In this legendary scene from the The 2008 martial arts classic Ip Man,
the Wing Chun master takes on 10 Karate blackbelts.
BROLL fight intro
I’ve wondered if it is possible for one person to hold their own against a large group of
attackers. There is something fascinating about a single defender laying the smackdown
when the odds are stacked against them. Standing approximately 5’3” and weighing
somewhere around 130lbs, the true Ip Man would have relied heavily on superior skill, tactics,
spatial awareness and positioning to defeat 10 simultaneous opponents. Unable to rely on size
advantage he would have attempted to force 1 on 1 interactions wherever possible. Even alongside
several companions, I wouldn’t want to find myself in the ring with Bruce Lee’s famed teacher.
While the real Ip Man is no longer around to confirm or deny the historical legitimacy of
this fight, Donnie Yen’s portrayal of the martial arts master is very
entertaining. In this cinematic portrayal, Ip Man makes bones look like crackers.
BROLL head stomp
It doesn’t take long for Ip Man to show his martial arts prowess,
catching his first attacker clean out of the air, slamming him to the ground
and incapacitating him with a swift stomp across the side of the head.
The first attacker doesn’t last very long in the meleee before
earning himself a visit to the hospital emergency department. Ip Man throws the
attacker onto his back on the ground and swiftly stomps on the side of his face.
Of course, we hear the gruesome sound effect of crunching bone as he does so.
With this move ip man strikes the lefthand side of the attackers jaw with the sole of his foot.
A sudden stomp like this would cause a fracture dislocation of the jaw where the jaw was both
broken and dislocated from its joints at the same time. While such a blow could be expected break
the mandible at its weakest point, the location of the blow would put a very large amount of stress
directly on the tempomandibular joint where the jaw inserts on the skull,
and would cause this joint to become separated. That would really suck, because not only would
you have the pain of the actual fracture, but you would also have your mouth stuck
open where you would not be able to stabilize it to prevent movement. Painful and uncomfortable at
the same time. This would be treated with an open reduction and internal fixation of the mandible
with plate and screw fixation or wiring, after the tempomandibular joint, or TMJ, had been reduced.
Not to mention, with the sudden rotational force applied to the head, there is a real possibility
that the attacker might also suffer an injury to his neck. This could range from a simple strain of
the cervical muscles, to a fracture, dislocation or combined fracture dislocation of the cervical
spine. There is even the possibility of the blow causing injury to the spinal cord as well,
with some degree of paralysis occurring as a result. At the level of the cervical spine,
any ensuing injury to the spinal cord would be likely to result in quadriplegia with all
4 limbs affected rather than paraplegia, where only 2 limbs would be affected.
Perhaps his speedy dispatching of the first attacker frightened the
other 9 combatants enough to make them second guess their movements and slow the onslaught.
He imobilizes his second victim with a standing arm bar and somehow has enough time deliver
7 blows before sweeping his leg and:
BROLL shoulder dislocate
Gotta love the sound effects. In case you were wondering, the shoulder joint is not
meant to move like that. Nor is it meant to bear the full weight of a human being,
far beyond its natural range of motion. The shoulder joint is capable of circumduction which
describes the movements that are possible at this articulation. Circumduction is a combination of
shoulder movements that include shoulder flexion, abduction, extension and abduction. Consequently,
it has a very large degree of freedom. However, when the shoulder is abducted forcefully,
it is pushed beyond the extent to which the soft tissues can maintain stability.
Forced abduction of the shoulder is likely to result in an injury to the anterior labrum at
the front of the glenoid. The labrum is like the early warning bumper located at the edge of the
saucer on which the arm rests. With an injury to the labrum, the shoulder becomes unstable
and a dislocation results. In this case, it would be an anterior dislocation where the humeral head
comes out of the front of the shoulder joint. The dislocated humeral head would tear the labrum off
the glenoid creating a Bankart lesion. The humeral head would be damaged where it became perched on
the rim of the glenoid. This divot is known as a Hill-Sachs lesion. If this attacker were lucky, he
would be able to return to activity after a full course of physical therapy without any subsequent
shoulder instability. If he were unlucky, he would suffer from recurrent instability of the shoulder
and would require a shoulder stabilization procedure to be performed by an orthopedic
surgeon. REgardless, it will be a long time before he is competing in karate again. And for the
record, I am not convinced that the shoulder would actually make that sound when it was dislocated.
BROLL knee snap
This move is even better than the last… Not only does
Ip Man prove that he can defend against at least two simultaneous attackers,
but he demonstrates one of the worst possible things that can happen to the knee joint.
To be honest at this point, if I saw one of my colleagues' knees bend like that,
I may just give up Karate right then and there. Clearly, the knee is not supposed to move like
that. This is an example of a knee dislocation caused by forced hyperextension of the knee. This
is a catastrophic injury to the knee that results in multiple ligamentous injuries of the knee. It
is often associated with concomitant injuries of the vasculature and the nerves that traverse
the back of the knee as well. This is an emergent injury that requires immediate medical attention
within 6 hours to avoid the death of muscle and nerve tissue. If untreated within that time frame,
amputation may even become a possibility as muscle and nerve tissue start to necrose
and become dysfunctional. Successful treatment of this injury will require a stated approach
over several weeks and months. Initially, the vascular and nerve injuries will be repaired,
the capsule of the joint repaired, the joint stabilized with an external fixator frame,
and preventative fasciotomies of the lower extremity performed to avoid compartment
syndrome. This is a problem that is caused by uncontrolled swelling within a muscular
compartment following severe injury. Later, once all swelling has resolved, and good vascular flow
to the leg has been established, ligamentous repair can be performed using a combination of
autografts taken from the patient and allografts from donors to recreate the
various ligaments of the knee that have been injured. In the end, this attacker
is looking at a 1-2 year recovery at the least following this martial beat down by the ip man.
BROLL neck chop
A chop to the back of the neck such as this could be devastating… You might find:
a hyperextension injury of the cervical spine or even a fracture of the posterior elements.
Hyperextension injuries of the spine, although uncommon, are quite serious. They can include
various unstable fractures of the upper cervical spine, fractures and dislocations of the lower
cervical spine, and even cord compression problems such as central cord syndrome.
But I might prefer one Karate strike to the neck to a four second barrage
of rapid fire punches that bounce my skull up and down off the dojo floor.
BROLL punch machine gun
Can you say conc conc conc concussion? Out of everything that has happened so far,
this exchange presents the best chance for the attackers to subdue the mighty Ip Man. Alas,
the opportunity is squandered and the black belts allow Ip Man to have his way,
then stand to face those that remain. Both of Ip Man’s next two victims are
incapacitated with an attack that involves accute damage to the neck.
First Ip man throws a man by his chin with
enough rotational force to send him spinning through the air.
Second, he delivers a falling elbow to the back
of a man’s neck. The first of these two attackers could suffer a rotational injury
of the cervical spine which could include unilateral or bilateral dislocated facets,
vertebral fractures, or a combination of both. All of these injuries are unstable and will require
some type of stabilization for successful treatment. Many of these injuries will be
associated with neurological deficits which range from radiculopathy to various cord syndromes. The
second attacker receives an elbow to the base of his cervical spine for his troubles. Certainly
not what he was expecting when he arrived at the dojo in the morning,
but of all the neck injuries so far, this one is probably the most benign.
Fortunately for this attacker, because his face was already against the mat,
this blow is likely only to result in an injury to the posterior elements of the cervical spine
at its base. This translates to a fracture of the spinous process of one or more vertebrae.
Painful yes, but with minimal clinical impact otherwise. Please sir, may I have another?
INSERT MEDICAL INFO.
The attackers finally decide to overwhelm Ip Man with their superior numbers, but he is up to the
task, stepping over a crawling fighter as he blocks and delivers blows to 4 people at once.
BROLL 4 v 1
For a moment, two fighters remain. Ip Man turns the first one into a human punching bag.
BROLL punching bag
Taking this many punches in rapid succession, leaves the man convulsing on the floor,
and may have caused contusions or bruises of the chest wall,
rib fractures, and possibly even a pneumothorax, where the lung partially collapses. All of
these injuries will make it difficult and painful to breathe and may require surgical
intervention if the partial collapse of the lung progressively prohibits respiration or breathing,
otherwise known as a tension pneumothorax. Chest contusions and rib fractures are usually
treated non-operatively with symptomatic measures only. Tension pneumothoraces will require needle
decompression in an urgent setting and definitive treatment with a surgically inserted chest tube
attached to a vacuum pump to remove the air outside of the lung. Eventually,
once reinflation of the lung is confirmed, the chest tube is removed and the incision sewn shut.
BROLL final attacker Then finally, we are left with just one
opponent. A slow dramatic walkup, then before the attacker even knows what has happened,
his head is between Ip Man’s knees and he sustains a series of blows to the face without defending
himself at all. This attacker receives an unlucky 13 direct blows to the face….at
point blank range….while his head is being cradled and blocked ip man’s knee. You know, because you
wouldn’t want the attacker to move while he was getting face pummeled. This attacker’s face
would literally be a mess after this barrage of straight punches. Injuries that would be expected
would include a comminuted fracture of the nose, potential fractures of the maxilla, potential
fractures of the mandible or jaw, likely fractures of the orbitals, and possibly even injuries to
the eyes themselves. No doubt about it, this attackers face would be all kind of jacked up.
He would also likely suffer a closed head injury such as a concussion or an intractranial bleed.
Which is probably a good thing because he would be less likely to remember his manhandling by
ip man. In the short term he would likely require intubation and ventilator support as a result of
extreme swelling of his face that might occlude his airway. Once stabilized, he would require
the attentive care of a maxillofacial surgeon, and possibly also an ophthalmologist. Stabilization of
his fractures would require plate osteosynthesis with contoured titanium plates and screws.
Most definitely, it will be a long time before this attacker is able to do anything,
and he is quite likely to be sucking back pureed food through a straw for an extended period.
To be honest, if the fight escalated from here and Ip Man was faced with 20 attackers at once–
I might be inclined to put my money on the Wing Chun master. Especially with plot armor
on his side. As always, that’s been a word from Dr. Chris, not your everyday ortho.