRL, but with Bateman rushed to the hospital for further assessment of the injury there are certainly concerns for a 4+ week recovery period.
Viliame Kikau came through the collision with Bateman unscathed, but unfortunately was assisted from the field later in the same game with what initially appeared to be an ankle or knee injury.
Kikau appeared to be in considerable pain as he lay on the turf, and even when he was able to be properly assessed in the sheds he was still in so much pain the Panthers medical staff were unable to determine if the injury was to the ankle or knee.
Reviewing the injury video showed Kikau's right leg get caught under the Raiders tacklers, which caused his foot to violently turn/roll out and his knee to collapse medially.
This brings concern for injury to the syndesmosis (high ankle) and the MCL in the knee. Post game Kikau was shown in a moon boot with no brace on his knee, suggesting the concern at this stage is for an ankle injury.
If a medial/high ankle sprain (syndesmosis injury) is confirmed, considering the pain Kikau experienced there would be fears for a moderate to severe ligament injury (grade 2-3). A general recovery guide for high ankle sprains is:
Grade 1: 1-4 weeks
Grade 2: 4-8 weeks
Grade 3: 8-10 weeks
If a fracture is present this can also extend the recovery time beyond 10 weeks.
Staying with syndesmosis injuries, in news that will be encouraging for Viliame Kikau, it was confirmed this week that Daly Cherry-Evans is aiming for a 4-5 week return to play after surgery on a grade 3 syndesmosis injury.
This is an extremely accelerated recovery as most NRL players in the past have required at least 8-10 weeks to return from the same surgery type (tightrope repair of the syndesmosis).
For significant syndesmosis injuries that require surgery (usually due to severe ligament damage), historically this requires the insertion of screws into the joint.
Unfortunately screws present complications to the sporting population, as often (70% of the time) a second surgery is required to remove the screws in the 3-6 month range of recovery.
In recent years a new technique using a "tightrope" and an accelerated rehab protocol has made recovery much quicker (6-10 weeks as opposed to 3-6 months with screws).
The tightrope is a non-absorbable suture (thread/stitch) that is used to stabilise the joint, and it allows for an earlier return to weight bearing, rehab and sport.
Boyd Cordner achieved the quickest recovery from this surgery in recent times, getting back on the field in 7 weeks to play in the 2013 Grand Final.
However Aidan Tolman (10 weeks) and Waqa Blake (12 weeks) both showed last year this can be a difficult injury to return from within 2 months. DCE will take inspiration from Kieran Foran who looks a certainty to return next week in Round 9, 6 weeks after suffering the same syndemosis injury and requiring tightrope surgery.
There have been 2 recent cases in the AFL of players returning in under 6 weeks, so an accelerated return is possible.
With Origin 1 occurring 5.5 weeks post surgery for the Sea Eagles captain, his rehab will have to progress perfectly to allow him to run out for Queensland in the opening game of the series.
In quite the game of injury carnage between the Raiders and the Panthers, Isaah Yeo was also forced from the field early in the first half with a suspected dislocated shoulder.
If this is confirmed a thorough assessment of his shoulder stability will be undertaken by Panthers' medical staff, and scans will be performed to check the severity of damage to the shoulder joint. Recovery time is then heavily based on the level of stability and severity of damage.
If the joint appears stable and there is minimal structural damage, a strengthening rehab can be performed for 3-6 weeks before trialling a return to sport. Surgery is often still required, but can be delayed to the off-season in these cases if the strengthening rehab program is successful in reducing the risk of re-dislocation.
Unfortunately if there is significant instability and structural damage to the shoulder, this often results in a high risk of re-dislocation and further/long term damage to the shoulder joint. In these cases shoulder reconstruction surgery is performed, which usually requires 3-6 months recovery.
Addin Fonua-Blake was restricted to 24 minutes after suffering a suspected meniscus injury early in the first half. In good news for the Sea Eagles, AFB was able to return in the second half with his knee heavily strapped, however coach Des Hasler said post game scans would still be performed to assess the severity of the injury.
The meniscus is cartilage in the knee that provides shock absorption within the joint. The most common rehab options for an injury to this structure are:
- if only a minor meniscus injury that does not block movement in the joint, player may require 1-2 weeks to allow the pain to settle but can play through.
- if there is a tear significant enough to require surgery, keyhole surgery is performed to "trim" the torn meniscus with a 4-6 recovery time.
Players can have more significant surgery to repair rather than remove the torn cartilage, but this is less common during the season as it requires a much longer recovery (3-4 months).
Lachlan Croker "felt a pop" in his hamstring during a run and will also go for scans to determine the severity of the strain. Even the most minor of hamstring issues are difficult to return from within a week, and with a high rate of recurrence (10-30%) it's often an injury that medical staff are conservative with a return to play. General recovery times are:
Grade 1: 2-4 weeks
Grade 2: 4-6 weeks
Grade 3: 6+ weeks
Malakai Watene-Zelezniak failed to finish for the Panthers with a suspected rib injury. If scans show no significant fracture most players are able to return in 1-3 weeks with pain relief/chest guard. If a fracture is present this can require 3-6 weeks before a return is possible to allow for adequate healing.
Jesse Ramien (minor AC joint sprain) and David Fusitu'a (rib cartilage) were both been ruled out of the Knights vs Warriors match. Both issues are mostly pain tolerance related which can limit function, but are unlikely to require extended absences for either player.
Josh McGuire was fired up as he came from the field on Friday night, suffering a suspected calf strain during a straightforward hit up. The good news was he was able to weight bear through his left leg as he came from the field, and was later shown moving quite freely in the sheds. This is usually a sign that the strain is on the minor end of the scale, and coach Paul Green confirmed the initial hope was it wouldn't be an extended recovery for McGuire.
If scans show McGuire has only sustained a grade 1 or 2 calf strain as hoped, the usual recovery range is 1-3 weeks (grade 1) or 3-6 weeks (grade 2). With Origin 1 only 4.5 weeks away, both Cowboys and Queensland fans have their fingers crossed it is the most minor of strains.
Philip Sami was able to play for 40 minutes after suffering a high ankle sprain before eventually coming from the field in the second half. The fact he was able to play on is often a good sign the injury isn't significant, with minor high ankle sprains requiring up to a month on the sideline.
James Maloney's Origin hopes have copped a blow with the NSW incumbent facing a two game suspension.
The out-of-form Penrith five-eighth was hit with two charges out of Saturday's loss to the Raiders.
Maloney was booked for an 11th minute chicken wing on John Bateman (video below) and a 54th minute dangerous throw on Josh Hodgson (video above).
Maloney is under pressure to retain his NSW five-eighth spot following the Panthers' 2-6 start to the season.
Both charges carry maximum suspensions of one game, meaning he faces two games all up.
Maloney would be suspended for one game if he takes the early guilty plea to both charges.
In other judiciary news, Penrith youngster Liam Martin (dangerous throw) is facing a week regardless of plea.
Ben Matulino (dangerous contact) can escape suspension with an early guilty plea.
FULL NRL CASUALTY WARD
Kieran Foran (Ankle, Round 9)
Raymond Faitala-Mariner (Knee, Round 12)
Josh McGuire (Calf, TBC)
Te Maire Martin (Bleed on brain, Indefinite)
Nene MacDonald (Ankle, Round 21-season)
Kyle Feldt (Groin, Indefinite)
Korbin Sims (Arm, Round 10-12)
Gareth Widdop (Shoulder, Round 20)
Jack de Belin (Stood down, Indefinite)
Tim Mannah (Ankle, TBC)
Dylan Brown (Back, Indefinite)
Nathan Brown (Pectoral, Round 14)
Will Smith (Broken arm, Round 10)
Kaysa Pritchard (Personal leave, Indefinite)
Stefano Utoikamanu (Ankle, Round 9)
Slade Griffin (Knee, Indefinite)
Aidan Guerra (Ankle, Round 20-23)
Nathan Ross (Foot, Retired)
Jesse Ramien (Shoulder, TBC)
James Maloney (Facing suspension, TBC)
Liam Martin (Facing suspension, TBC)
Isaah Yeo (Shoulder, TBC)
Viliame Kikau (Knee/ankle, TBC)
Malakai Watene-Zelezniak (Rib cartilage, TBC)
Dean Whare (Hamstring, Round 10-11)
Sam McKendry (Knee, Indefinite)
Tyrone May (Stood Down, Indefinite)
Frank Winterstein (Knee, Round 9-10)
Greg Inglis (Shoulder, Retired)
Adam Doueihi (Knee, Round 10)
Braidon Burns (Hamstring, Round 11)
Cory Denniss (Shoulder, round 20)
John Bateman (Eye socket, TBC)
Joey Leilua (Neck, TBC)
Joseph Tapine (Ankle, Round 17-19)
Jordan Rapana (Ribs, TBC)
Brett Morris (Knee, Round 9)
Ryan Hall (Knee, Round 9)
Jake Friend (Biceps, Round 19-22)
Aaron Woods (Foot, Round 16)
Matt Moylan (Hamstring, Round 10)
Wade Graham (Knee, Round 11-13)
Shaun Johnson (Hamstring, Round 11)
Addin Fonua-Blake (Knee, TBC)
Lachlan Croker (Hamstring, TBC)
Dylan Walker (Stood down, Indefininte)
Tom Trbojevic (Hamstring, Round 12)
Albert Hopoate (ACL, Season)
Daly Cherry-Evans (Ankle, Round 11)
Api Koroisau (Calf, TBC)
Jorge Taufua (Calf, TBC)
Trent Hodkinson (Knee, TBC)
Scott Drinkwater (Pectoral, Round 14)
Tom Eisenhuth (Throat, Indefinite)
Brandon Smith (Calf, TBC)
Josh Aloiai (Concussion, TBC)
Benji Marshall (Hamstring, Round 9)
Chris Lawrence (Broken jaw, Indefinite)
Josh Reynolds (Knee, Round 11)
Michael Chee-Kam (Stood down, Indefinite)
Philip Sami (Ankle, TBC)
Michael Gordon (Concussion, TBC)
Tyrone Roberts (Concussion, TBC)
Nathan Peats (Pectoral, Round 16)
Ryan James (ACL, season)
Dale Copley (Thigh, Round 9-10)
Kodi Nikorima (Calf, TBC)
David Fusitu'a (Ribs, TBC)
Jazz Tevaga (Calf, TBC)