Tokyo, 1994, starting with medical training

Chapter 20 Bring me a needle!

The four Kirschner wires form a temporary internal and external support system.

The shattered joint surfaces have been initially stabilized.

So far, everything has gone smoothly, even more smoothly than expected.

Next, we deal with the smaller, free-floating bone fragments.

The anesthesiologists and nurses all stopped what they were doing and stared at the scene in disbelief.

Is this something a resident physician could perform?

Is this really not a machine that has already performed thousands of similar surgeries?

"Periosteal elevator".

Kazusuke Kiryu put down the hand drill and began cleaning a small piece of bone attached to a ligament.

He needs to peel the bone fragment off the surrounding soft tissue and then put it back into the defect on the joint surface.

This is an extremely delicate operation.

Just as he gently touched the bone fragment with the tip of the dissector, an accident occurred.

The bone fragment was not pried up as expected.

It moved only slightly, and then the entire joint surface structure experienced an extremely subtle, ominous vibration.

All the bones in the surgical field underwent a chain reaction of tiny displacements, like dominoes falling.

"Occult ligament tear combined with joint instability."

Kazusuke Kiryu paused for a moment.

Imagawa Ori frowned as well, quickly identifying the problem.

Kazusuke Kiryu is right.

This is a problem that cannot be detected by X-rays or CT scans.

When the patient fell, not only did he suffer a fracture, but the ligaments connecting the bone fragments also tore in a way that was not visible to the naked eye.

This results in the overall stability of the wrist joint being far worse than it appears on imaging.

Conventional reset methods are ineffective here.

Any attempt to reposition a single bone fragment will damage other structures that have already been repositioned, through the torn ligaments.

This is a dead end situation where a single move could have far-reaching consequences.

"Stop, I'll do it."

Imagawa Ori's voice came through.

The only remedy now is to abandon prying and directly install steel plates, using pressure screws to press everything together, sacrificing some joint surface flatness in order to preserve the larger structure.

Although the patient's joint function will be severely affected after the operation, at least the worst outcome of the joint completely collapsing can be avoided.

This is an operation that only she, as the chief surgeon, can perform.

Kiryu Kazusuke ignored her.

He maintained the posture of holding the periosteal elevator.

"I told you to stop!" Imagawa Ori emphasized. "I'm taking over the surgery now. You can leave."

But Kiryu Kazusuke still didn't move.

He closed his eyes, and after two or three seconds, he opened them again.

"Open 5 1.0 mm Kirschner wires."

He put down the periosteal elevator and reached out his hand.

The scrub nurse was stunned. She blinked and looked at the surgeon.

Imagawa Ori was about to erupt.

"Don't make a sound."

Kiryu Kazusuke said in a deep voice, without even raising his head.

Upon hearing this, everyone stopped what they were doing.

Takikawa Takuhei's mouth dropped open. A resident doctor was telling the surgeon to shut up?

The scrub nurse also felt that the world had gone mad, but she dared not make any moves because she did not have the surgeon's permission.

Even if he's an assist, he's still just an assist in the end.

Kiryu Kazusuke's hand hovered in the air for a few seconds, but he didn't get the Kirschner wire he wanted.

There was no response.

But he didn't withdraw his hand. Instead, he stared at the floating bone fragments in the surgical field and spoke calmly.

"The problem now is not with the bones, but with the loss of soft tissue tension."

"Give me the needle, and I will use a multi-point anchoring method to first rebuild the soft tissue tension, and then use the ligament traction to allow the bone fragments to automatically return to their position."

After speaking, he slightly raised his eyes and looked at Imagawa Ori.

Imagawa Ori stared into his eyes.

Reconstructing tension?

This is theoretically feasible, but it requires godlike control over anatomical structures and the use of Kirschner wires.

Is it possible for the resident doctor opposite her?

"Bring me a needle."

Kiryu Kazusuke asked again in a deep voice.

"Give it to him."

Imagawa Ori gritted her teeth.

If we don't do it, this hand is practically useless.

If you do it, there might still be a sliver of a chance!

Anyway, the worst outcome can't be worse than it is now.

Of course, that's what they say, but what if Kiryu Kazusuke is ultimately just spouting nonsense...

Although there's no way to kick him out of the clinic outright, he won't be involved in her surgeries anymore, not even in writing medical records!

The scrub nurse immediately placed five thinner Kirschner wires in Kiryu Kazusuke's hand.

Kazusuke Kiryu picked up the first one.

He gently pressed the edge of the surgical field with his left index finger to determine the first needle insertion point.

The first needle was inserted obliquely from the base of the ulnar styloid process, not targeting the bone fragment, but rather the triangular fibrocartilage complex (TFCC) area of ​​the wrist joint.

The needle tip pierced the skin, precisely inserting itself into the edge of the torn ligament at an extremely tricky angle.

He didn't go any deeper, but instead gently bent the end of the Kirschner wire outwards.

This Kirschner wire becomes a miniature lever, instantly tightening the loose ligament structure.

"The second one."

With another needle in hand, Kiryu Kazusuke found another insertion point on the lateral side of the radial styloid process.

This time, the needle was aimed at the radial collateral ligament.

The same action is performed: puncture, and then the lever effect of the needle tip is used to tighten the ligament structure on the radial side.

In the operating room, everyone held their breath.

What is he doing?

He wasn't fixing the bone; he was using Kirschner wires to rebuild the entire ligament tension system of the wrist joint.

This is an unprecedented operation!

Takikawa Takuhei also craned his neck, trying to see every detail clearly.

Although his skills are not superb, he has the ability to discern whether others' skills are superb, just as customers do not need to know how to cook.

Imagawa Ori fell into deep thought.

She understood.

Kiryu Kazusuke's approach was not to fix the unstable bones one by one, but to do the opposite.

He first used Kirschner wires to construct a temporary ligament support. Under the action of this support, all the bone fragments that had shifted due to ligament laxity would be re-constrained and repositioned by external tension.

This idea is brilliant!

However, the required operational precision is simply beyond the capabilities of humans.

The nerves and blood vessels around the wrist joint are intricate, and even a deviation of one millimeter can lead to disastrous consequences.

"The third one."

Kazusuke Kiryu's voice remained steady.

This needle is inserted into the center of the back of the wrist joint, targeting the intercarpal ligament on the back side.

"The fourth one."

This time, the needle is inserted from the palm side to fix the ligament structure on the palm side.

Four 1.0 mm Kirschner wires, from four different directions, construct a perfect quadrilateral tension network.

Under the influence of this tension network, the joint surfaces that had already undergone slight displacement miraculously, slowly, and automatically returned to a flat state.

Those tiny bone fragments seemed to have been pressed back into their original positions by an invisible hand.

The entire surgical field, which had been in chaos, became orderly.

"The fifth one."

Kazusuke Kiryu picked up the last Kirschner wire.

He did not add any new fixed points.

Instead, gently tap the tip of the needle against the ends of the four fixed Kirschner wires one by one.

"bite."

"bite."

"bite."

"bite."

Four crisp metallic clanging sounds rang out in the quiet operating room.

Each tap causes the corresponding Kirschner wire to vibrate extremely slightly.

This vibration is transmitted through the steel needle to the ligament structure, releasing excess stress and allowing the entire tension system to reach final equilibrium.

"Periosteal elevator".

Kiryu Kazusuke gently touched the small bone fragment again with the tip of the bone-peeling tool.

This time, the entire joint surface structure was rock-solid.

Then, he easily pried up the bone fragment and, like a jigsaw puzzle, perfectly fitted it into the defect on the joint surface.

perfect.

Perfect repositioning in an anatomical sense.

And so, art is complete!

(End of this chapter)