- I'm Dr. Chris Raynor.
And I've been an orthopedic surgeon for the last 15 years.
I'm gonna talk about every bone in the body
by looking at the breaks, cracks and injuries
from "John Wick".
Humans are actually born with a few more bones,
but as they mature, some of those bones fuse together
so that the number is reduced.
If you think of a bone, it's kind of like an egg
that has a very hard outer shell,
which is the cortex of the bone.
The inside actually looks more like sponge.
You can actually squeeze it together and compress it.
There is liquid, blood, and fat.
And so when you break a bone it bleeds a lot.
The skull.
The occipital bone.
The occipital bone is located in the back of the cranium.
In "John Wick", we see him getting whacked in the head
with a bat.
Getting hit in the occipital bone
is not necessarily gonna be more painful
than any other bone in the head,
but you will have forward flexion
of the cervical spine as a result.
That in and of itself could cause injuries
in the neck region.
The parietal bone.
The parietal bones are located on the side of the cranium.
So, the pterion is the point at which the parietal bone
is the thinnest, and it's the most susceptible part
of that bone to injury.
If you injure the bone in this area,
there is a good chance that you could injure
the middle meningeal artery, which lies directly below,
and you could cause a hematoma
which could affect the flow of blood in that artery.
The temporal bones are on the side of the cranium.
If you're going to hit him in the head,
it would be one of the best places to do it.
The frontal bone is at the front of the cranium.
Anytime you have a head injury or a head blow
with significant amount of force,
you run the risk of concussion.
There isn't a set amount of force
that is required to give a concussion.
It varies from person to person.
The sphenoid bone.
These are the cavities that hold your eyeballs.
And the sphenoid basically produces
the back of that structure.
The sphenoid is an irregularly shaped bone,
so if you were to take it out and isolate it,
it looks like either a bat or a butterfly.
The ethmoid bone.
The ethmoid bone is located
just above and behind the nasal bones.
So you can't really see it from the outside of your face
and it produces a roof over the nasal cavity.
The nasal bone.
The nasal bones are basically located at the top portion
of your nose where your nose meets your face.
We definitely see some slaps and punches to the face
in "John Wick".
The palatine bone.
- [Speaker] The palatine bone is an essential structure
in the oral and nasal cavity of the skull.
This bone can be injured in association
with mid facial or pan facial fractures.
- The zygomatic bones.
The zygomatic bones forms the upper portion
of your cheek bone as it comes towards the side of the eye.
The inferior nasal conchae.
This helps to filter the air that we breathe.
Vomer. This separates the right and left nasal cavities.
The lacrimal bones.
The lacrimal bones basically make up the inner portion
of the orbit.
So they're just above the nasal bones.
The lacrimal bones are the most fragile bones in the face
because they're very thin plate shaped bones.
So in the event that you actually hit somebody
hard enough in the nose,
there is a possibility that you can cause
a very significant injury.
The nasal bones would then be forced up through the ethmoid,
which we said already is a very spongy bone,
up into the brain case that's above.
When that happens to John Wick,
that might end up being a problem.
Maxillae. Basically, the upper portion of your face.
The mandible.
So the mandible is the bottom half of your jaw.
The mandible is the strongest bone in the skull.
With your mandible, you could bite through smaller bones
in the hand or in the feet.
You'd be hard pressed to be able to bite
through larger bones in your forearm, or leg,
or anything like that.
But small bones, you could bite through for sure.
The bones of the middle ear.
The malleus, incus, and stapes.
The bones of the inner ear
are the smallest bones of the body.
These are the bones that help us to transduce soundwaves.
The neck.
Hyoid bone.
The hyoid bone is the only bone in the body
that doesn't directly articulate with any other bones.
Because it doesn't really articulate with anything,
it doesn't really have any protection.
So if you grab the neck
and you apply any significant force to the neck,
then you could break that bone.
When we see John Wick with a plastic bag over his head,
there is a possibility that his hyoid could be injured.
The force would have to be directed more posteriorly
to actually fracture the hyoid.
It's a very small and delicate bone
so it's not something that's very easily repaired.
And generally speaking,
for most cases where the hyoid bone is injured,
we will try to allow it to heal using non-operative means.
The spine.
When we were born, we have about 33 vertebrae.
As we mature, the bones of the sacrum and the coccyx
fuse to one another.
And so, instead of being individual bones,
they end up being one solid bone.
So we end up with a total of 24 vertebrae.
They are the cervical spine, the thoracic spine,
the lumbar spine, and the sacro spine.
The cervical vertebrae.
When compared to other vertebrae in the spine,
the cervical vertebrae are certainly much smaller in size
and more delicate.
This just makes sense because the amount of weight
that the cervical spine is supporting is significantly less
than other parts of the spine.
The typical trope is that they like to twist the head
and instantaneously kill people.
I'm not sure that that's the most efficient way,
but C3-4-5 keeps the diaphragm alive.
So if you can break the neck above the C3 level
that is going to be ultimately fatal
if the person doesn't get medical attention.
The thoracic vertebrae.
The lumbar vertebrae.
In the movie when John is thrown off the balcony
and he lands on his back,
I have to tell myself as an orthopedic surgeon
to suspend some disbelief,
because there is a very highly significant chance
that he would have suffered a fracture of his lumbar spine.
And in fact probably more than just his lumbar spine,
he probably would've fractured other parts of his spine
as well.
The lumbar vertebrae are significantly larger
than the vertebrae in either the cervical
or the thoracic spine,
because they're supporting much more weight
than are the other vertebrae of the spine.
The sacrum.
The sacrum is the bottom most portion of the spine.
And this is a solid bone,
that previously when we were embryos,
was a segmented portion of the spine,
but it is now fused to become one solid bone.
The coccyx.
The coccyx is the end most portion of the spinal column.
It's the bottom portion of the sacrum.
And it's basically a vestigial tail.
It's otherwise known as the tailbone.
The tailbone is not really protected by anything.
If you look at most of the other bones,
other than at joints,
those bones are surrounded by a significant amount
of soft tissue, including muscle and fat.
But if you touch your tailbone,
there's not really anything between the tailbone
and the hard surface that you're going to impact,
other than a small layer of skin.
When you land on your tailbone,
you are hitting your tailbone directly onto the floor
and that's why it's painful.
The chest.
The sternum.
The sternum is a flat bone
that resides in the middle of your chest.
Right about there.
The sternum plays an integral role
in helping to create stability of your chest cavity.
It's the location where the ribs wrap around your torso
and then they connect with the sternum,
so the sternum in conjunction with the ribs,
and then the spine behind gives the thorax
or the chest cavity, its strength and rigidity.
Generally speaking,
no bone is gonna protect you against a bullet.
Most bullets are traveling fast enough to break a bone.
In the "John Wick" series,
he has the benefit of a suit that has a Kevlar layer in it,
which is like a bulletproof vest,
which will help to dissipate some of the energy
so that you're less likely to penetrate the chest cavity.
The clavicle.
The clavicle is located at the top of the chest
in between the shoulder joint
and the sternal clavicular joint.
It is a bone that is injured quite frequently.
When we fall,
we have a tendency to want to protect ourselves
and put our hands out.
And if we fall to the side,
that bone ends up striking the ground on an angle.
So each of those fractures,
we're basically gonna treat the same way.
We are going to expose the bone,
which is what's called an open reduction.
Under direct visualization,
we are gonna take those two fracture fragments,
bring them back to one another.
We are going to provisionally hold them in place,
usually with a small pin, which is called a K-wire.
And then we will take a pre contoured plate,
which we will then place on top of the bone,
put screws on either side of the fracture,
and then we'll secure those screws to stabilize that bone.
When a bone comes through the skin,
this is what is known as a open fracture.
Bones do bleed.
Bones are like the assembly line for blood production.
That is where blood cells are born,
inside the marrow of the bone.
In some trauma situations
where we cannot get a good intravenous line in patients,
we will actually run IV fluids into the bone.
It doesn't work as effectively
as if you had an intravenous line,
but in the event that we can get no other lines,
we can actually put an intraosseous catheter
and keep you alive.
The scapula.
The scapula is relatively protected.
It lays flat against the thoracic cage on your back
and it has a thick layer of muscle both on the front
and the back surface.
The shoulder joint is kind of like the hip joint
in that it's a ball and socket joint.
However, where the hip joint is an actual socket,
the shoulder joint is more of a saucer.
When you have a force that is applied too quickly
or when the arm goes beyond its maximum range of motion,
sometimes that humeral head can slide off the face,
either to the front or to the back,
or in rare circumstances, down below or up top.
And this is what's called a shoulder dislocation.
The ribs.
Generally, most adults have 24 ribs. 12 on either side.
We see John Wick break more than a few ribs.
[John groaning]
So when you suffer a rib fracture,
there's always a chance that some other structures
normally protected by the ribs, can be injured.
Most likely this is going to be the lungs.
Those injuries can be associated with pneumothorax,
which is where air can escape the lung,
but still sit inside the chest cavity.
Or also a hemathorax or in some cases a hemo-pneumothorax.
Those are the kind of injuries that are most common.
Some people have extra ribs
and this is basically a congenital deformity, if you will.
Or it was just a spontaneous mutation.
So generally speaking,
the extra ribs are located in one of two places.
Either the cervical spine or the lumbar spine.
The arms.
So there are generally three bones in the arms.
We have the upper arm, which is made of the humerus.
- [Speaker] The humerus bone is the longest bone of the arm
and supports movement in the arm and shoulder.
- The radius and the ulna.
The radius and the ulna are likely bones to be fractured.
And that is a function of our desire to protect ourself
in the event that we fall.
There's no such thing as a funny bone. This is a misnomer.
What you have is a nerve.
It's in very close proximity to the end of the elbow
on the medial aspect.
And this is the ulna nerve
that lies just behind the medial epicondyle.
So when you bang your funny bone,
what you're doing is you are banging the nerve
which is the ulna nerve.
And you are squishing the ulna nerve
between the surface that you have banged
and the medial epicondyle.
The hand bones.
So you have the small irregular bones
which make up the wrist, and there are eight of those.
And those are called the carpals.
The carpal bones of the wrist are arranged in such a way
that there is a tunnel, which is called the carpal tunnel.
Through this tunnel, the nerves and the tendons,
flexor tendons of the wrists are housed.
A common problem that people will have,
if there is any inflammation
that's associated with these tendons,
is carpal tunnel syndrome.
It takes some time to recover after carpal tunnel surgery.
So you may have transient numbness and pain in your hand
for almost a year after carpal tunnel release.
Just adjacent to those, you have the five metacarpals.
The metacarpal is a group of five bones of the hand
between the phalanges and the carpals
that makes up the rays of the hand.
Even though the metacarpal bones are small,
they're still classified as long bones.
The next grouping of bones are the phalanges,
are what people refer to as the fingers.
The thumb is a unique digit
in that not only can it flex and extend,
but it can also rotate into a movement
that we call opposition.
In the Savannah,
we needed to be able to grasp to climb trees.
And so the thumb allows us not only to grasp
with our fingers,
but is what provides almost 50%
of the function of your hand.
It is very easy to lose a finger, actually.
Reattaching a finger is called a re-plantation.
This is a relatively difficult procedure
where we have to basically reconstruct the joint capsule
to provide stability to the joint.
We then have to reconstruct the nerves
and the blood vessels, both arteries and veins,
so that there's blood supply to and from the finger.
And then we have to provisionally stabilize that
while all those structures heal.
The pelvic girdle.
Ilium, ischium, pubis.
There are two spaces in between hip bones.
So you have the top of the pelvis,
which is called the pelvic inlet.
And that's about this big.
And then you have the bottom space,
which is called the pelvic outlet
and that's about this big.
The strongest part of the pelvis is the acetabulum.
And this is where the ischium and the ilium meet.
And the reason why this is the strongest
is because this is what makes up the socket
of the hip joints.
So this is where most of the force of the hip
is distributed.
One of the most unique injuries
that you can have to the pelvis
is what is called a wind sweat pelvis.
If you are driving and then your car were T-boned,
with a high enough energy of impact,
you can not only push in the near side of the pelvis,
you can also push out the opposite side of the pelvis.
The legs.
The femur.
The femur is the largest long bone of the body
and it is also the strongest bone of the body,
as it sees the most compressive force on a day to day basis.
If you are eating marrow from a cow,
it is most likely that you are eating it
from the femur bone.
The equivalent is the femur in the human.
If you have a femur fracture,
you can bleed two liters of blood
out of your femur into your thigh.
So, almost half your blood volume.
The fibula.
The fibula is quite commonly used
as what we call a vascularized bone graft.
We can take bone from anywhere in the body
and move it to another.
Generally we will do this with non-vascularized bone,
so bone that does not have an active blood source
that is attached to it.
However, with the case of the fibula, a nearby artery,
perineal artery, can be used to transplant that bone
to another area.
And at the same time, bring with it a blood vessel
that will improve the likelihood that that bone
will be incorporated at the new site.
The tibia.
- [Speaker] The tibia or shin bone
is the second largest bone in the body after the femur.
It can be fractured along its length
when kicking hard objects
or when checking kicks with your leg.
- [Dr. Raynor] The patella.
The patella articulates with the distal femur.
It is contained within the tendons
on the front aspect of the leg.
So the quadricep tendon attaches to the top
and the patellar tendon attaches to the bottom.
Those tendons basically hold the patellar in position,
so as you bend your knee,
the patella will move up and down a groove
on the front of the distal femur,
which is called the trochlea.
And the knee will be kept in position, medial and laterally,
by that trochlea groove.
And it will protect the front of the knee.
The feet bones.
The foot bones are interesting
in that they are similar to the bones of the hand,
except that these bones are weight bearing.
As such, the foot has a number of arches
which help to support the weight of the foot
and to allow it to move dynamically
as we stand and mobilize.
The tarsal bones.
The tarsal bones form the posterior aspect
of the arches of the foot.
The metatarsal bones.
The metatarsal bones are known as the rays of the foot,
and they form the front half of the arches of the foot.
The phalanges.
The big toe has two phalanges and the other toes have three.
In the past when our ancestors lived in the Savannah
where we were climbing and we needed to hold onto branches
and swing from branch to branch,
we needed to use not only our hands, but also our feet.
At that time, our feet looked much more like hands,
and so they have a lot of bones
with a large number of articulation
to allow them to perform hand like movements.
Although we still have those bones,
our feet no longer function in the same manner
that they did in the past.
So when you break the digits of your feet,
because the actual digits are so short,
there really isn't a lot of bone
that's available for us to fix.
And normally when we fix a fracture,
we want to have an adequate number of points of fixation
on both sides of the fracture.
But if the actual bone that we are fixing
is only a centimeter long,
what we will tend to do is splint them
to the next adjacent straight foul lengths
where we will buddy tape them together.
That was each and every bone in the body.
Thanks to John Wick and Captain Jack Marrow,
I think we got 'em all.
And now for the final send off.
[object clattering]