Tokyo, 1994, starting with medical training

Chapter 67 Intuition

If it's just a matter of ordinary good luck, Takikawa Takuhei might be able to pull off a decent surgery.

But how about he explains the underlying principles?

He could explain it clearly; it's impossible that he's still just a medical student after all these years.

On the schedule for this surgery, the first assistant was Kazusuke Kiryu.

After eliminating all the impossibilities, only one possibility remains, and needless to say, it must have been him who did it.

"Alright."

Imagawa Ori stuffed the X-ray film back into the bag, interrupting Takigawa Takuhei's incessant chatter.

That's enough.

Did they mistake her for a medical trainee who knows nothing?

"Let's arrange for rehabilitation intervention as soon as possible."

"yes!"

Takikawa Takuhei could only shut his mouth, still feeling unsatisfied.

The next patient is in ward 612, a single room.

Although it's not an extremely luxurious VIP suite, it's still a high-end ward that requires out-of-pocket payment, and those who stay here are usually middle-class people with some financial means.

This patient was admitted to the emergency room yesterday afternoon and was assigned to Kenji Tanaka.

A humidifier was running in the ward.

On the hospital bed by the window sat a woman in her fifties, wearing an elegant silk nightgown, her hair still perfectly styled even during her hospital stay.

Mrs. Ando slipped and fell down the stairs yesterday, landing on her hands.

These middle-class housewives, who have a little money but are extremely afraid of death, are one of the most troublesome groups in the medical department.

They complain at the slightest inconvenience, and they call the doctor over to ask questions for ages about even the smallest things.

"Report your medical history."

Imagawa Ori stood by the bed, her hands in the pockets of her white coat.

Kenji Tanaka immediately stepped forward and opened the medical record folder in his hand.

"Patient Miyoko Ando, ​​54 years old."

"The chief complaint was pain and swelling in the right wrist, accompanied by limited range of motion, for one day."

"The patient's current medical history is that yesterday afternoon, while going down the stairs at home, he accidentally missed a step and fell, landing on his right palm and sustaining the injury."

"Emergency X-ray showed a distal radius fracture on the right side, with the fracture line located at the metaphysis and exhibiting typical dorsal displacement."

"Fortunately, there was no obvious collapse or step-like feeling on the joint surface."

"In summary, this is a typical Colley fracture."

"Considering the relative stability of the fracture ends, the initial diagnosis was conservative treatment, with manual reduction under local anesthesia. After satisfactory reduction, a plaster cast was applied for fixation."

This is a standard diagnostic and treatment plan.

Colley's fracture, also known clinically as a distal radius extension fracture.

The typical appearance of this type of fracture is that the distal fracture fragment is displaced dorsally, resembling an upside-down dinner fork, hence it is also referred to as "dinner fork deformity" during diagnosis.

This is one of the common cases in the First Surgical Department.

Kenji Tanaka has been working here for over a year and is very adept at handling the situation.

Mrs. Ando leaned against the pillows, holding a fashion magazine in her left hand, her eyes fixed on the crowd.

"Doctor, how long will the cast last?"

"I'm going to the first tea ceremony class next month, and it looks terrible with a cast on."

"Can we not use a cast?"

The first tea ceremony of the new year is called "Hatsufu".

For these wealthy women who use this as their social circle, this is a matter of utmost importance.

"Mrs. Ando, ​​it takes a hundred days to recover from a broken bone." Kenji Tanaka could only force a smile. "I'm afraid you won't be able to make it to the Hatsukama next month."

"Plaster casts usually need to be immobilized for 4 to 6 weeks, and rehabilitation training is required after the cast is removed."

"If you don't get a cast, the bone will grow crooked, and your wrist may become deformed and you'll always be in pain."

This is the standard answer.

But Mrs. Ando was clearly not satisfied. She frowned and patted the blankets on the bed with the book in her hand.

"Isn't there any other way?"

"I've heard there are minimally invasive surgeries available now. Is it possible to have one?"

Money is not a problem.

She turned her gaze to Imagawa Ori, who appeared to be the highest-ranking person in the group.

Imagawa Ori did not speak.

She picked up the bag of X-ray films from the bedside table, held it up, and looked at it against the light coming through the window.

A stark black-and-white image of bones came into view.

There is a clear fracture line at the distal radius, but it does not enter the articular surface. There is a slight angulation towards the dorsal side, and the overall alignment is acceptable.

It is indeed a Collesia fracture. Just put on a cast and go home to recover, and that's it.

Imagawa Ori watched for a while but did not offer any opinion.

"Takikawa, what do you think?"

She handed the film to Takikawa Takuhei, the specialist doctor beside her.

This is also a privilege reserved for senior physicians.

Examining subordinates also buys you time to think.

"Yes."

Takikawa Takuhei took the film and examined it closely.

Look at the front first, then the side.

Radial height, palmar tilt angle, ulnar deviation angle...

He quickly went through the data in his mind, but there was nothing particularly special about it.

This is a typical Corley fracture, with very little comminutedness; it's a whole bone.

"Judging from the X-ray, although there is some displacement of the fracture ends, it is not serious."

"The continuity of the bone cortex is relatively well-organized."

"Moreover, the patient's bone quality is quite good, with no obvious osteoporosis."

"I think Tanaka-kun's judgment is correct; conservative treatment is the first choice."

"Surgery allows for early mobilization, but it will leave a scar and carries a risk of infection."

"This is a bit of overtreatment for non-intra-articular fractures."

For cases like this that seem simple and whose surgical indications are borderline, it's better to do less than more.

Even with conservative treatment, if the recovery is slightly worse, the patient can only blame themselves for the severity of the fall.

If she has surgery and gets a scar, or if she develops any complications, this kind of difficult middle-class housewife will definitely cause a huge uproar.

This is based on experience.

"Um."

Imagawa Ori gave a noncommittal reply.

"Kiryu, come and take a look too."

But then she turned to the side, making room for the people behind her.

This immediately made the atmosphere in the ward somewhat strange.

Kenji Tanaka and Takuhei Takikawa exchanged a glance, both seeing the confusion on each other's faces.

Is there a problem with this?

impossible.

The emergency room report was largely consistent with the two people's assessment, and the radiology department did not call to report any critical values.

Did I miss something?

But at first glance, this film doesn't seem to have any problems.

However, Imagawa Ori had a gut feeling that something was amiss.

As a specialist who has reviewed countless X-ray images, she not only looks at the bones themselves, but also at the relative positions between them.

In this lateral radiograph, the arrangement of the carpal bones seems... a bit off?

But she couldn't figure out exactly what went wrong for the time being.

After all, X-rays are only two-dimensional projections, and many fine structures overlap, which can easily cause visual errors.

Kazusuke Kiryu did not refuse.

He took the film and, instead of looking at it through the window like the others, inserted it directly into the film reader on the wall.

Snapped.

The switch was turned on, and the cool white backlight illuminated.

He stepped forward and stood in front of the film review lamp.

With just one glance, he automatically created a three-dimensional model of the wrist in his mind.

On the anteroposterior radiograph, the fracture line at the distal radius is indeed very clear.

I looked at it carefully for a few more seconds.

Kazusuke Kiryu had already made a diagnosis in his mind.

(End of this chapter)