England's scrum-half Alex Mitchell has been ruled out of the remainder of the Six Nations with a hamstring injury sustained during Saturday's 42-21 defeat to Ireland. The Northampton star had started England's last 10 Six Nations matches and was head coach Steve Borthwick's preferred number nine heading into the tournament.

Mitchell's absence leaves England scrambling for options at scrum-half, with Leicester's Jack van Poortvliet replacing him off the bench in the 24th minute against Ireland. Bath's Ben Spencer and Sale's Raffi Quirke, who has been called up as additional cover, are now in contention to start against Italy on March 7th. The injury raises the prospect of an entirely new half-back partnership, with George Ford coming under pressure from fly-half rival Fin Smith.

England entered the tournament with high hopes after 11 successive victories but now face Italy in Rome attempting to regain stability rather than challenge for silverware. The Azzurri have enjoyed an impressive campaign, beating Scotland and pushing Ireland and France hard in defeat. England have won all 32 previous meetings with Italy, but Mitchell's absence adds another layer of uncertainty to their faltering Six Nations campaign.