Despite the historic temper, France is shaking and the phones of maxillofacial surgeons are vibrating everywhere. In order to know what sauce Antoine Dupont will be eaten with, unfortunate victim of a heavy tampon, Thursday evening, during the match against Namibia, and suffering according to the latest news from a “maxillo-zygomatic” fracture, we contacted one of the specialists in the discipline, Doctor Cédric Hardy, from the Aquitain Center for Maxillofacial Surgery.
If he takes all the usual precautions that prevail in this case, not having been able to examine the captain of the XV of France himself, in tears Thursday evening after leaving the field, there remains no less pessimistic about the player’s return in the coming weeks.
First of all, what is a maxillozygomatic fracture?
It’s a fracture of the cheekbone, the bone that we feel under the eye. It’s a fracture of what we call the zygoma.
Is this an injury that you are familiar with?
Yes, absolutely. We work in a region of Ovalie and we are regularly confronted with these types of injuries. We receive a lot of amateur and professional players who have suffered the same type of fractures, it is unfortunately quite common among rugby players.
As a specialist, when you see the shock live, what do you say to yourself? Ouch?
Yes, that’s exactly it, we say ouch! We had the same fear for Jonathan Danty, remember, against the South Africans in Marseille (fracture of the orbital floor, last November 22, in Marseille). Same type of high kinetic impact, and therefore same fear. Even if they are high-level athletes, they are strong guys and they do not have the same physiology as us, automatically, on a zygomatic bone, we say to ourselves that there is something that must have broken or, at least, crack. This will be the real work of Professor Lauwers’ team in Toulouse – which has a great team -, namely to assess whether the fracture is displaced and whether there is a need for intervention, or not. What if there was an extension of the fracture to the bone below the eye socket? All this will condition the player’s recovery.
If we understand correctly, we are not yet talking about an operation but about additional tests, once the hematoma has resolved, in order to know whether we need to operate or not, right?
Professor Lauwers will see him clinically, he will see the images, and it is the scanner which gives us the diagnosis. Then, three possibilities. The first is that there is a fracture but it is not displaced, in this case surgery is not necessary, we let the bone consolidate on its own. But we are still talking about six weeks minimum. Second option: It’s inappropriate. But there are movements which allow us, through external maneuvers, to reduce the fracture by replacing the bone in the correct position, and by doing that, it holds itself together. This allows us to correctly position the malar (the zygomatic bone) but not to have to make large openings and not to put material, what we call osteosynthesis, that is to say plates and screws to fix the bone, which remains a comfortable option. Even if, there, it’s almost eight weeks without contact. And so the last option, the worst, is that there is a fracture that has shifted and is unstable. In this case we have to go through plates and screws in order to reposition the bone.
And there?
And there it’s a minimum of eight weeks, not to mention that the equipment then has to be removed, because rugby players are exposed to a greater risk of new fracture than the general population.
So we have the feeling that it’s going to be long in any case…
Unfortunately yes. The only element that could be positive for a return to competition is that it is a non-displaced crack and that in four weeks we can validate his return to the field. But, despite everything, this type of impact will almost inevitably have consequences in its capacities of engagement, to make contact. He took a huge toll, we all saw it, and returning to competition at this level of intensity can have a significant psychological impact, even though Antoine Dupont is tough and strong in the head. The body remembers it, the head too. This is what players almost systematically tell me after such an injury, it’s always complicated to go back into battle without the slightest apprehension.
The staff was still talking this morning about a form of hope, of possibilities “ good news » in the next 48 to 72 hours, once the hematoma has resolved. So the idea is to wait for the hematoma to disappear in order to make a definitive diagnosis and therefore an action plan?
I honestly think they already have it with the imagery. The rest has more to do with things of the order of refining, on the general examination of the bone, to be able to examine it and to press on the fragments without hurting it too much, in order to feel, with the finger , the movement of fractures. But the scan he had to take already gives the diagnosis.
Can wearing a mask be useful?
It can be more from a psychological than a mechanical point of view. And it can only be useful in the case of a non-displaced fracture, which can reconsolidate in four weeks. It would mainly allow him to be reassured, but no more. The only way to protect a player with such an injury would be an NFL-style full-face mask, which is not allowed. This matter seems really compromised to me.
The difficulty is to assess the risk to the player’s health in the long term. The desire and motivation will be there, it’s the meeting of a lifetime, he’s at the peak of his career, but if we put him back on the field too quickly, won’t we does not pose an additional risk? Antoine Dupont is a competitor, and as is often the case with them, especially in such an event as a Rugby World Cup, he will avoid the risk to be back as quickly as possible . It will therefore be the role of the surgeon and his team to assess the benefit/risk balance and to discuss it with the player. Each time, we can choose the type of care according to each patient, their interests, their desires. In the end there will be a real discussion to weigh the pros and cons.
Especially since the probabilities of receiving a new shock in the same place, if he returns in the quarter-final or semi-final…
[Il coupe] Are obviously high.
And in this scenario, are we talking about even greater dangers, particularly from a vision point of view?
That’s exactly it, the real subject is the orbit, it’s the eye. The orbital floor is just behind this bone and is often fractured. It is a kind of eggshell, so it is in turn fractured by repercussion. The shock wave, by moving the cheekbone, will fracture this small bone and it must be reconstructed, otherwise we may have problems with 3D vision, with what we call dystopias. A drop in one eye relative to the other inevitably has consequences. We must therefore take a long-term view. There is this World Cup deadline, but you also have to think about your entire career behind it. It is the role of the medical staff to discuss with the player and the staff of the France team, in order to make the best decision.