ALTHOUGH PETR CECH LOST consciousness after the blow to his head, first reports suggest that he soon regained consciousness. Even so, no head injury of this sort is trivial.

Head injury is the principle cause of death or long-term disability in 75 per cent of serious accidents to under-35s. When there is serious long-term damage after a head injury, it is usually either because the skull has not only been fractured but that the bones have been knocked out of alignment, there has been splintering of bone and, as a result, a penetrating wound. The other cause of serious brain damage is sudden deceleration.

Those who suffer a depressed fracture from a blunt instrument, such as a boot or elbow, in which the skull bones remain well aligned, not fragmented and with no splinters that have penetrated the brain, usually do well. Even so, a neurosurgeon may have to elevate the fracture, rather as in the same way a depression on a ping-pong ball needs to be elevated. After an injury of this type, scans are essential to make certain that there has been no internal bleeding.

If a depressed fracture is associated with a penetrating injury to the brain, and lacerations and bleeding from its vessels, the surgeon needs to stem any haemorrhage, drain the blood and remove any irretrievably destroyed brain tissue.

Even, as is likely, the fracture in this case was easily elevated and there hasn’t been any bleeding from lacerated vessels, Cech will have to be treated like any other severely concussed patient. For at least 24 hours he will need careful monitoring, with his eye reflexes, his responses to pain and verbal commands regularly tested as well as his blood pressure, pulse rate and temperature being recorded.

Cech is fortunate to have been injured near the Radcliffe Infirmary in Oxford. The neurosurgical unit there has been one of the most respected for more than 60 years. But it is likely to be many weeks before Cech plays again.