England have been dealt a hammer blow before the defence of their Six Nations title after it was confirmed that Billy Vunipola has sustained a fractured forearm in yet another injury setback for the No 8.

Vunipola will see a specialist this week to determine a time frame for his return but he is almost certain to miss England’s Six Nations opener on 4 February in Italy and his participation at any stage of the tournament is now in serious doubt.

The 25-year-old was taken off during half-time of Saracens’ Champions Cup draw with Ospreys and afterwards the Saracens assistant coach Alex Sanderson revealed that Vunipola could not feel his wrist. A subsequent x-ray has confirmed the worst and while the recovery time for a fractured forearm can vary greatly, Ireland’s Joey Carbery sustained a similar injury in mid-November and is yet to return.

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It is desperate news for England, with Nathan Hughes also unavailable for at least the first three Six Nations matches with a knee injury, and similarly deflating for Vunipola, who was making just his second appearance after nearly four months out of action with a knee injury that required surgery. He also missed the British & Irish Lions tour last summer with a shoulder injury and has started once for England since the autumn of 2016, having missed the first three matches of the 2017 Six Nations with a knee injury.

Vunipola has been outspoken when discussing the strains put on professional players, saying in September: “I just want people to understand that having surgery is not fun, and it’s not fun being injured. It gets to a point when you are just done.” He was, however, sanguine following his latest setback, posting on social media: “One of these days I might actually be able to play more than two games without breaking (no pun intended).”

Vunipola’s injury also compounds Eddie Jones’s woes in the back row, with Hughes, who has worn the No 8 jersey with distinction over the past 12 months, and Tom Curry also absent through injury. Sam Simmonds, who shone in Exeter’s win against Montpellier on Saturday, is now favourite to start at No 8 in Rome., having done so against Samoa in November

Adding to Jones’s selection headaches is the fact that James Haskell was sent off in the closing stages of Wasps’ defeat by Harlequins for a dangerous tackle in which he floored Jamie Roberts after making contact with the Welshman’s head. He has apologised to Roberts on social media but will face a disciplinary hearing this week and any suspension of three weeks or more will rule him out of facing Italy.