 Welcome back to the channel, everybody. Today we're going to be doing another reaction video or injury reaction video. This time it's going to be about my favorite comedian who suffered an injury recently. I was going to do a video on this injury and kind of describe it after it happened, but Brian Sutterer, who's also a YouTuber and physician, did a very good video on that and you know, I can't compete with that. However, recently, Tom Segura brought his trauma surgeon onto his podcast to discuss his injuries and he ended up posting a ton of different radiologic images. It has left me no choice but now to react to this video, although these videos are usually just snooze-fest videos. Nobody watches these videos. The last couple of reaction videos I did to accidents got like five views, but you know, I'm here for it. All right, so let's go ahead and get started with Tom Segura's injury. Let's go. All right, so first and foremost, if you haven't seen Tom Segura's injury, the first thing we're going to do here is watch his injury, which is pretty painful to watch, but I've seen it before and those of you who haven't seen it, I apologize in advance because you don't like squeamish things or broken bones. Close your eyes, trust me. He's armed, he's armed. I've seen this a whole bunch of times and it is still terrible every time I watch it. And also his friend and comedian, Bert Reicher, who basically flipped his arm back from this to this, did a very good job there, but that's for another video. All right, so now we got that out of the way. Let's get into the actual video or the actual video podcast where Tom Segura had his trauma surgeon and they discussed some of the stuff from this injury and his surgery. And then I remember I was sitting with you where you came in and I was like, yeah, I actually have no video. And you were like, oh, I'd like to see that. And it always helps to see how the injury happened when you're about to treat the injury. So I mean, that makes sense. I would have done the same thing. When you see them as the surgeon, what hits you, I mean, like when you see the two, I have two like pretty severe injuries, right? So since most of you all don't know what he actually did, he actually ended up with that fall, his patella tendon snapped, and then he also fell on his left arm and he broke his humerus. He also has radial nerve palsy from that stretching of that nerve when his hand was to the back. So those are essentially here's three injuries that trauma surgeon had to fix. So I think in the interest of time here, so this isn't like a 45 minute video, I'll skip forward to some of the images and kind of go over that as they go over it. All right, so just by looking at this X-ray, so I have this light in the corner of my eye, so I can't really see it very well. But if you look to see at this patella here, the patella is actually very high when it should be down here more, closer to the distal part of the femur or the proximal knee essentially. So this patella is just by looking at it. I know that it's high and we would call that patella alta. Now there is a whole equation that you can do to essentially measure the patella alta and I always forget it, so let's look it up. So we'll talk about patella alta real quick. So I just put up this radiopedia article here. So patella alta, also known as high-riding patella, which is what we usually say when we're talking to other physicians or whatnot. It's characterized by the position of the patella when it's considered high, usually idiopathic, but it could be secondary to patella tendon rupture, which is what Tom's a grad. So on sagittal X-ray, which is what this is, we use a something called the insol solvati ratio. So basically on the lateral, you measure the patella and then you measure the distance from the inferior portion of the patella to the tibial tuberosity. The mean normal is around one. So if that ratio is greater than 1.2, you have patella alta. It's less than 0.8 patella baja and the normal is the 0.8 to 1.2 range. So that's a little bit about how we can tell on X-ray. The other thing we can do is look for soft tissue swelling about the knee. Now usually on X-rays, you'd be able to window this and see the soft tissues a little better. There's a little effusion up here as well. I can't really see it on this particular X-ray. Soft tissue, swelling, effusion, a high-riding patella or patella alta, all signs, especially after an injury, I'd be concerned for patella tendon rupture. Just saw this one X-ray image of the lateral or sagittal part of the knee. So if you look at that little ball in the front, like this is the side view of the knee, that little ball in the front is your kneecap. Which is in the wrong place? Yeah, so it's sitting really, really high. Yeah. It's sitting a lot. See, it's exactly what I'm talking about here, high-riding patella or patella alta. Most patella tendon ruptures at the inferior portion of the actual patella and there's usually associated with a little fragment of bone there too that you can see when they rupture it. But his actually wasn't. It was more central in the tendon, which is very odd. You don't see that very often, which means he had some crazy amount of force to rupture the center of the tendon. Usually ruptures at its weakest points at the attachment, not the actual center of the tendon. This is a very strong tendon, by the way. Here's the MRI. This is a sagittal or a projection looking at the lateral part of the knee or like this. Coming in that way. So you have the patella up here. This is the femur. This is the tibia. Patella up here, which is very high, mind you. And this ripply tendon, which is the patella tendon. Now this should be very nice and straight. The problem is this one's very wavy, which means it's very lax and ruptured in this case. This is very a tell-tale sign. Think of like a bungee cord that's attached or pulled and attached between those two bones. So if the bungee cord were to rupture, it would get very saggy and kind of just like wave around because it's not taught like it should be. And I'll show you an image of what the patella tendon should look like on MRI when it's not ruptured so you can see the difference. All right, so this is a lateral or sagittal image of a T1 MRI here. Here's the patella again. Notice how straight and taut this patella tendon is as my mouse goes over it. This black line is the patella tendon taught, not ruptured. Now let's go back. Let's look at his again. Look how wavy and loose this patella tendon is. Classic sign that it's ruptured. There's also a lot of fluid out here too, which you'll be able to see better on a T2 sequence or a fluid sensitive sequence. So like, yeah, this is a ruptured patella tendon. It's likely somewhere in the middle here because you can see actually this part is still attached to the inferior patella. And down here at the tibial tuberosity, it's also attached, which is very strange in a patella tendon rupture. So let's keep going. So if you look at the MRI, the resident was like, yeah, the ultrasound says that it's ruptured in the middle of the patella tendon. You know, all of us are in comfort. So me, partners, we're sitting in there and we're like, that never happens. It's so, it never happens. What are you talking about? Dude, this is classic. They're already just bashing the resident off of what he saw on the MRI. And even before they looked at it because they're right, that never happens, but doesn't mean the resident's not right. And he's like, no, no, no, that's what it says. Then we get the MRI and we look at the MRI and we're like, it looks like it ruptured in the middle of the tendon or at least, you know, you see how that thing is like folded? The little black line that's folded. Yeah, that right there. That should just be a straight line going directly to the tibia. So that's the tendon. Yeah, so that's the tendon. Yeah, you can see this portion of the tibial tuberosity is likely pulled off a little bit. It's not completely ruptured off of the tibial tuberosity, but it does look like it's de-hissed a little bit. Usually since the tendon ruptures off the inferior or lower portion of the patella, you essentially just suture through the patella into the patella tendon. In this case, you can't do that because it's ruptured in the center of the tendon. So you kind of just have to suture the tendon together. So normally you make some drill holes through the kneecap and you pass stitches through the kneecap and you tie them over the top and that just repairs that tendon. So let me show you what he's talking about. So this is just a diagram of what he's talking about here. So usually the patella tendon will rupture at the inferior portion or the lower border of the patella and you just basically suture through the patella and drill some holes, suture through the patella and into the tendon, kind of tighten it back up. But his patella tendon ruptured around here so you can't really drill holes in the patella or the kneecap and suture that in. So this is why it complicated to a little bit but I don't do this surgery, so I'll let him finish. It's just the opposite of what we usually do. I've had to do that twice in my career. Wow. A lot of times when people tear their patella tendon it's because they had some tendonitis like either at the top or at the bottom of the tendon that's been there for a while. And so it just speaks to how much force you're able to generate. So I'm super strong. You're super strong. Yes, I am. Yeah, so it takes some power to literally just rupture that tendon. Again, this is one of the strongest tendons in your body. To rupture that is take substantial amount of force. All right, so now we have the T2 weighted sagittal MRI of the knee. So this is still the lateral projection of the knee. This is T2 weighted or fluid sensitive sequence which means that any fluid is going to be very bright on this sequence and you can see all of the fluid in the joint space here between the patella and the actual femur. You have tons of fluid in the edema which is blood products, just reactive swelling edema, fluid, synovial fluid, all out here in the soft tissues. And this tendon is essentially just frayed and not connected anymore. There's no taut black line going from the patella to the tibial tuberosity. It's just wavy soft tissue, no connected tendon. This is a pretty solid tear here. If you look really closely, you can see some edema at the lower portion of the patella here because maybe the patella when it ruptured the patella hit on the femur and caused a little small contusion in that bone. But yeah, pretty crazy, I'm right here. Go to the, I think there's an x-ray of the humerus. So now we got the arm radiograph here, the arm x-ray. So this is the scapula here, clavicle and acromion here. And this is the humeral head, the humeral shaft. And as you see, it is broken and sheared off and laterally displaced here on this particular PA image. The elbow joint is immediately angulated. So this is a nice displaced, maybe minimally comminuted fracture. It looks like a pretty clean break with some fragments out there. So you can fix this with a plate and screw internal fixation which they did. And I remember a resident coming in and I was like, oh, where's the incision gonna be? And he was like, oh, it'll be along your tricep. And I was like, okay. And I woke up and it's on the bicep. And I was just curious, like... The resident's always giving incorrect information. Well, in this case, it's not incorrect, but... Like you cut through the muscle, I guess, right or no? So you don't, you kind of spread, right? You do. Yeah, you don't actually cut through the muscle. They would cut down through the skin. They would essentially just use forceps and kind of spread those muscles open so they can expose the bone. You don't actually have to cut through the muscle. You spread through it in a point where there's nerves that come in from both sides and they're two separate nerves. So you work through that area in between them. So, I know it's, it's not, it's bananas. It's so crazy that you do this. It is weird when you think about it. We do this so often. I don't do orthopedic surgery, but in my line of work, interventional radiology, we do these procedures so often that it's like second nature to us. It's just like, you know, making a sandwich or whatnot. It's just like making a sandwich or whatnot. But when you tell people this, their mind is blown. You forget how crazy it is, the stuff we do. So here we have the, these are intraoperative films. This is just the C-arm images in the operating room. You put the first humeral plate in a few screws and it'll probably add a stronger one too at the end of this. You can see these little bony fragments out here too. Then we put a big plate that actually allows us to, to really kind of protect your arm. There we go. So they extended the plate, a nice beefy plate here. Screws everywhere. This thing isn't doing anywhere. All right. So I hope you all enjoyed this video. The reason I went over his injury, even though it happened a while ago, is because he had so much imaging on this particular episode of his podcast. So if you learned something, let me know in the comments below. If you want me to do more videos like this, also let me know. Hopefully it's not a snooze fest like the other videos have been in the past. On that note, smash the like and subscribe button. Follow me on Instagram and TikTok if you don't already and I'll see you all on the next video. Peace.