Week 11 Bills Injury Review- Dolphins

How severe is Nsekhe’s injury?

Another week, another win. The Bills move to 7-3 on the season with a convincing win over the Miami Dolphins in Miami Sunday afternoon. This is the best start for the Bills since 1999 & 10th time in franchise history that they started 7-3, all previous Bills teams made the playoffs with varying degrees of success. While the Bills are continuing to march towards the postseason, they will be without a key contributor moving forward. This & other injuries will be detailed below. 

WR Isaiah McKenzie (left knee)

McKenzie suffered a left knee injury when he caught a pass going out of bounds with :55 left in the 2nd quarter. CB Nik Needham was close by but unable to break up the pass, instead falling & hitting McKenzie’s lower leg. It appeared to hyperflex his left knee, causing McKenzie to get up & limp off the field. 

Thankfully this was close to halftime where he was able to get some rest & get a quick assessment to ensure he could play in the 2nd half. This injury appeared to be minor & is not something I expect him to show up on the injury report with later this week.

S Siran Neal (concussion)

Neal suffered a concussion midway through the 2nd quarter on the kickoff with 7:41 left following Hauschka’s FG. Unfortunately, the video is not available yet as there was a touchback & the camera followed the ball & not the players. It was reported he was shaken up on the play, but once All-22 comes out, we may get a clearer view of what exactly happened. Neal enters the concussion protocol with no guarantee he is cleared for next Sunday. 

OT Ty Nsekhe (right ankle)

Nsekhe suffered a rather severe right ankle injury with 9:14 left in the 3rd quarter. This was a routine run play by Singletary up the middle when Nsekhe’s foot was caught from behind by Dolphins DE Avery Moss, landing on the back on Nsekhe’s heel, forcing the ankle to roll under the big man violently before his body caught up & he falls down in obvious pain. 

He was immediately placed into in an air cast & carted off, waving to fans but in significant discomfort. The result: a likely ankle dislocation with fibula fracture. There is a concern that he suffered a tibia fracture as well, but he may have spared the more significant bone due to the ankle rolling as much as it did before he fell over. 

300px-Fibula_Fracture
Credit: physio-pedia.com

According to Monday’s press conference, more tests were being performed on Nsekhe’s ankle with no definitive answer at this time. 

This could be for several reasons: 

  • The swelling may have been so great that imaging did not show the true extent of the damage.
  • There isn’t an actual break but significant ligament damage on the lateral portion of the ankle.
  • The Bills know exactly what is going on (they likely do) & are sitting on the info because they have no reason to release it until they feel they’re ready or can sign someone to replace his roster spot. 
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Credit: physiodirectnz.com

Looking at an alternative video angle from Thad Brown, there is the possibility that Nsekhe avoided a break but dealing with quite a severe inversion ankle sprain. He would have injured the anterior talofibular & calcaneofibular ligaments when Moss landed on his ankle. There is a slight chance he avoided a fracture due to observing the heel sliding out, relieving pressure off the fibula as he went down. 

The sheer fact that he was placed into an air cast & carted off without the ability to place weight through his leg isn’t ideal. His season is possibly done, heading to IR for surgery & rehab if my original suspicions are confirmed. I am not certain but if you go on NFL Gamepass & watch the replay, it appears as though the snap of the bone is audible. I’ve played it multiple times in a row. 

This may be a similar injury to what LB Matt Milano suffered last season. if so, a recovery timeline for Nsekhe would be 6-9 months with my guess being closer to 8-9 months. There are several factors including: 

  • Nsekhe is 34 years old, Milano was 24 during his injury.
  • Nsekhe is 6’8”, 325 lbs. Milano is 6’0”, 225 lbs. 
  • Nsekhe’s bones are thicker & are required to accept more weight than Milano’s, requiring a longer healing time & associated recovery.

While 34 is still a youthful age, it is getting up there when it comes to the NFL. Nsekhe can & should make a full recovery, but considering the mileage on his body, it’ll be interesting to see whether he is able to return to full form in order to compete for a roster spot next year. He should be close to, if not fully ready for training camp & should be able to participate in OTA’s in 2020. He is clearly a talented player, the Bills have him under contract for another year, it may come down to how he looks in camp.

For the interim, OT Cody Ford slides into the starting role he has alternated with Nsekhe all season. OT Ryan Bates will likely move to back Ford up. Once Nsekhe moves to IR, the team may elect to fill his roster spot with practice squad players OT Brandon Hitner or OT Victor Salako. The other option is to find a street free agent or another player off another team’s practice squad. Either way, GM Brandon Beane already has a preliminary plan in place. 

Other observations from today’s game injury-wise include noting Nsekhe’s replacement OT Cody Ford is still wearing a hinged elbow brace with a compression sleeve on the left elbow from the injury in the Eagles game. Each week he wears this brace further confirms that he suffered some type of injury to the UCL ligament in the right elbow & the brace provides protection as the ligament heals. 

Other injury news to note is that DE Jerry Hughes was active & played his usual snap count, highest among the DL group. I had originally stated that Hughes would miss the game & I was wrong. While I did not observe every single snap, he did not appear to be compensating or limited. This also creates the thought that the team is not sold on rookie DE Darryl Johnson. While no one expects that Johnson can be an effective player such as Hughes, it shows that an injured Hughes is still better than a healthy Johnson. 

The loss is Nsekhe is going to hurt. While he is older, he showed the ability to play very well with the offensive unit. Ford is able to step in & contribute, but his play has been marred by penalties & inconsistent play. He will suffice, but the quality of play at the position will suffer. However, the Bills are 7-3 & even with a 3-3 finish to the season will give the Bills double-digit wins for the first time this millennium. The Bills are still very much in control of their destiny & can make noise in the playoffs if they played like they did Sunday.

Author: Dr. Trimble

My name is Dr. Kyle Trimble and I am, first and foremost, a Buffalo Bills fan!! When I am not cheering on the Buffalo Bills, I am a Physical Therapist. To give a background on myself; I was born and raised in Erie, PA, moved to Buffalo in 2006 to begin my studies at D'Youville College towards becoming a Physical Therapist at which time I became a devoted Buffalo Bills fan.  I graduated in 2013 with my Doctorate in Physical Therapy and moved home for several years. Moving back to the Buffalo area in 2016, I have gained extensive experience in outpatient orthopedics, skilled nursing, acute care hospital, and home care. Having obtained a significant wealth of knowledge that continues to grow, along with a undying fandom of the Bills, puts me in the unique position to educate my fellow fans about our great team. 
I am currently an injury spotter working with Dr. David Chao, Orthopedic Surgeon @ProFootballDoc based out of San Diego. In this role, I provide real time updates regarding injuries during the game. I hope you enjoy what I publish and I welcome any comments or questions you may have.
Disclaimer: My opinions are my own.  Any thoughts I have on the injuries is based on media reports, my knowledge of the injury, and speculation based on the information currently available.