Tokyo, 1994, starting with medical training

Chapter 54 is indeed good.

To be honest, Takikawa Takuhei felt a mix of emotions.

He is thirty-four years old this year.

His peers either obtained their specialist qualifications long ago or couldn't bear the suffering and switched to becoming general practitioners, while he was still struggling in the First Surgery Department.

It's not that he didn't try.

He works harder than anyone else, arriving earliest and leaving latest every day, and always volunteering to do all the dirty and tiring work.

His notes were the thickest when the professor was lecturing.

But the world of surgeons is a cruel, results-oriented world.

Being clumsy is the original sin.

His hands weren't dexterous enough, and his mind wasn't quick enough. He was always a step behind on the operating table and couldn't understand the professor's techniques, which were "more felt than explained."

But he was just not willing to give up.

Unable to accept that after all the hard work of studying for medical school, all I could do was go to a rural clinic to prescribe blood pressure medication to the elderly.

Today, he was hit hard again.

A medical trainee who had only graduated six months prior understood the operational logic in just a few casual words.

"Senior, don't let go."

Kiryu Kazusuke stood opposite him, not giving him much time to wallow in self-pity, and reminded him.

The fracture ends have been anatomically reduced, and the soft tissue hinge tension is perfect.

However, if temporary fixation is not performed immediately, the tension from muscle contraction will cause the bone to spring back open once the clamps are loosened, rendering the repositioning ineffective.

"Ah! Okay!"

Takikawa Takuhei snapped out of his daze and quickly agreed.

But he soon discovered an embarrassing reality: both his hands were occupied by the reset pliers, leaving him no free hand to hold the electric drill.

If Professor Nishimura or Assistant Professor Mizutani were to take the stage, they should loudly reprimand the resident doctor to come and take over the forceps.

"Operate with one hand, use Kirschner wire for temporary fixation."

Kazusuke Kiryu spoke up again to remind him.

Having just received the "Perfect Fracture Anatomy Reduction Technique" from Imagawa, he is confident that he can maintain the reduction entirely using muscle tension, without even needing forceps.

But Takikawa Takuhei couldn't do it.

He is a mortal and must rely on tools.

"clear!"

Takikawa Takuhei took a deep breath, switched his left hand to grip the handle of the repositioning forceps, freeing up his right hand.

"Kirschner wire, 1.5 mm, electric drill."

The scrub nurse patted the drill with Kirschner wires attached into his palm.

Although the final step is to install steel plate screws, it is necessary to temporarily fix it with Kirschner wires first as a precaution, freeing up the reset pliers to make way for the steel plate.

Takikawa Takuhei picked up the electric drill and began drilling the first remote locking hole.

With perfect repositioning as a foundation, the remaining internal fixation procedures are purely carpentry work.

Even if he's incompetent, he wouldn't mess this up.

The first Kirschner wire passes obliquely through the proximal cortex, through the fracture line, through the butterfly-shaped bone fragment, and finally into the distal cortex.

It feels very solid.

Takikawa Takuhei then inserted a second Kirschner wire, which intersected with the first one for fixation.

That's it now.

Takikawa Takuhei released his left hand and removed the reset clamp.

The fractured ends remained perfectly still, maintaining perfect anatomical alignment.

He finally breathed a sigh of relief.

"Next, we'll install the plate." Takikawa Takuhei's confidence returned somewhat. "Distal fibular anatomical plate, 7 holes."

In 1994, before the widespread use of locking plate (LCP), one-third tubular plate or dynamic pressure plate (DCP) of the AO standard was used.

These types of steel plates are not pre-shaped and need to be manually bent by the doctor during the operation according to the shape of the bone.

Takikawa Takuhei took the bending pliers.

He began to bend the steel plate forcefully, following the curve of the fibula.

Once, twice.

He compared it to the bone surface, felt the curvature wasn't enough, and bent it again.

"That's about it."

He attached the steel plate to the outside of the fibula and held it in place with bone clamps.

Then they started drilling, measuring depth, tapping, and screwing in screws.

Throughout the entire process, Kiryu and Kazusuke simply stood quietly in Ichisuke's position, holding a hook in their hands, responsible for exposing their line of sight, without uttering a word.

But he was thinking something else entirely.

The pre-bending curvature of the steel plate is slightly insufficient, and the fit at the far end is slightly poor.

While screws can provide a tight seal, the extra tension can cause postoperative swelling to last for two more days.

The insertion point of the first screw near the proximal end is a bit too far forward.

Although it does not affect the fixation strength, it may irritate the peroneus longus and brevis tendons, leading to postoperative pain.

If the tapping hand is unsteady, the thread engagement force will be poor.

To prevent the screws from loosening, postoperative rehabilitation training must be postponed for at least two weeks.

You've made great progress, Takikawa-senpai.

But Kiryu Kazusuke did not speak up to correct him.

First, although these flaws exist, they are all within acceptable limits.

This is the so-called "functional restoration" standard. As long as the bone has healed and the patient can walk, the surgery is considered successful.

He himself can pursue ultimate perfection, but to demand that of a mass-produced doctor like Takikawa Takuhei is to nitpick.

Secondly, in the end, he was just an assistant.

Unless the surgeon's actions would cause a serious medical accident, the assistant surgeon has no right to criticize the surgeon's technique on stage.

That's overstepping authority.

The instructions on resetting the device earlier were just a temporary fix. If we were to interfere with even things like hammering nails or inserting steel plates now, wouldn't that be just looking for trouble?

Of course, Takikawa Takuhei was unaware that he was being criticized so harshly.

He was basking in the exhilaration of the successful surgery.

Nourishes—

Tighten the last screw.

The C-arm machine was pushed in to see through the image, and a clear image was displayed on the screen.

The length of the fibula has been restored, the rotational deformity has been corrected, the articular surface is smooth, and the plate fits well.

If you were to measure it with a ruler, you might find that the physiological curvature of the fibula is slightly straighter, and the tip of the lateral malleolus is about half a millimeter higher.

But in Takikawa Takuhei's eyes, this was perfect.

This was the most brilliant fibular fracture surgery he had ever performed in his career.

"Beautiful!" He couldn't help but give himself a thumbs up. "Kiryu-kun, look at this reset, it's absolutely amazing."

Kiryu Kazusuke awkwardly chuckled and chimed in, "It's really good."

"So, should we work on the medial malleolus next?"

"Okay! Let's work on the medial malleolus!"

Takikawa Takuhei turned around and began to treat the fractured tibia on the inside of his body.

Compared to the comminuted fracture of the lateral malleolus, the fracture line of the medial malleolus is relatively simple, consisting of a transverse fracture.

All you need to do is reposition the bone fragments and then insert two hollow screws.

But before starting, Takikawa Takuhei subconsciously asked, "On the medial malleolus, can't we just insert two 4.0 hollow screws?"

Kazusuke Kiryu glanced at the X-ray image on the C-arm machine.

"no."

"Look here, the fracture line may seem simple, but it was caused by vertical shearing force."

"If only hollow screws are used, the shear resistance is insufficient, and the fracture fragments will shift proximally when bearing weight after surgery."

"We must use steel plates."

"Use a T-shaped support steel plate for anti-slip fixation."

The book does have this concept, but in practice, people usually just use two nails to save time.

Takikawa Takuhei paused for a moment, then nodded: "Whatever you say."

The next step is not difficult.

The skin was incised, the subcutaneous tissue was separated, the fractured ends of the medial malleolus were exposed, the fracture was reduced, and a plate was placed.

Takikawa Takuhei's movements became much faster.

When the last stitch was tied and cut, the clock on the wall pointed to 5:30 p.m.

"Thanks for your hard work."

Takikawa Takuhei took off his surgical gown, looked at the stable vital signs on the monitor, and let out a long breath.

This was absolutely the fastest double ankle fracture surgery of his career!

Ten minutes have passed in an hour.

This surgery, which was originally expected to take at least two hours and might even drag on into the evening, has already ended.

Moreover, the quality of postoperative repositioning in the past could only be described as passable.

But today...

Looking at the near-perfect reset image on the C-arm screen, he was overwhelmed with excitement.

(End of this chapter)