Chapter 53: Chapter 0051: Really Didn’t Understand

“A traction abduction position, the fracture hasn’t been properly realigned, and we’re already ready to operate?”

“Wait till later when we’re in trouble and the intramedullary nail can’t be inserted.”

“Is it that this kind of fracture is seldom treated?”

“Let’s see, I’m not sure either.”

“Heard it is supposed to be normal walking the day after surgery, whether the operation can be completed now is still uncertain.”

“Overblowing things, it will burst.”

The next-door teaching room started to discuss, everyone was very disappointed with the opening scene.

Like a movie, heavily promoted before release, everyone is eager to see it. On the day of release, the streets are empty as everyone rushes to the theatre, but after finally managing to buy a ticket and watching it– it’s a lousy movie, no eye-catching scenes at all.

The towering image of Yang Ping also lost some credit in the young people’s hearts. As the saying goes, even a clever wife often overspends, talent depleted, everyone sighed in their heart.

In older people with osteoporotic femur fractures, a minimally invasive approach is usually used. The PFNA intramedullary nail is the first choice for internal fixation of these fractures. This surgical technique, positioning is very important, internal position or neutral position are acceptable, definitely cannot proceed with an abduction position, the intramedullary nail simply can’t be inserted. Realignment of the fracture is equally important, the fracture must be realigned first, otherwise, the next steps can’t be carried out. Correct position and good realignment are necessary conditions for surgery.

How can the operation be successful now when the two mandatory conditions are not met?

In the neighboring teaching room, there are senior doctors like Dr. Jin, and directors such as Director Ouyang and Director Bai, all of them want to see Yang Ping perform surgery, after all, the legend of how miraculous Yang Ping is has been circulating among them.

Among the young doctors, besides the ones rotating and students in standardized training, the majority specialise in orthopedics, possessing basic understanding of these routine operations. Seeing that the procedure has already started even before achieving necessary positioning and reduction, they couldn’t help but voice their opinions.

“This young man probably doesn’t have much experience with lower limb fractures, rushed to the battle?” asked Fatty, an attending physician under Dr. Bai, to Dr. Jin.

Dr. Jin shook his head: “I don’t understand!”

Fatty said: “Why would Director Han feel reassured to let him go ahead, not even checking his basics. There are plenty of people who are good at hand surgery but all other surgeries are a mess.”

“Probably Director Han was in a hurry to catch his flight, he didn’t explain clearly?” another doctor suggested.

“Impossible, it was said that Elder Man Zhang himself specifically requested him to do it.” someone who knew the situation explained.

“This is an awkward situation now, but it’s fine, Tian Yuan will definitely come later, if it doesn’t work out Tian Yuan can handle it, it’s a matter of minutes.” someone from the spinal surgery department joined the discussion.

“This operation is simple actually, the bone fragment on the inside, I heard it’s embedded in the muscle, it won’t be able to be realigned if not cut open. In minimally invasive surgery, this kind of bone fragments can be ignored, as long as the main bone fragments are matched properly in the front and side view, just insert the nail and it will be done. Now, even the main bone fragments are not realigned well, how will this end later?”

“What realignment, even the body position is misaligned.”

People became more and more daring to speak out.

At this time, Tian Yuan also came in. Seeing that Song Zimo was there and there was no shortage of hands, he didn’t want to stay in the operating room, fearful of Elder Man Zhang’s dislike of a crowded room and the lax sterile concept, so he simply came to the next room to observe along with everyone else.

Although Su Yixuan is a nurse, she is a specialist orthopedic instrument nurse and has a strong understanding of operations. She has attended countless surgeries of this kind and naturally understands these. The positioning and realignment really doesn’t seem right, the operation will be very awkward later.

She felt nervous in her heart, this wooden guy, usually, even for laying a piece of cloth on the operating table, he demands perfection, today he’s doing surgery for Professor Zhang, why would he haphazardly start the surgery without placing the body in position and properly realigning the fracture, could he have been too nervous and made a mistake?

Yang Ping and Song Zimo went to wash their hands.

Through the glass, Song Zimo noticed everyone’s expressions and understood what they were thinking.

Next to the sink, Song Zimo said: “Everyone is worried, won’t you explain?”

While washing his hands, Yang Ping said: “What’s to explain? They’ll know once the patient can walk two steps after the surgery.”

The saying may be coarse but it’s to the point: a boxer who claims they will win a thousand times before a match is less effective than one who lands a knockout punch on the opponent on stage.

After washing their hands, Song Zimo disinfected, Yang Ping began to put on surgical gowns and gloves, his face remained calm, not overly reacting to everyone’s query.

Su Yixuan glanced at him several times, her eyes seemed a little anxious. Yang Ping smiled at her, indicating not to worry, he had everything under control.

As if linked by a kind of spiritual connection, Su Yixuan immediately dropped her nervousness and began to arrange the instruments, checking the PFNA intramedullary nail, spiral blade, locking screw, wire cable, and supporting instruments.

The engineer from the instrumentation company was standing by, checking with Su Yixuan using a laser pointer. If any errors or omissions occurred, they risked facing a chief surgeon with a bad temper, so he was not at all negligent.

After disinfecting and draping, and ceremoniously verifying all items before the surgical procedure, the operation commenced!

Yang Ping made a three-centimeter incision on the top and bottom of the greater trochanter, took the bone hook from Su Yixuan and gently probed the bone hook into the incision below the greater trochanter.

“He isn’t trying to realign the fracture fragment on the inside, is he? That should be embedded in the muscle, it’s impossible to realign.”

“When I was training in Beijing, there was a big shot who wanted to show off a bit, trying to realign the muscle-embedded bone fragment in a minimally invasive procedure, but he failed and ended up giving up.”

“As soon as it is embedded into the muscle, either give up or open up.”

“Yeah, the bone fragment embedded in the muscle, even when cut open for realignment, it’s sometimes strenuous, how could it possibly be sorted out in a closed reduction?”

“For this kind, doesn’t need to realign all the fragments, right?”

The bone hook was inserted, practically without any probing, it was pulled back.

“Four steel cables, one by one, hand them over!”

Three steel wires, one attached to the other, run along the bone surface, guided by the introducer to each respective position on the opposite side. The fourth wire intertwines and mingles with the other three wires, for reasons unknown.

“Pull on the traction carrier, internal rotation!”

Zhang Lin and Little Five immediately help adjust the traction carrier.

“Continue to adduct the muscle, yes, keep going, stop!”

“Retract the lever three rounds.”

“Okay! That’s it.”

Each sentence was like a command from a superior, clear and unquestionable. On the operating table, all actions adhere to the orders of the chief surgeon. The authority of the chief surgeon guarantees the discipline of the surgery.

Zhang Lin and Little Five are now entirely clueless about the steps and can only mechanically follow them.

“I underestimated you. You have a deep understanding of the attachment of muscles to each part of the skeleton, the function of each muscle, and the relationship between different muscles,” Song Zimo said from the side.

“Since you call me your senior, wouldn’t you acknowledge me if I didn’t have some skills?” Yang Ping said while operating.

The bone fragments lodged in the muscle were easily extracted. The tip of the bone hook latched onto the bone fragment, gently moved, repositioned. The first steel wire was placed in the center of the fracture, tightened around, and the tail of the wire was cut off.

Fluoroscopy!

Everyone retreated from the operating room again. After one exposure, they returned. The x-ray on the C-arm machine screen showed the fracture had been anatomically reduced. One could almost mistaken it for unfractured if they didn’t look closely.

The direction and force of the traction were just precisely right.

“Damn! Can it be done like this?”

“I didn’t understand.”

“The positioning and reduction just now seemed intentional. But I didn’t understand it. Does it have something to do with the bone fragment inserted into the muscle on the inner side?”

Dr. Jin asked Director Ouyang.

No one knows what the others are thinking, but Zhang Lin and Little Five feel like they’ve been tricked. They thought they were hastily called to action and were worried about failing. Turns out their worries were completely unnecessary—they even managed to remove the bone fragment lodged in the muscle. How they did it, they can’t wrap their heads around.

The second steel wire, the third steel wire looped around, tightened, and the tail end was cut off.

The tip of the large rotator was directly opened, a guidewire was inserted, followed by an intramedullary nail, precisely placed within one attempt. The guidewire was removed, and the guide needle of the spiral blade was knocked in.

Fluoroscopy–

The guide needle of the spiral blade was in the perfect position, not a bit more, not a bit less. It was in the middle line in the lateral view of the femoral neck and the lower-third in the anterior view of the femoral neck. Its tip was just a bit away from the circular boundary of the femoral head.

“A 90 mm spiral blade.”

After measurement, a hole was drilled with an electric drill, and the spiral blade was knocked in.

The locking screw at the lower end was drilled, depth gauged, and a screw was smoothly inserted.

Steel wire!

The fourth steel wire was tightened and the tail end cut off. Looking now, it astonishingly interweaves with the previous three wires to form an integrated structure. It created a fascinating tension band structure on the outer side.

No one could understand this maneuver, even Song Zimo seemed puzzled: “What’s this?”

“A person with an IQ approaching 250, still needs to ask me?” Yang Ping screwed in the cap on the intramedullary nail, trading places with Song Zimo.

Song Zimo started rinsing and suturing, just a few small incisions, quickly sutured up, not even needing drainage.

Finally, fluoroscopy was performed for confirmation.

The whole process took just over ten minutes. For a regular intertrochanteric fracture, in top-drawer hospitals with substantial surgical volume and skilled surgeons, they can finish in just over ten minutes if someone is there to assist. However, with this type of fracture where the fragment is lodged in the muscle, minimally invasive surgery can’t realign it, and most likely it would eventually require an open surgery, or the fragment would have to be abandoned.

Everyone stared at the screen. The operation was over just like that? They didn’t understand. They could somewhat comprehend the first three steel wires, but truly couldn’t make heads or tails of the last one.

Dr. Jin, sitting amongst the crowd, kept gazing at the screen and took pictures of the surgery. Also present, Director Ouyang asked, “This surgery is a bit unconventional, did you understand the purpose of the last steel wire?”

“Not yet, but I should understand by tomorrow.” Dr. Jin shook his head.

Song Zimo lifted the sterile drape, and suddenly Professor Zhang spoke, “Ask the ophthalmology department to consult me tomorrow. My eyes aren’t working well.”

He actually lay there and watched the whole surgery.

He didn’t make a single comment, which was unlike his temperament. He would usually offer some guidance.

Yang Ping gripped Professor Zhang’s hand. “Don’t worry. Tomorrow morning, I’ll have the nurses give you a walker. You should be able to walk then. You won’t blame me for nothing, will you?”

Professor Zhang said, “Let’s talk about that after I take a few steps tomorrow.”

The Head nurse of the operating room came over, “Professor Zhang, you’re feeling okay, right?”

The phone of the Head nurse rang. It was Dean Xia. He directly called her cell phone and asked Yang Ping to take the call.

Yang Ping went to the changing room to call Director Han and assure him everything went well.

Song Zimo leaned against the bench, “What an ingenious idea!”

The others were buzzing with discussion.

“What’s the meaning of that last steel wire? Really didn’t understand.”

“You’re asking me, then who should I ask?”