Friends, video game aficionados, budding medical experts: I’m back. It’s been away for a little while, but the Video Game Clinic is returning once more to offer scientific opinions no one asked for about another famous video game scene. This week’s patient comes courtesy of the great Power Bomb Attack, who suggested I take a look at the extensive and painful-looking injuries sustained by PlayStation icon Solid Snake – or Naked Snake, as he is better known in this particular game, Metal Gear Solid 3: Snake Eater. I must confess I’m not very familiar with Metal Gear; my lone exposure to the series was a spirited but ultimately doomed attempt to complete MGS2 in my early teens, and I haven’t been back since. In my defense, Metal Gear is absolutely batshit insane, which I feel is kind of a barrier to anyone new to the series who wants to jump in; but the sad truth is that I suck at stealth games, and I am 100% certain that if I tried to play another Metal Gear game, I would have given up/thrown the controller out of the window within the first five minutes.

But enough about my pitiful video game skills: we’re here to laugh at diagnose some gruesome physical harm. First, though, a little backstory on how our hero ended up at death’s door in the first place. MGS3 is a unique, ambitious game set years before the events of the first two Metal Gear instalments, around the height of the Cold War. It thrusts Snake deep into the Soviet jungle, where he is charged with infiltrating an extremist organisation, killing his old mentor and basically preventing World War 3. That’s a bit of a simplification, but Metal Gear lore is notoriously convoluted, and it isn’t that important here anyway. What intrigues me most about the game is that your health isn’t measured by a simple life bar that depletes arbitrarily when you get hurt; it tries to reflect how certain injuries would affect the body in real life. For example, if Snake falls and breaks his leg, he’ll walk with a limp until you do something about it; if you eat some spoiled food, you’ll get a gastrointestinal infection. It’s a groundbreaking system that challenges the player to think carefully about how to stay healthy and survive, and it beats the hell out of the trusty health pack in terms of authenticity – but how accurate is it really? Let’s take a look.

Patient: Snake, AKA… actually, I have no idea what his real name is.

Presenting Complaint: well, see for yourself:

In the clip above (via AdamSpencer87), Snake has a tense stand-off with his former teacher, The Boss, as she announces her defection to Russia. Snake, stunned, tries to stop her by force, but she overpowers him easily and rather casually throws him off the bridge – not before brutally snapping his arm at the elbow, just for good measure. Snake plunges into the river below and is carried a few hundred metres downstream by the surging current, eventually washing up on the bank. He’s wet, cold, and probably in extraordinary amounts of pain because, oh yeah, HIS ARM IS NOW BENT THE WRONG WAY. He’s also sustained a few hefty gashes on his arms and torso, all of which leads us to…

Doctor’s Notes: Snake’s medical problems are probably pretty obvious if you’ve watched the video, but let’s look at things in a bit more depth. First, he almost certainly has a fractured/dislocated elbow. It’s impossible to know the detail and severity of the fractures without an X-ray, but it takes a huge amount of force to make someone’s arm bend in the opposite direction, so it’s safe to assume that this is a serious injury. The biggest threat comes from disruption to the blood vessels and nerves that supply the rest of the arm and hand. If any of the three main nerves (radial, median, ulnar) are stretched or even severed by a piece of bone sticking out where it shouldn’t be, you’ll lose function in the muscles that are supplied by the affected nerve, and the arm will become weak and useless. Even worse, if the main artery that crosses the elbow (the brachial artery) is damaged, the blood supply to the forearm and hand will be lost, and the arm will die.

Yeesh. If that’s not enough, a traumatic injury like this will cause a lot of swelling in the limb as the body’s inflammatory response kicks in. Swelling increases the pressure within muscle groups, and if this gets bad enough, the rising pressure can restrict the blood flow to the muscles and can damage them permanently. This is called compartment syndrome, and in addition to being a medical emergency, it’s exquisitely painful; compartment syndrome needs an urgent operation to cut open the tissue surrounding the muscles and release the pressure (called a fasciotomy), otherwise the affected muscles will be irreparably damaged.

The two situations I talked about above – neurovascular injury and compartment syndrome – are at the worst end of the spectrum in terms of complications for this kind of fracture/dislocation. The best case scenario for Snake, assuming he can get his forearm facing the right way again, is that he will have a very sore, very swollen, very stiff left elbow for a few weeks, and he may not be able to regain full of use of it again. The worst case scenario is a dead arm – and I don’t mean “dead arm” as in, “my older brother punched me and gave me a dead arm”, I mean the arm has no blood supply and will need to be amputated to avoid gangrene. And let’s not forget about the lacerations to his upper body, which we’ll see in a later video – Snake is probably covered in all kinds of mud from his impromptu white water rapids journey, and those cuts are very likely to become infected.

Diagnosis: Snake’s had a rough day so far. Let’s list his medical issues before looking at how to treat them:

• Fracture/dislocation of the left elbow, which could lead to neurovascular injury, compartment syndrome, loss of function in the arm and even loss of the arm itself.
• Lacerations to his arms and torso, with a high chance of infection.
• Fractured rib; if this is sufficiently displaced, it can puncture other structures like the lung (causing a pneumothorax) or spleen (causing internal haemorrhage), depending on which rib is affected.

Treatment: I don’t normally look at how to manage the injuries sustained by our video game heroes, but MGS3 makes a point of letting you treat your various wounds and illnesses, so I wanted to assess how their medical knowledge stacks up.

(Video via Darkbitcold stone)

The advice given by ParaMedic in this clip is actually pretty sound: bone fractures generally need fixing in the correct position, often with a cast or splint, so that they heal fully; and lacerations will need disinfecting and bandaging, to prevent infection and blood loss. I do have a couple of issues, however. First, the elbow injury Snake has sustained was a high-impact trauma, and the damage to the bones and nearby nerves and blood vessels is likely to be quite complicated; I’m very doubtful that simply splinting the arm with a bit of wood will allow the elbow to heal properly. Second, there is no way in hell that Snake would be able to relocate his elbow like he did in the video. Reducing a dislocation or fracture is a delicate procedure, usually needing more than one person to apply gentle force in the right directions to get the bones facing the way they should. And, if you hadn’t already guessed, it is extremely painful for the patient – people often need sedation to relax them enough to perform the manoeuvre. So forgive me for not believing that Snake can just bite down on a piece of bark and yank his arm back into place without any assistance.

Real-Life Prognosis: that elbow is not going to heal properly. Snake has a high chance of losing significant function in the arm, and in the worst case, could lose the arm altogether. Those cuts are almost definitely going to become infected, too.

Video Game Prognosis: press a few buttons and, hey presto! Wounds healed, elbow never felt better. All thanks to a little bit of wood and some bandages. Now go get ’em, Snake!

Thanks for reading these silly articles. I really enjoy writing them, and as long as there are ridiculous acts of violence in video games, I’ll be there to tear them down with logic and medical science. Please let me know in the comments if you have any more suggestions for future subjects, and tell me if I can be doing anything better; there is a ton of jargon in medicine, and I want to try and strike the right balance of being understandable without insulting people’s intelligence. In the meantime, if you find that your elbow is bent in an awkward position, for the love of god, don’t try to put it back in place yourself. Just go to hospital.