Editor’s note: this post originally ran after Blake Geoffrion’s injury on Nov. 10th, 2012 – we’ve republished it today for those who want to know more about what happened to the former Hobey Baker winner, given the bad news – today he told the Montreal Canadiens he plans to retire from professional hockey.

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Update on the update: John Glennon reports that Geoffrion has yet to officially retire.

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November 12th, 2012

Hockey fans filled the Bell Centre last night, eager to see Montreal’s AHL affiliated Hamilton Bulldogs take on the East Division-leading Syracuse crunch. A massive JP Côté hit on Hamilton’s Blake Geoffrion ended with Geoffrion skating off clutching his bleeding face, and later heading to a Montreal hospital for surgical repair of a skull fracture.

Blake Geoffrion arrived in Montreal late last season as part of the deal that sent Hal Gill to Nashville. He played thirteen games with the Habs, and began this season with the Hamilton Bulldogs where he’s managed a decent six points in ten games. Last night’s game in Montreal was a big deal both for Geoffrion, whose hockey heritage has roots with the Canadiens, and for hockey-starved fans. A crowd of over 18,000 showed up to watch Hamilton take on the East division-leading Syracuse Crunch. Slightly past the halfway mark of the first period, Geoffrion was carrying the puck up the boards when Syracuse’s Côté delivered a massive check that launched him into the air.

 

 

Geoffrion didn’t lose his helmet, and got up fairly quickly to skate off the ice. When he did, he was bleeding from the left side of his head. Later came the news that he’d been taken to hospital with non-life-threatening injuries, and that he was undergoing surgery for a head injury. This morning the Canadiens released a statement clarifying that Geoffrion had suffered a depressed skull fracture, and that he was in stable condition in the ICU.

How can a guy wearing a helmet have a depressed skull fracture?

Helmets provide direct physical protection from extracranial injuries (injuries to the outside of the skull). A skate hitting a helmet doesn’t do the same damage as a skate hitting a bare head. Helmets protect against intracranial (brain) injuries by taking a direct impact and spreading it over both the outer plastic surface of the helmet and the inner foam liner. The collapsible liner also allows the head (and thus brain) more time to decelerate, which should reduce the damage a sudden stop causes to the contents of the skull.

So how does Geoffrion end up bleeding and with a fractured skull if his helmet never left his head? Geoffrion looks to have come down hard on the left side of his head. When 191 pounds of hockey player goes up, it must come down. Coming down on your feet, back, or side is one thing. When all that weight comes down on your head you’ve got a variety of possible problems. A blow directly to the top of the head (an axial load) can cause vertebral compression fractures (remember the Mason Raymond injury?). A blow on the edge of the helmet (like on the side of the head) doesn’t allow the surface of the helmet to absorb the impact. All that force is directed to just the edge. Just under the edge is a lot of important stuff, like the skull, the brain, the blood vessels that supply the skull and the brain, etc. Applying a huge force to a small area with that much important stuff generally doesn’t end well.

Speculation

Blake Geoffrion obviously hit his head on the ice. It also looks like he may have hit his head on the boards on the way down, and possibly that Côté’s skate hit him once (maybe twice) in the face. None of that is fact. That’s all information gleaned from multiple views of several less-than-great quality YouTube videos, and frankly it’s irrelevant. While any or all of those possible injuries could cause a laceration, a skull fracture, or a laceration and a skull fracture, we know everything we need from the official press release. Depressed skull, surgery, out indefinitely, complete recovery expected.

What do you do with a depressed skull fracture?

Surprisingly, sometimes you do absolutely nothing. A depressed skull fracture is exactly what it sounds like – a break in the skull that’s displaced inwards. If the fracture isn’t too badly displaced and hasn’t injured any underlying structures, they’re sometimes left alone to heal on their own.

:( indeed.

A surgical repair is a must when the fracture fragment is depressed by more than the thickness of the skull itself, if there’s any pressure effect on or damage to the brain or other tissues underneath, if there’s a CSF (cerebrospinal fluid) leak, or if there’s a laceration in the scalp overlying the fracture. If none of those conditions are met these fractures are sometimes repaired for purely cosmetic reasons (nobody wants a giant forehead dent). Early repair is the key to avoiding infection, and that was evident in the fact that Geoffrion was in the OR shortly after his injury.

So how exactly do you fix these things?

You find a neurosurgeon. You go to the OR with that neurosurgeon, and he or she does some neurosurgical magic (there’s a reason their residency lasts approximately forever). The scalp is opened, and the fracture fragments are removed and allowed to soak in an antibiotic solution. The underlying area is carefully inspected, and any damage to the dura (the covering over the brain) is repaired. The vasculature is also inspected and repaired, because once the bone pieces are back in place the skull once again becomes a closed system, so any bleeding could quickly lead to increased intracranial pressure (which is really, really bad). If the fractured bone is in fragments, it’s reassembled with wires or plates. If it’s too badly damaged to be replaced, titanium mesh or acrylic plates can be used to cover the hole in the skull.

What next?

Depending on how bad the fracture is, and how bad the wound is contaminated, serial CT scans might be performed for a few months after surgery to ensure there’s no brain abscess forming. The likelihood of complications is related to how quickly the injury was identified and repaired (quickly, in this case), if there was an extended loss of consciousness (reminder: Geoffrion skated off the ice), and how bad the area under the fracture was damaged (no idea).

While bone itself heals in four to six weeks, the determinant on how quickly this injury heals is whether there’s any associated brain injury. If you hit your head hard enough to break it, chances are you probably also have a concussion at the very least. Geoffrion is out indefinitely because there’s no way to tell right away what the extent of his injury really is. Unlike intracranial pathology that would show up on a CT scan (like a brain bleed), concussions are insidious little jerks that make themselves known by making their victims feel like utter crap, especially when they try to exert themselves. The fact that the Canadiens have said Geoffrion will make a complete recovery is outstanding, and suggestive of there having been few complications.

Remember Ben Fanelli?

In 2009, Ben Fanelli of the OHL’s Kitchener Rangers was checked into the boards by Michael Liambas of the Erie Otters. Fanelli was knocked unconscious and airlifted to hospital, where he was found to have skull and facial fractures. Fanelli is not only back playing with Kitchener, he heads up Headstrong: Fanelli 4 Brain Injury Awareness which in cooperation with the Brain Injury Association of Canada aims to improve awareness of brain injuries in sports. That’s pretty damn cool.

 

You can follow Blake Geoffrion and Ben Fanelli on twitter! Funsies!