The Spaniard defeated Italy’s Fabio Fognini 2-6, 6-4, 6-2, 6-1 but only after suffering a bizarre self inflicted injury when leading 3-0 in the fourth set.

The four time champion, and holder of a men’s record 22 Grand Slam titles, was hurt when his racquet bounced back off the court as he stretched for a ball, hitting him squarely on the nose.

The 36 year old dropped his racquet to the Arthur Ashe Stadium floor and sprinted to the sidelines, where he lay on his back with his nose bloodied.

The Australian and French Open champion required a medical timeout to have the wound tended before resuming the match with a bandage across the bridge of his nose.

It was the third time in the match that the trainer had been summoned onto court.

“I was a little bit dizzy and it was a little bit painful,” admitted Nadal, who said he had suffered a similar injury in the past caused by a golf club.

He feared he had broken his nose in the incident.

Nadal said that despite being a set and 4-2 down, he was happy to have recovered after coming into the tournament still worried by the abdominal injury he suffered at Wimbledon.

That problem caused him to forfeit his semi final at the All England Club against Nick Kyrgios.

It also came in a year which has seen him suffer a fractured rib and have to play the entire French Open with pain killing injections in his left foot.

“I had to play better. It was one of the worst starts ever for me in my career,” he said.

Nadal also admitted his concerns over his wife Mery Perello due to give birth to the couple’s first child in the coming weeks.

Spanish media reports claimed she had been admitted to hospital as a precautionary measure.

“My wife is fine, but in the end, these are situations that are sometimes more difficult to manage when you are away from home,” said Nadal.

Nadal goes on to face France’s Richard Gasquet, against whom he boasts a 17-0 career record, after coming through Thursday’s late night scrap which saw a total of 15 breaks of serve and 97 unforced errors.

Fognini defeated Nadal from two sets down at the US Open in 2015.

Buoyed by that memory, the 35-year-old swept through the first set with breaks in the third and seventh games against a sluggish and error plagued Nadal.

It was the second successive match in which Nadal had dropped the first set after he suffered the same fate in his opener against Australian wildcard Rinky Hijikata.

The first five games of the second set were all breaks, with Nadal forced to call the trainer to treat blisters on his left hand at 2-3 down.

Fognini stretched to a 4-2 lead before Nadal reeled off the next four games to take the set and level the tie.

In each of the first two sets, Nadal had managed to hit a meagre three winners.

The Spaniard, however, then doubled his winners count to grab the third set against a suddenly dispirited Fognini, who needed a medical timeout to have his right foot bandaged.

Nadal coasted to a 3-0 lead when his bizarre injury temporarily stalled his progress to the last 32.