Is there no limit to this doctor's skills?

Chapter 161 One teacher, one student, remained completely silent!

A C-arm X-ray machine, also known as a mobile C-arm X-ray machine, is a medical device used for real-time imaging during surgical procedures.

It gets its name from its C-shaped external frame.

Its main function in orthopedics is to provide temporary fluoroscopy!

During intramedullary nailing, the first fluoroscopy is performed when the guide pin passes through the fracture ends.

The purpose of fluoroscopy is to confirm that the guide needle has passed through the fracture ends and that the distal end of the guide needle is still inside the medullary cavity.

However, C-arm fluoroscopy is only one way to determine this.

A simpler and more effective method is to use a guide needle to make a "thump-thump-thump" sound.

If the guide pin passes through the fracture site and enters the soft tissue, you won't hear a "thump thump thump" sound when you perform the procedure.

You'll be surprised to find the tip of the needle protruding from somewhere on your skin, even giving you a devilish smile...

However, it is clear that Guo Ziyuan is not a novice orthopedic surgeon; he has absolute confidence in his insertion of the guide pin.

Shan Chenchu ​​is an associate chief physician. If he can't even hear the sound of Guo Ziyuan's guide needle tapping the blind end of the medullary cavity, he should have changed careers long ago.

Patients won't allow you to treat them worse just because your father is a department head.

"Reset it!" Shan Chenchu ​​finally had a bad feeling.

He turned his head and looked at Guo Ziyuan, his eyes momentarily filled with fear.

His broad eyebrows began to stand up, and his outer eye socket and inner eyeball formed an almost parallel ring.

After Nie Yunqi pressed down on the lower part of the patient's thigh to stabilize it, Guo Ziyuan did not hesitate to grab the patient's ankle with both hands and begin to apply traction.

The treatment principle for fractures is divided into three steps.

Repositioning, fixation, and rehabilitation!

The main purpose of the surgery is to reposition and fix the object.

Before complete anatomical reduction, temporary reduction and fixation need to be performed manually!

The temporary reduction using manual reduction is further divided into approximately two steps.

Complete traction.

To restore fracture displacement, with precision down to anatomical reduction or near-anatomical reduction.

Guo Ziyuan skillfully pulled the lower limbs until the muscles were completely relaxed, and then slowly externally rotated the ankle, which was originally somewhat internally rotated, to the "functional position"!

An incredible scene unfolded: the lower limbs, which were originally in a deformed position, were perfectly stabilized into a functional position.

This time, Guo Ziyuan did not casually say that he could not see through objects.

"C-arm, mid-tibia, anteroposterior and lateral view." Guo Ziyuan placed a gauze pad with a display strip on the patient's mid-tibia and lower leg for positioning.

"We've seen through it! Everyone, step outside for a bit," Guo Ziyuan called out.

Orthopedic operating rooms have special isolation rooms made of lead plates, which are usually located next to the operating room.

Unless it is a particularly urgent surgery, orthopedic surgeons will not wear lead aprons and be exposed to radiation during surgery.

Shan Chenchu ​​nodded mechanically and followed Guo Ziyuan and his group out of the operating room.

The circulating nurse started pushing the C-arm machine.

She held the remote control herself, so the timing of when the X-ray was activated was determined by the circulating nurse.

The C-arm machine is not heavy. If there are no extra orthopedic surgeons present, the circulating nurses will help push the C-arm machine.

After all, Yilan Central Hospital does not have a professional operating room imaging technician.

……

After the circulating nurse arrived at the isolation room, she pressed the shutter button on the remote control.

The C-arm machine's panel flashed for a moment, and then a calf anteroposterior X-ray appeared on the panel.

The objective position at the moment of perspective was fixed as a 'film'.

The circulating nurse continued to enter the operating room and moved the head of the C-arm machine to perform lateral positioning.

Her movement of the C-arm camera at this moment did not affect Guo Ziyuan and others' viewing of the film.

Guo Ziyuan, Shan Chenchu, and the others all focused their attention on the C-arm machine's image reading panel.

The patient's right lower limb tibia is shown in an anteroposterior view, revealing the cortical bone, medullary cavity, and guide pin!

This contrasts sharply with the C-arm fluoroscopy images taken before the surgery.

Before the operation, after the patient's midshaft tibia fracture, the distal end of the fracture was offset medially and laterally towards the tibia.

The current radiographs show that the cortex of the distal and proximal ends of the fracture is almost joined together.

The medullary cavity has become a relatively closed cavity!

The extraosseous cortical shadow of the tibia and the intraosseous cavity shadow form a smooth and standard "curve"!

The force lines of bones are vertical, but the shape of bones is not a standard straight line.

Most bones in the human body have a certain degree of smooth curvature.

This was a near-perfect reset.

Moreover, Guo Ziyuan only had his body reset once.

It's not that after resetting, an X-ray is taken, then the resetting and adjustment are made based on the X-ray results, and then the resetting is performed again.

For chief physicians at Yichang Central Hospital, having to reposition a patient three or four times is perfectly normal.

Although it's not uncommon for someone to successfully reset the device on the first try, such cases are extremely rare, occurring only once or twice every six months to a year.

This is mostly a coincidence.

but?

Dan Chenchu's understanding was shattered, and his Dao heart finally began to crumble!

He was wearing a mask, so no one saw his stubble trembling as his facial muscles twitched.

"Dr. Guo..."

"The repositioning is quite good." After saying that, Shan Chenchu ​​shut his mouth, his eyes and emotions unreadable.

Dan Chenchu ​​swallowed three or four mouthfuls of saliva in a row, almost drowning in his own saliva.

Guo Ziyuan nodded, his tone as usual: "It's not bad!"

Guo Ziyuan did it on purpose.

This is the best thing for the patient, the best thing for Shan Chenchu, and the best thing for ourselves.

I have this skill, so I can't possibly deliberately not show it just to consider your psychological balance, Shan Chenchu, right?

The circulating nurse went out again and, seeing that no one was exposed outside the operating room, pressed the photo button once more.

After a brief screen flicker, the side-by-side upright images were refreshed.

Instead, we have freshly produced lateral calf X-rays!

The purpose of a positive-view image, simply put, is to display a two-dimensional space from left to right.

A lateral view, simply put, shows a planar space from top to bottom.

It can be observed that the medullary cavity in the lateral radiograph also forms a smooth arc, and the proximal and distal cortex and medullary cavity of the fracture fit together perfectly.

This is an extremely high-quality reset effect.

In fact, if it weren't for the fact that this was a guide needle that penetrated into the bone marrow cavity, it would be difficult for anyone to discover the subtle and barely visible fracture line.

Guo Ziyuan was admitted to the orthopedics department. He only glanced at the room before going straight inside.

"Expand your spinal cord! Starting from the 9th, we should be able to provide it up to the 12th..." Guo Ziyuan shouted to the circulating nurse.

"Prepare the intramedullary nail mold, approximately size 11!"

"If size 11 is a good fit, then we'll just use size 11 implants!" Guo Ziyuan provided plenty of information.

The medullary reamer and the tibial scalpel are two different things.

Generally, if the medullary cavity is narrow, it needs to be gradually enlarged with a reamer to ensure successful implantation of the intramedullary nail.

Some non-reamed intramedullary nails can be implanted directly.

However, non-reamed intramedullary nails are extremely rare. Guo Ziyuan in his previous life had never used one, and he didn't even bother to ask.

The intramedullary nail mold is a metal mold similar to a prosthesis, manufactured by a company, and serves as a "prototype" for temporary adaptation to intramedullary nail fixation!

It can be similar to the shoe sizes you see on the shelf when you go to buy shoes.

Guo Ziyuan's "medical advice" was quite accurate.

The surgical nurse, Chen Lingzhi, finally dared not say anything more this time.

She is a specialist nurse in orthopedics and has performed so many fracture surgeries.

If she still can't see by this point that Dr. Guo Ziyuan is an expert in orthopedics, then she might as well quit being a specialist nurse.

Capable people tend to be arrogant when their professional abilities are questioned.

Moreover, he brought this on himself!

Why do you question someone else's professional competence?

"Here you go, the bone marrow expander, number 9." Chen Lingzhi's voice was soft and sweet, and her attitude was obedient.

The look in their eyes began to show worship.

Even Chen Lingzhi's beautiful eyebrows and phoenix eyes were scrutinizing Guo Ziyuan's earnest gaze.

According to them, Dr. Guo is not very old; he is only of master's age.

He's quite handsome.

He has a calm and composed demeanor, but can be ruthless when necessary.

Judging from his eyebrows, if Guo Ziyuan weren't a mask killer, he would be an absolutely handsome and masculine man.

This can be seen from the bulging biceps that Guo Ziyuan accidentally showed during surgery.

Or, to put it another way, an orthopedic surgeon, as long as it's not kidney failure!

Basically, you don't need to worry about physical strength.

Just focus on doing your job well. If you're short, just make sure you don't get shaken to death when the wok is flipped.

They can even use the strength of their hands to make you do it...

Of course, this was all hearsay from Chen Lingzhi; at present, she was still just a young woman.

At most, it's just the 'young woman' who occasionally looks at erotic pictures!

Chen Lingzhi's ears turned slightly red for a moment...

However, Chen Lingzhi still listened intently, afraid of missing a single word from Guo Ziyuan.

This man is no pushover; he's quite fierce.

"Number 10".

"Just give me number 12." Guo Ziyuan's actions were smooth, his judgment was experienced, and his movements were swift.

Of course it's done smoothly. Guo Ziyuan had performed at least several hundred such surgeries in his previous life.

He can even sense what to do next by tethering a dog.

"Trial molding".

"Get a size 11 implant!"

After receiving the actual prosthesis, Guo Ziyuan carefully pushed it into the medullary cavity along the guide pin.

This is a push, which requires a lot of force.

With the nail tail flush with the bone end, Guo Ziyuan also confirmed that there was no rotation or displacement.

"Let's see through it again!"

"If there are no problems, can I step down now, Director Shan?" Guo Ziyuan asked as he left the operating room, handing it over to the circulating nurse to push the C-arm machine.

The problem was handed over to Shan Chenchu.

Anyone who has had fracture surgery knows this!

The treatment of fractures involves reduction and fixation.

The difficulty of the surgery lies in repositioning the patient!

How to fix it after repositioning?

Medical device companies have already prepared the "formulas"...

What is a "formula"? It's an existing routine that you just need to follow.

If the reduction is effective and the intramedullary nail is perfectly placed, then it is only necessary to drill holes at the distal and proximal ends of the fracture and insert locking screws to enhance stability.

These screws have special instruments that create corresponding holes. You just need to cut open the skin according to the holes and insert the locking screw.

To put it more simply.

For example, doing exercises.

The top student has already finished the answers; you can just copy them without needing to add anything yourself.

You don't need to use your brain to create anything "original" or "analytical"!

Shan Chenchu ​​is certainly not a fool.

He was certainly aware that he was now a complete "clown".

The reasons and schemes behind his decision to bring Guo Ziyuan to the operating room now seem more clownish than a clown's!

"But I still think that learning more formal orthopedic surgery techniques is the best course of action."

"Our team's last two surgeries were for tibia and fibula fractures and humerus fractures."

"These are all standard trauma surgery procedures."

"It's perfect as an introductory disease category."

This was what Shan Chenchu ​​said in less than thirty minutes.

Therefore, Shan Chenchu ​​certainly remembered it.

Yes, less than half an hour had passed since Shan Chenchu ​​said those words.

In fact, from the start of the surgery until now, the timer in the operating room has only gone on for 00:11:23:33!

It took Guo Ziyuan about six or seven minutes to get from the emergency department to the operating room in the surgical building.

Five minutes to change clothes, three minutes to wash hands, and one minute to put on the surgical gown...

During the eleven minutes of the surgery, Guo Ziyuan also had an X-ray examination once. Each X-ray examination and positioning process must have required at least a minute of adjustment time, right?

So, in fact, Guo Ziyuan only took about nine minutes to complete an intramedullary nail fixation surgery for a tibial fracture.

The average operation time for this type of surgery at Yilan Central Hospital is one hour.

This is no exaggeration!

This is data that Shan Chenchu ​​himself knows.

Guo Ziyuan, 11 minutes.

Even including the time spent tightening the locking screws, it only takes about half an hour at most.

It saved almost half the time.

Shan Chenchu ​​knew where people from her hospital would waste time.

The first step is guide needle puncture.

Our staff uses a "golden finger" to insert the guide needle!

The "golden finger" is not a cheat code found online; it's a tool that helps guide a needle through the fracture site, delivering the needle to the distal end of the fracture.

Then, an X-ray will be taken to confirm that the guide needle has entered the bone marrow cavity.

Reset!

A typical fracture reduction procedure usually involves multiple reductions.

Three or four times is rare, but ten or twenty times is not uncommon!

If anyone claims to have performed fracture surgery and can get the fracture back in place in about ten attempts, you can just turn around and leave.

This isn't a proper orthopedic surgeon at all; he's just talking big...

What if he doesn't talk nonsense?

You can leave now. You're not worthy to talk to someone like that. Who do you think you are, and who do they think they are?

Re-examination, repositioning...

It's the theme song for fracture surgery.

There's only one possibility why Guo Ziyuan didn't play the theme song: his skill level far surpasses the average.

Guo Ziyuan wasn't uninterested in trauma surgery, but rather in the simple surgeries performed at his hospital!

In Guo Ziyuan's view, the fracture surgeries performed in his department are exactly the same as the debridement and suturing he does in the emergency department's operating room!

The results of the X-ray examination are in, and they are perfect.

Under the spatial compression of the intramedullary nail, the alignment of the medullary cavity and the cortical bone is closer to perfect.

Of course, Guo Ziyuan didn't leave immediately; he wasn't in a hurry.

……

Guo Ziyuan waited patiently for the lateral radiograph to come out before he could finally relax.

He expressed his gratitude: "Director Shan... thank you for the teaching surgery."

"I think I should go."

After Guo Ziyuan finished speaking, he began to take off his clothes.

Anyone with eyes can see that Guo Ziyuan is being sarcastic.

Who was the lead surgeon before? Who was the instructor?

It's Guo Ziyuan.

However, Guo Ziyuan said that Shan Chenchu's teaching had two points.

First, it should be stated that the surgeon is Shan Chenchu.

There are still operations to be performed, and Shan Chenchu ​​has to step in, otherwise you won't be able to take the lead.

Secondly, I feel I should leave.

What I'm saying is, shouldn't you, Shan Chenchu, also feel like you should get out of here?

What kind of J8 can you teach me?

Facts speak louder than words.

A direct, professional rebuke is more painful, more memorable, and more irrefutable.

You keep teaching them, but they never say a word!

As expected, Shan Chenchu ​​remained silent and dared not utter a sound.

……

The circulating nurses didn't dare to breathe.

The scrub nurse watched Guo Ziyuan's departing figure with a mixture of curiosity and fear.

Will Guo Ziyuan complain about himself to the nursing department?

He said he would go.

Director Shan is really something, why didn't he tell us earlier that Guo Ziyuan was such a powerful expert?

Ignoring everything else, let's just look at the surgery time.

How many surgeons would dare to just drop the knife and leave after ten minutes or so?

……

After Guo Ziyuan left, Shan Chenchu ​​turned to Nie Yunqi and asked, "When did your provincial hospital start performing intramedullary nailing surgery?"

Shan Chenchu ​​couldn't think of any other reason, so this was the only one she could come up with.

Guo Ziyuan was fed intramedullary nails every day at the Provincial People's Hospital, and he dreamed about intramedullary nails.

They even rubbed it every day while wearing the inner tube nail cover!

It must be a rape!

Nie Yunqi's mind was also a bit foggy at this moment, so he was seriously thinking about the question: "It was probably in the 90s."

The 1990s were a period of rapid development for intramedullary nails, and many hospitals in China were using this internal fixation device at that time.

It wasn't until medical science continued to advance and medical resources were increasingly distributed to lower levels that most prefecture-level city hospitals and county hospitals began routinely performing fracture surgeries.

The number of fracture patients in top teaching hospitals is gradually decreasing, until they are almost "disappearing"!

Asking is pointless!

Shan Chenchu ​​was in a bad mood at the moment.

If teaching and having Guo Ziyuan undergo surgery are not enough reasons to lure him into the operating room, what other reasons could there be?

Unable to provide an answer, Shan Chenchu ​​could only continue performing surgeries!

He has to be the surgeon, so he must finish the remaining work of tightening the locking screws before he can officially be considered the surgeon.

Collect the surgeon's fee.

About ten minutes later!

Just as Shan Chenchu ​​finished implanting the locking screw, and was about to clean the incision so that Peng Lei could finish suturing,...

Guo Ziyuan stepped into the operating room again: "Brother Nie, let's cancel the next surgery!"

"For a subcutaneous hematoma of this severity, it's best to let it subside for a while before performing surgery."

"Huh?" Nie Yunqi was very surprised when he heard Guo Ziyuan's words.

Subconsciously, Nie Yunqi nodded: "Oh."

However, Nie Yunqi discovered a crucial point: "Wait, Xiao Guo, how do you know who the next surgery patient will be?"

Only orthopedic surgeons can see the surgical schedule.

Guo Ziyuan can go and see the operating room's surgical schedule.

However, the surgical schedule only shows the surgical method.

Guo Ziyuan had clearly reviewed the surgical patient's medical records and X-rays...

Guo Ziyuan was too lazy to explain to Nie Yunqi that he knew Nie Yunqi's employee ID account and password by heart.

Moreover, he wasn't afraid of Nie Yunqi investigating.

The operating room's surgical slip contains the patient's hospital number, and Guo Ziyuan can access this information using the emergency department's account and password.

"Of course it can be done, but the recovery will be a little slower..." Guo Ziyuan said and then left.