or surgeon and sports medicine physician
and today i'm reviewing BMX racing BMX
Street and BMX tricks fans yeah that's
what I'm doing today so before we get
started welcome to my channel where I
make orthopedics and sports medicine
easy to understand now BMX racing is not
something that I follow very frequently
I did have a BMX bike when I was young I
think it was called like the Red Baron
or something like that since then I have
not been on a BMX bike and I have not
followed or watched vmx racy or BMX
trick or anything like that so all these
videos are gonna be new to me
for the purpose of this video I tried to
collect a bunch of different videos
about BMX from different BMX disciplines
including BMX racing BMX Street and BMX
tricks I'm gonna comment on the injuries
that occur and how I think those
injuries should be treated let's get
right to it okay so for this first one
we have a young man who's riding his BMX
bike in the street and he just looked
like he's out in front of his house and
he's just riding just kind of doing a
little bit of tricking here and there
and let's see what happens okay so he
attempts to do a trick I'm not sure
exactly what that trick is called maybe
it's called tail whip or something like
that if you know what that's called be
sure to let me know in the comment
section down below and the only thing
that I could do on my BMX was basically
do a bunny hop but at any rate so he
does this trick and when he does so it
appears as though his foot slips off the
pedal and because of the momentum with
him moving forward and spinning at the
same time he basically rolls over on his
ankle and we can see that his ankle
basically ends up in a position 90
degrees to which it should be with his
foot facing back towards the middle of
his body so this is basically a
supination external rotation meaning
that his foot has turned towards the
outside and this is a Mack
that will usually result in a fracture
dislocation of the ankle and with this
mechanism of injury there is usually a
predictable series of events that can
occur typically the patient will have a
short oblique fracture of the fibula
which is the smaller of the two bones at
the ankle in addition to that they may
also have a posterior malleolus fracture
this is a fracture of the back of the
tibia which is the bigger of the two
bones of the ankle also have a fracture
a small fracture of the medial malleolus
which is another part of the tibia which
is again the bigger of the two bones at
the ankle usually there are also a
number of associated ligament sprains
that occur with this injury while it is
not mandatory for all three of these
fracture types to occur with this injury
mechanism it is however possible for all
three of these fracture types to occur
with a supination external rotation type
of fracture I don't know but that sounds
like a lot of science so let's move on
to the next one so this next video comes
to us courtesy of the MTV's TV show scar
so in this video we have a young man who
is attempting to jump down two flights
of stairs
with dice dr. Chris no he's not I'm a
doctor
no you're not they know I'm here to tell
you dr. Fox apparently dr. Chris has
been hijacked by Rory under dr. Chris
Goetze DDT by real superhero dr. Chris
gets choked out I want you the total I
don't know right my chin go long time
was rainbows usually have a treasure at
the end I'll let you do your thing huh
Thanks and generally speaking a flight
of stairs is approximately 10 feet and a
distance of I don't know at least 50 to
60 feet with no helmet he actually does
successfully jump down the flight of
stairs and all looks to be okay until of
course the split second when the tires
touched the pavement on the down side of
the stairs and when that happens well we
see that his front tire basically
exposed we can see that the front of the
bike collapses and basically this young
man face-plants into the pavement
did I mention already that he wasn't
wearing a helmet so he basically
faceplant onto the pavement from a
height of 20 feet after jumping a
distance of about 60 feet with no
freakin helmet to add insult to injury
not only does he
faceplant but then he basically slides
on his face for a distance of 15 20 feet
before he comes to a stop we can then
see the ambulance attendants who have
arrived and who are putting a collar
around his neck and basically loading
him into the ambulance and although we
don't get a close-up look of his face
after he's crashed we can't anticipate
some of the injuries that might occur
from this type of mechanism certainly we
can expect there to be some facial
lacerations and abrasions in addition we
might expect that he would also have
suffered some sort of facial fracture it
either his mandible maxilla or even
around the eyes or the orbitals these
are all common injury patterns
with blunt facial trauma other injuries
that we might expect would include
injuries to his dentition or his teeth
as well as some kind of closed head
injury such as a concussion on the low
end or a subdural hematoma on the high
end we can see here that after having
recovered that the rider describes some
of the injuries that occurred last
nations and abrasions of the face and
also of his upper extremities in other
words his hands and arms and the loss of
a tooth for which he now has a bridge
but in my opinion if that's all that he
suffered after falling from a height of
20 feet directly onto his face on the
pavement at a high rate of speed then I
think the students are actually pretty
freaking lucky so for this next one we
have a rider who is known on YouTube and
his name is Jack moon and we can see
here that he is practicing his BMX
tricks inside of a ride park and
although I don't know what the name of
this trick is basically he is trying to
do a front flip with a 540 degree twist
at the same time and land on the ramp in
the opposite direction and ride away but
in this particular case he does not land
the trick successfully as he's
approaching the ground to land this
trick his left foot slips off of the
pedal and lands on the ramp
Wow his right foot and body remain on
the bike as the bike rolls away the
planted foot turns to the outside and
externally rotates away from his body
this results in a fracture dislocation
of his left ankle by a pronation
external rotation mechanism this of
course is a different mechanism of
injury than what occurred with the first
rider that I showed you as with the
first type of ankle fractures this
mechanism the pronation external
rotation also has characteristic
injuries that occur the progression of
injuries that is typically associated
with a pronation
rotation type of ankle fracture includes
a transverse fracture of the medial
malleolus or the inside part of the
ankle a short oblique fracture of the
fibula which is the smaller of the two
bones of the ankle and then finally a
posterior malleolus fracture of the back
of the tibia which again is the larger
of the two bones of the ankle this of
course is an injury that will require a
closed reduction in the acute setting if
after the reduction the x-rays show that
the ankle fracture has been anatomically
reduced with no displacement at the
joint surfaces then this is a fraction
that may be treated in a non operative
manner however if after the close
reduction there is greater than one to
two millimeters of displacement at the
joint surface or if there is widening of
the syndesmosis which is the space
between the two bones fibula and tibia
or if the mortis of the ankle in other
words the joint space that is created by
the fibula the tibia and the tailless
underneath if there is widening of the
mortise then this is an injury that will
require surgery and generally this would
be an open reduction and internal
fixation with plate and screw fixation
on the fibular side and screw fixation
on the medial malleolus side if you
don't understand anything that I just
said to you and your head is spinning
like a freaking top then let me
summarize it for you in the crows Notes
version basically with this type of
injury fracture
you're gonna break possibly one two or
three parts of your ankle this is going
to mean that we need to put it back in
the place like this if it doesn't look
good enough when we put it into place
like that then we're gonna need to cut
you open and we're gonna need to put
some plates screws and other hardware in
order to make sure that it looks pretty
on the x-ray and it works like it's
supposed to okay usually this is an
injury that will take somewhere in the
neighborhood of six to eight weeks to
heal
and if all goes according to plan once
it is healed you'll be able to get back
to riding a BMX bike just like you were
able to in the first place there have
been numerous videos about riders trying
to tame el Toro it's a big set of stairs
so in this particular video this rider
wants to take it up a notch
so not only does he attempt to jump the
full set of stairs but he decides that
he is going to basically do a 180 on his
approach to the stairs and then jump the
stairs yellow so let's get it and once
again he is attempting this maneuver
without a helmet
so let's get that's not my official
position by the way you should wear a
helmet helmet will save your life but
apparently these guys think they're not
cool or something because they just
don't wear them so we can see that as he
approaches he's gathering speed
everything looks good plane is getting
ready for takeoff he does the 180 and
then he basically jumps before he even
gets halfway down the stairs that
something is wrong because he is already
halfway off the bike and then as he
approaches the ground we see that he has
basically become separated from the bike
and he is not going to land anywhere
close to the bike fortunately he
approaches the ground feet first which
actually gives him an opportunity to
absorb some of the shock as he impacts
the ground however as he still has his
forward momentum and he continues to
rotate throughout the air as he lands
with his feet on the ground
his body is whipped back causing him to
strike the back of his head into the
ground on the pavement and on a bow it
appears that he strikes his head on the
pavement and it's not until we see the
slow-mo view from
opposite direction that we see the true
mechanism of his injury and here we can
see that this rider is extremely with a
capital extreme extremely fortunate
because he does not actually strike his
head on the pavement in this particular
case we see that the bike which is
falling to the ground behind the rider
actually bounces into the air and
subsequently strikes him in the head
which is what causes the laceration as
the cameraman quickly comes over to his
assistance we can see that he is awake
and with a normal level of consciousness
unfortunately he has a large laceration
within the hairline on his head but this
appears to be the extent of his injuries
although he did not tame El Toro
it seems that he got away lucky with
only a laceration to his scalp
perhaps he'll consider wearing a helmet
the next time ok so let's go on to the
next one here we have a young man who is
actually wearing a helmet I'm gonna give
props to this young man because she is
wearing the most important piece of
safety equipment he is wearing a helmet
and he's basically riding in a skatepark
attempting various tricks as he comes up
the ramp he attempts to do a forward
flip and unfortunately he becomes
separated from his bike once he is
separated from his bike he begins to
rotate faster than the bike and he
therefore comes into contact with the
ground before the bike does as he makes
contact with the ground we see that his
left foot touches first and his body
continues to move forward while the left
foot is planted with his left foot
planted and his body still moving away
from the planted foot his left foot
pronates and then extra
rotates away from his body I've said
this several times in many of my other
videos bones are awesome in compression
but they absolutely suck in rotation and
here there is no exception to this
statement we can see here that the bones
of the ankle hold on for as long as
possible but eventually the fibula gives
up and we have a fracture dislocation of
his left ankle as with the injury to
jack mold we can see here that the rider
has suffered a pronation external
rotation injury so we've seen a number
of injuries that have occurred with BMX
street and with BMX tricks but now let's
look at an injury that occurs with BMX
racing so in this video we have some
riders that are going over a series of
whoops and as they do so two of the
riders become tangled in the air one of
the riders ends up beginning to rotate
in the air and he lands off of his bike
colliding with the ground when he
contacts the ground he does so upside
down with his head and neck in forward
flexion this may often be a fatal injury
mechanism and we can see here that when
the rider contact the ground immediately
his body goes limp this may be because
one he has suffered a loss of
consciousness and no longer has motor
control of his body or this may be
because - he has suffered a spinal cord
injury at the level of the cervical
spine and he no longer has motor control
of the spinal segments below the level
of the spinal cord injury
of course this presentation may also be
a result of him suffering both of the
above but until first responders
actually examine this rider it is
impossible to tell which of these
mechanisms has occurred and I'll go we
don't get to see the actual injury
pattern that did occur we do hear the
narrator say that this young man
suffered a fractured
spine he suffered a broken neck
fortunately for this rider after
undergoing fixation of his cervical
spine with bone grafts from his pelvis
he was able to make a full recovery
following this injury with a combination
of courage and a bone transplant from
his hip Matt made a full recovery this
outcome is extremely fortunate because
the cervical spine fracture pattern that
typically occurs with this mechanism of
injury is called a flexion teardrop
fracture and unfortunately for most the
flexion teardrop fracture has a high
incidence of corresponding neurologic
injury the flexion teardrop fracture
typically occurs when there is severe
compression of the cervical spine
combined with forward flexion usually
the anterior or forward structures of
the cervical spine are compressed while
the posterior structures in other words
these structures at the back are
distracted which can cause significant
instability of the cervical spine you
may even have forward translation of one
segment of the spine over top of the
other
this is typically associated with
transection of the core in other words
the spinal cord gets cut in half and
that's usually a bad thing oftentimes
there are fractured fragments of the
bony vertebrae which are pushed
backwards into the spinal cord resulting
in a spinal cord injury one thing that I
can tell you for sure
is that none of that sounds very good so
there you have it today I've been
reviewing BMX racing BMX Street and BMX
tricks fails I hope you've learned
something about ankle fractures and
cervical spine fractures as well if you
liked the video be sure to give it a big
thumbs up and share it with somebody
that you know and if you've ever
suffered injury from BMX racing BMX
street or BMX tricks fails then let me
know down in the comment section down
below
as always that's the word for ducks
Chris not your everyday sport though
just a flesh wound
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