In the midst of one of his best games this season, Buffalo Bills DT Jordan Phillips sacked Dallas Cowboys QB Dak Prescott late in the third quarter and began to celebrate with his teammates. Not drawing attention to his wrist, Phillips realized something was wrong holding his right wrist closer to his side as he walked off celebrating as the punt return unit took the field.
A while later, Phillips would be deemed questionable to return due to a wrist injury, ultimately not finishing the game. Not much was made about the injury until Monday afternoon during the usual press conference. It was announced that Phillips had undergone wrist surgery and was officially week-to-week. This was a stark change in what was perceived as a wrist sprain at the time.
With the various structures in the wrist, it was anyone’s guess as to the exact nature of the injury until Tuesday. Journalist Ryan O’Halloran of The Buffalo News reported that Phillips had dislocated his wrist but that his goal was to be back by the playoffs should they make it.
This was very surprising news all things considered and leads to a lot of questions as to when Phillips will realistically return and what his performance may be like. All those questions will be answered below.
The Anatomy
Evaluating the anatomy of the wrist, the carpals and distal ends of the radius & ulna make up the wrist as you can see in the picture below. There are multiple ligaments and bones in the wrist connecting everything. Clinically significant ones include the scapholunate ligament, the lunotriquetral ligament, & the triangular fibrocartilage complex (TFCC), among others.
Functions of the wrist include flexion, extension, radial and ulnar deviation along with pronation, supination, and grip strength. All important functions are necessary to play football, among other things.
The Injury
Looking below, Phillips gets in the backfield to begin to wrap up Prescott for the sack. As he swings his right arm around, the heel of his hand slams into OT Terence Steele’s right buttocks, knocking him down. Due to Steele falling out of the way, Phillips can finish the tackle and get the sack.
Despite the well-timed pun in the tweet, it’s possible that Phillips did indeed dislocate his wrist when it slammed into Steele. Alternatively, it may have dislocated when the wrist hit the ground on the sack. Considering Steele’s body could have initially absorbed some of the force from Phillips’ arm with the resulting force knocking him down, I’m not sure if there was enough force to cause the dislocation compared to when he hit the ground. Without Phillips clarifying, we are left guessing.
Wrist Dislocations
Wrist dislocations are the result of high-force trauma with the wrist in hyperextension. These can also occur due to a fall on an outstretched hand. Three types of wrist dislocation include:
- Perilunate dislocation- this is when the capitate bone and the distal wrist and hand dislocate as a unit, usually in a dorsal direction or upwards. Imaging will show the capitate bone out of alignment. These are the most common carpal dislocations.
- Lunate dislocation- this is when the lunate bone rotates out of its normal anatomic position. The bone rotates 90 degrees in a volar direction or downward towards the palm. This will show the lunate bone out of alignment.
- Scapholunate dissociation- this is when the injury drives apart the scaphoid and lunate and creates instability within the joint.
Other types of injuries within the area can cause a wrist fracture/dislocation including but not limited to Bennett’s fracture, Galezzi fracture, base of fifth metacarpal fracture, Colles fracture, radial or ulnar styloid fracture, but for the sake of staying focused on Phillips’s injury and what we know, they are not considered.
Surgery
One of the odd things about the injury was the unknown initial need for Phillips to undergo surgery for the wrist injury. Now knowing that it was a wrist dislocation, this was an acute emergency that needed to be addressed immediately.
Had there been a delay in surgery, the median or ulnar nerve could have been further injured as it is compressed when the bone is pushing on the area, causing nerve damage. Avascular necrosis was also at risk in the scaphoid and lunate which is where the bone dies due to poor blood supply, leading to scapholunate advance collapse. Chronic pain, instability, and arthritis would have led to a significant loss of function as a result.
To begin the realignment and surgery, a distraction force is applied to the wrist followed by either flexion or extension based on the type of dislocation. This allows for easier relocation for the bones to slip back into carpal alignment. Once realigned, the use of K-wires, percutaneous pins, or screws are used to help stabilize the area.
Based on the presentation when Phillips was at the hospital, it’s hard to determine the associated structures damaged and surgical approaches. There is also the possibility that a scaphoid fracture was sustained which could have required a pin to stabilize the area in addition to the dislocation. Based on the information we have currently, I am not assuming a fracture occurred.
Return to Play
This is where we have to assume the team is giving us some level of accurate information. Here are the facts that we know:
- The wrist was injured with an axial load with the wrist in hyperextension.
- There was a wrist dislocation that required surgery.
- He is officially week-to-week.
Going off of this information, this narrows down a realistic timeline for Phillips. There is not a ton of literature on returning to sport with football players, but there is some. According to research, roughly four weeks of playing time is lost and four out of five players in the study were able to return within the same season. Granted, this study was completed in 1994 with likely advancements in techniques and timelines, but this was also referenced in 2019 by a group of doctors that included Dr. Leslie Bisson, team physician for the Buffalo Bills.
Another case study revealed a collegiate football player who suffered a wrist dislocation and underwent surgery, returning to play linebacker within three weeks of the injury. Six months following the injury, he had the screws removed.
Looking back at the NFL, Dallas Cowboys LB Sean Lee suffered a dislocated left wrist in 2011 and only missed one game. He didn’t appear to suffer any drop-off in production when looking at his stats from that season.
Scapholunate Dissociation
Had this been a scapholunate dissociation, this would have been a more severe injury with a much longer timeframe.
- We saw this with Kansas City Chiefs LB Nick Bolton who was slated to miss two months this year but missed five games and six weeks due to the bye in the middle.
- Ravens S Marcus Williams suffered a dislocated wrist in 2022 and missed seven games and eight weeks overall as he recovered. It wasn’t defined whether he had surgery, but considering the acute nature, it was very possible.
- St. Louis Rams OT Darrell Williams saw his season end in 2015 due to a left dislocated wrist with associated damage, missing the last seven games of the year.
- Former Arizona Cardinals RB David Johnson suffered a dislocated wrist and missed the remainder of the year after suffering the injury in the first game in 2017.
- Former Denver Broncos EDGE Shane Ray suffered a complex wrist dislocation in 2017 and missed several years of playing before attempting a comeback with the Bills this preseason.
- One final example of the more serious wrist dislocation is former Washington Redskins S Duke Ihenacho suffered a dislocated and fractured wrist, missing the rest of the 2015 season.
I bring up all these examples because they all projected for the player to miss extended time and in the case of Jordan Phillips, the outlook is more positive. This is all with the assumption that the information that they are providing is relatively accurate with the timeline.
Based on the information above from the research, understanding the injury, and reporting from the team, I would expect that Phillips could reasonably miss 2-3 games and return to play with a club.
An injured reserve stint could be in play if they need the roster spot as Brandon Beane was discussing earlier this week.
Update: he was placed on injured reserve on 12/21. He is eligible to return during the divisional playoffs.
They do need to be mindful of roster movement when considering that DT DaQuan Jones has opened his practice window and is slated to return at some point. Currently, the Bills have DT Eli Ankou and DT Andrew Brown as potential practice squad call-ups to fill the needs until Phillips returns.
Despite the club, he could still be relatively effective as a defensive tackle. Remember, he played the last quarter of the season with a torn rotator cuff and labrum where he essentially played with one arm. At one point, he was leaning on people and using his body more than his arms to block and tackle. There doesn’t appear to be any literature supporting an overall decline in the production of play even when returning quickly or in later seasons from what can be found even with more severe injuries.
This was far more severe than originally anticipated but these guys are big and move fast, damage happens when they collide. I hope Jordan Phillips returns quickly and can help the Buffalo Bills make a deep playoff run.
Top Photo Credit: Lauren Leigh Bacho/Getty Images
