batman the dark knight of gotham is an orthopedic surgeon's worst nightmare
and i'm going to prove it to you in only a few minutes listen up everybody i have some news
hey interns i'm dr chris rainer and i am not your everyday art though i teach you about
injuries orthopedic surgery and medical topics in a way that's easy to understand and entertaining
today i'm going to show you why i think that batman is an orthopedic surgeon's worst nightmare
i'm gonna break down some of the injuries from a batman movie to illustrate my point not that i'm
a pessimist or anything but any night that the dark knight is roaming around town the gotham
city emerge is gonna be busy and the orthopedic surgeon on call is going to be earning his salary
most definitely given the batman generally doesn't kill criminals you wouldn't think this would be
the case but he always seems to find creative ways to break his opponents but enough of the chit chat
let me just show you what i'm talking about here are five major injuries that prove that batman
is in fact an orthopedic surgeon's worst nightmare at least when he is on call that is let me know
at the end what your casualty count was we'll compare notes and i will see if you were right
we're going to be taking our information from a scene from the movie batman vs superman
it is a fantastic scene to break down because there are a lot of bad guys available to be broken
and here batman is very busy doing what he does best keep in mind that during this scene
there are several opportunities for batman to be injured as well but here i'm only going to focus
on the injuries to the bad guys so first thing anytime you're in a situation where everyone
is standing around with their guns pointed at one another um this is bad juju bad juju
not sure about the strength of these charges but even if they were only comparable to firecrackers
which i am almost certain they are not you would still have multiple people with burns
hand fractures and possibly even amputations of digits
i don't think his elbow was gonna like that no not really
that is going to end up as a shoulder separation between the collarbone and
the acromion at the very least if not also a clavicle or collarbone fracture
number one my first reason this is a penetrating chest injury although it is not strictly an
orthopedic injury it is certainly an injury that will keep the trauma team busy with a penetrating
injury like this you have to worry not only about the ribs that may have been broken as the
projectile entered the chest but also about the structures that are inside the chest that may have
also been in the path of the projectile at this location the upper lobe of the lung is directly
in the path of the projectile and this type of injury would result in entry and exit wounds
through the upper lobe of the lung this would likely cause injuries where either air or blood
could escape the lung but is still trapped inside the chest cavity pneumothorax and hemothorax
respectively if the batty was really unlucky he would have both air and blood trapped in the chest
a hemo pneumothorax of course at this level the projectile would also fracture the scapula
or shoulder blade a thin triangular plate shaped bone on the back of the chest wall
with luck this would only be a small hole through the scapula but in all likelihood this would cause
the thin scapula to shatter into many pieces many of which would be likely too small to fix
wait am i on call here yo i'm not fixing that and to add insult to injury bruce wayne finishes this
bad guy off with some good old blunt trauma to the chest which could potentially break even more ribs
which could cause a pulmonary contusion or bruised to the lung or even a flail chest where multiple
segments of ribs are broken in more than one place and are floating in the chest wall this guy
is definitely going to keep the trauma team busy reason number two getting forcefully kicked in the
side of the head while being suspended upside down from the ceiling is gonna hurt and is
probably not the way you were thinking of spending your saturday night this batty is quite likely
going to suffer a cervical spine injury from the lateral bending of the neck associated with the
kick both cervical spine fractures and cervical dislocations are definitely on the table here
if these injuries are unstable it is possible this guy could end up a quadriplegic where the function
of both his arms and his legs is compromised if he was particularly unlucky he would also have
suffered a skull fracture in the side of the head in either the parietal or temporal bones
whoops now it is generally true that batman does not kill the bad guys but i guess that accidents
do happen and that occasionally a bad guy or two finds themselves in an unsurvivable situation
certainly this situation with the grenade is not going to end well for the baddies in the corridor
but i guess that since it was the baddies that activated the grenade in the first place
it wasn't really batman that killed them they technically off themselves so i guess that takes
the dark knight off the hook for the moment at the very least we are talking about forearm contusions
here but quite possibly forearm fractures as well generally speaking this is the mechanism by which
transverse fractures of the ulna also known as a nightstick fracture are caused i wonder
if a night stick fracture is caused by batman can we call it a night stick fracture
this is going to result in a jaw or mandible fracture and quite possibly even an extension
type of neck or cervical spine injury reason number three this is definitely going to result
in concussion but it might also cause a cervical spine injury as a result of the forward flexion
of the neck and possibly even a posterior skull fracture falling from a height onto your back is
generally not a good thing but being forcefully thrown from a height onto the floor directly onto
your back and onto the back of your head is definitely a problem no cap with a concussion
the brain is temporarily damaged by a blow to the skull because the brain actually floats on liquid
in the skull anytime you get hit in the head you actually get two blows for the price of one
the coup injury occurs when the brain on the side of the impact hits the inside of the skull
the contractu injury occurs when the brain bounces off the skull then crashes into the other side of
the skull creating another injury there as well two hits for the price of one of course with the
severity of the impact shown here the neck would be forced into forward flexion upon impact of the
head with the floor this might result in a burst fracture of the cervical spine where one or more
vertebrae blow out their back wall into the spinal canal and the spinal cord or a facet dislocation
where one vertebrae jumps its connection with an adjoining vertebrae neither of these injuries is
desirable and both result in serious instability of the cervical spine there is also the potential
for a skull fracture at the back of the skull with injury to the posterior aspect of the brain
including the cerebellum and any time that you injure the skull you have to worry about the
possibility of bleeding under the skull either outside or inside the lining of the brain this
includes epidural subdural and subarachnoid bleeds any of which can kill you either quickly
or over time another concussion for a bad guy although not as forceful an impact
as with the baddie being thrown to the floor there is still the possibility of
a posterior skull fracture when the bad guy is smashed backwards onto the crate
more of the same but here the opportunity for a skull fracture is doubled with either
an anterior skull fracture when he is struck ouch by the crate or a posterior skull fracture
when his head bounces off the brick wall judging by the blood that was left on the wall
i would guesstimate that at the very least posterior skull fracture was in order
of course there was also the possibility of an extension type of cervical fracture of the neck
resulting from the crate smashing him in the forehead here everybody is getting bruises
or contusions for breakfast and nobody is allowed to leave the table until they eat
everything that is on their plate and if bruises are not enough batman is always happy to upgrade
your meal with a jaw or facial fracture even if it is not on the continental breakfast menu
anytime that you forcefully extend the elbow in this manner you are likely to injure the elbow
the shoulder or both given that there is no wonky angle at the level of the elbow or shoulder it is
likely that here the elbow and shoulder were only sprained with relatively minor injuries
to the supporting ligaments while he might not need an orthopedic surgeon i hope this bad guy's
health insurance plan has robust coverage for physical therapy because my man is gonna need it
now this is a non-orthopedic injury i am not fixing that you cannot put a plate or screws
on that likely a few facial fractures here if not at least a few loose chiclets reason number four
falling to the ground is a common mechanism of injury to the extremities wrists and ankles are
often injured when people try to stop themselves from hitting the ground in an effort to protect
their heads but using your face to protect your hands or feet is definitely not the recommended
approach to minimize injury when being thrown to the floor this batty is definitely likely
to suffer a facial fracture a lefort one two or three variant he is almost certainly going to
suffer a concussion of major proportions but those might be the least of his concerns if he has an
extension cervical spine injury that leaves him a quadriplegic this type of mechanism could result
in a variety of cervical spine fractures that include an extension teardrop a posterior arch
c1 fracture a posterior atlantoaxial subluxation or even a hangman's fraction either way
none of these are good and you don't want them for christmas between the facial fractures and
the cervical fractures this bad guy is going to be spending a whole lot of time under the care of
the trauma team and is going to inherit a crap ton of orthopedic hardware as a result of his injuries
concussion definitely a concussion for the bad guy quite possibly even an intracranial hemorrhage or
a bleed inside the brain tissue yo and don't even get me started on batman but that is a
topic for another date reason number five here batman seems to have a problem with the overall
mobility of this baddie's elbow as he performs a manipulation without anesthesia for more
information about manipulations under anesthesia check out my last video about dr snapp's
tic toc chiropractor extraordinaire however here believe me there is no sedation and this injury
is going to freaking hurt with hyperextension of the elbow the ligaments that support the elbow
are torn and disrupted an elbow dislocation where the two bones separate from each other
at the level of the joint is the result however in extreme cases where the joint is extremely
hyper extended or where the hyperextension occurs very very quickly the humerus can be fractured
in addition to the elbow being dislocated this creates what is known as a floating
elbow where the elbow is not attached to anything above or below and from an orthopedic perspective
it is a real problem and if it is an open injury which i suspect that this would likely be
where the bones come out through the skin then it is even more serious treatment would be extended
and would include multiple procedures including irrigation and debridement or washout of the wound
temporary fixation with an external fixator frame fasciotomies of the muscle compartments
of the arm and possibly the forearm to relieve pressure definitive fixation with orthopedic
instrumentation to stabilize the humeral fractures ligament repair to restore stability to the elbow
after it was successfully realigned or reduced and possibly even nerve or vascular repair if
the nerves or blood vessels that traverse the arm or the elbow were injured trapped or transected
during the initial injury make no mistake about it this baddy's arm is jacked all the way up
and it will take an orthopedic surgeon quite a few hours and the assistance of other surgical
specialists to set this bad guy straight this is certainly one example of where crime does not pay
facial contusion
yo another concussion
and just because that wasn't enough of an injury for the bad guy to remember batman buy
some penetrating chest trauma for good measure actually come to think about it with concussion
there is a good possibility that the bad guy will have some retrograde amnesia where he forgets
events that occur prior to his injury so there is a good chance he won't even remember what happened
so in that case it was a good idea for batman to follow up with the penetrating chest trauma
that way the baddie will only have to look down at his chest to see the scar to remember that he was
skewered by the gotham knight well played batman well played and to cap off the henchman beatdown
batman finishes with a forceful toss that would likely result in rib fractures scapular fractures
intra-thoracic or internal chest injuries and possibly even a spine fracture not bad
four minutes of work so what was your score how many casualties did you count i counted 17 at one
quarter playback speed if you counted something different let me know so that is why i think
that batman is indeed an orthopedic surgeon's worst nightmare when on call thanks for watching
i will see you for rounds next week and as always that's been a word from dr chris not your everyday
a ortho