Chapter 149 Three heads, six eyes (Third update, please subscribe)

Author: Jiangdi Youbai

Chapter 149 Three heads, six eyes (Third update, please subscribe)

A fracture is not simply a broken bone as we simply think.

Academically, it has its own definition.

Disruption of bone integrity and continuity.

Therefore, we can boldly infer that as long as the continuity and integrity of the bone are interrupted, it can be considered a fracture.

This is different from what we think, as the name implies, that the two things are separated very simply and rigorously.

The broken ends of the fracture are irregular, and there is a lot of residual blood and broken bone fragments. If these bone fragments are not cleaned, they will form compressive tissue between the broken ends of the fracture.

Failure to achieve a perfect anatomical reduction is a bit like if there is mud on the soles of your shoes, you will feel an uneven feeling when walking on the road.

Moreover, the broken ends of the fractures will also separate, and after separation, they may still poke into the muscles, or become stuck between several muscles.

Under such circumstances, forcing a reset will definitely not work...

Now Longyuan probably needs to find out the specific cause, whether it is an intrusion or the compression of fracture fragments...

Soon, the C-arm machine, also called a temporary intraoperative X-ray camera, took pictures of the patient's fractures.

There is a fracture in the middle part of the tibia, and the broken end of the fracture is displaced. There are no large fracture fragments between the displacements, but there are relatively small fracture fragments.

In other words, the fracture is separated and the indications for surgery are obvious!

If the fracture fragment is small, then it is not the compression caused by the fracture fragment, then it must be that the fractured end of the tibia has been displaced and penetrated into the muscle, or in some muscle gap.

This cannot be shown on plain films.

According to the current state and shape of the fracture separation, Wu Xie's mind instantly flooded with a large number of professional knowledge nodes.

First, there is the medial insertion point of the tibia. The medial muscle group composed of the semitendinosus, semimembranosus, and tibialis endometrium originating from the ischial tubercle pulls the proximal segment of the tibia, tilting it inward and forward.

Then, the fractured end of the distal tibia moved to other positions under the pull of other muscles. Moreover, this was not just a simple fracture pull and displacement——

During the shift, there are muscles that block the middle!

The diameter and strength of the muscles of the lower limbs are quite large. It can be said that the current fracture ends are tightened. It has become more complicated than during the initial surgery!

Lu Junyin and Luo Wei looked at it and roughly understood that this surgery was probably caused by an accident during the previous reset process.

As a result, the broken ends of the fracture, which were originally only slightly separated and displaced, became even more displaced and turned into a more difficult and complex fracture!

When everyone approached the operating table again.

Long Yuan frowned slightly.

The current situation is quite complicated. This was something that could not be shown through X-rays or CT scans available in the hospital before the surgery.

The fracture is now highly displaced and it is difficult to reduce it, and violence cannot be used!

Otherwise, the fracture that was originally separated may be pulled apart when you use brute force. If the fracture occurs again, it will be a comminuted fracture.

So this is a shitty surgery?

If the reduction of the fracture is the key point of the entire fracture surgery!

So how to deal with this kind of muscle pulling fracture displacement is the key point of fracture reduction.

At this time, you need to use clever methods to resist muscle stretch!

Long Yuan was on the operating table and continued to pry for a while, but the broken ends of the fracture that were being pulled were like two naughty children, completely disobedient and just refused to go home.

Long Yuan felt that at this time, if you continue to wait, it would definitely be meaningless, and the problem should be solved.

He raised his head and said, "Director Lu, take another bone peeler and press it for me!"

Bone peeling is not only used to peel off fracture fragments, but it is also one of the magic tools for compressing fractures.

What Long Yuan wanted to do was to press the broken end of the fracture fragment to counteract it so that the broken end would not shift under the pull of the muscles. Then he used manual repositioning to pull the separated broken end out of the muscle.

Leave and return to your original position!

Director Lu frowned slightly and said, "Doctor Long, the broken end of this fracture is diagonal, so the pressure may cause it to break."

Although this was a rejection of Long Yuan's opinion, Director Lu still said it. The entire operation does not belong to Long Yuan alone. If an accident occurs during the operation, it is the entire team that will increase the workload!

Then it made Long Yuan’s first surgery show even more embarrassing!

"Well!" Long Yuan pondered for a while and took a few deep breaths.

"Now the broken ends of the fracture are widely separated. It is easy to break when one side is stressed, and there is compression inside. We can't fix it with a Kirschner wire first so that the entire bone can bear the force." Long Yuan said to himself.

Kirschner wire fixation is a kind of temporary fixation during surgery. Various fracture surgeries will use Kirschner wire temporary fixation during surgery.

"Excursion, please give me two K-wires to try." Long Yuan still thinks it's better to be on the safe side. Otherwise, if the fractured fragment breaks again, the workload will be much greater than it is now!

"Okay, Doctor Long." Not to mention that Long Yuan is the doctor who provides support.

The circulating nurse naturally respects the opinion of the surgeon.

She knows some orthopedics, but she is definitely not good enough to give advice on Longyuan surgery. Moreover, temporary Kirschner wire fixation of fractures is a normal operation!

Just after Long Yuan got the Kirschner needle and was about to inject the Kirschner needle, he suddenly said: "Brother Wei, change positions with you Wu Xie. I will first inject the Kirschner needle in the direction from inner to outer."

After Wu Xie heard the words and came to the place where Luo Wei was standing before, he sighed slightly in his heart, covered his face with a mask, smiled slightly, and then decided to help Long Yuan.

Longyuan is now conducting a tentative operation, not a decisive operation!

In other words, with the current level of Long Yuan, it is still extremely difficult to deal with this fracture. It may not be impossible to solve it, but it will be particularly difficult to solve it.

Without any special hesitation, Wu Xie quickly changed the fracture reduction technique from proficient to expert.

The only way is to specialize. If there is still no solution after reaching specialization, then it depends on fate?

Can!

After a lot of knowledge poured into his mind, Wu Xie immediately discovered it.

If Long Yuan was like this and forcibly nailed the K-wire to a larger tibia while out of the air, it would actually be the same as when he asked Director Lu to hold it down before.

The best way now is to find a suitable point and remove the tension from the medial muscles that end on the inner side of the tibia——

Muscles are equivalent to rubber bands. Rubber bands are pulled in the hand and are similar to springs.

If the rubber band is not stretched, there will be no reaction force of the stretch. At this time, Longyuan does not need to rely on temporary fixation with Kirschner wires. The fracture can be reduced manually with relative confidence.

Well, in open reduction, manual reduction is also an important component.

It’s just that most open reductions are manual reductions of fractures under direct vision, while ordinary manual reductions are closed non-fracture reductions under direct vision.

Previously, Wu Xie was standing below the surgical site. The medial muscles originate from the ischium and end at the inner side of the tibia. The muscles run above the surgical site. Even if Wu Xie wanted to help, he was a little helpless.

It just so happened that Luo Wei and Luo Wei had now changed positions, and now they were in the second assistant position. Naturally, Wu Xie wanted to help.

"Brother Wei, wait a moment." Wu Xie's voice was very low and he only stopped Luo Wei without disturbing Long Yuan's thoughts.

Luo Wei turned his head slightly when he heard this——

Seeing that while Wu Xie was using his right hand to pull the hook, his left hand silently placed it in a very clever position on the patient's inner thigh. Then, after pressing it, it just slid down slightly.

In an instant, the increase in friction caused by Wu Xie's left finger pressing down directly smoothed out a large part of the traction and displacement of the proximal tibia caused by the patient's semitendinosus muscle group, causing the originally bifurcated fracture to break.

It seems to be aligned with the original skeletal path.

This is quite amazing!

Lu Junyin was a little dazed on the spot, while Luo Wei stiffened up and looked at Wu Xie, his eyes motionless.

But unlike Lu Junyin and Luo Wei, when Long Yuan saw this scene, his pupils shrank slightly and he didn't even have time to think about why this happened.

But through his understanding of fractures and the depth of his knowledge, he knew that the current situation was very conducive to the surgical process, and he shouted without thinking: "Don't move, keep this posture!"

"I'll reduce the distal end and align the fractured ends!"

The opportunity for surgery is fleeting.

Therefore, Long Yuan didn't even think about what kind of injection point Luo Wei had been asked to expose to him, and what kind of Kirschner needle he was going to give.

He threw the electric drill in his hand lightly, then grasped the patient's ankle and began to slowly traction.

Then, like a tug-of-war, the broken end of the fracture embedded in the muscle was pulled out from the muscle gap, and blood was seen on the bone edge!

After the farthest end left the muscle layer, it returned to its normal position with a bang, regaining its restrained freedom!

Then Long Yuan immediately removed the pulling force, allowing the far end of the fracture to coincide with the proximal end of the fracture controlled by Wu Xie!

"Give it? Viagra? Give it a Kirschner's injection!" Long Yuan quickly ordered, then looked at Luo Wei in a daze and almost cursed.

Can Kirschner wires be temporarily fixed? I just finished saying that, now our broken ends are brought together, why don't you deal with it? What kind of psychological quality do you have?

Luo Wei was very embarrassed at the time. He held the blood vessel clamp in his hand and opened and closed it twice in the air. He felt lonely and had no idea what he was doing...

Those blank eyes seemed to say: Brother Yuan, where did you agree to let me fix the needle insertion point for you?

Long Yuan stopped himself from getting angry: "Viagra, Kirschner needles are temporarily fixed!"

When Luo Wei heard this, he handed over the vascular forceps holding the Kirschner wire to Lu Junyin, the first assistant on the other side. Then he picked up the Kirschner needle and the electric drill, and inserted the first Kirschner needle very well into the inside.

Go to the outer direction and nail the fractured fragments!

Then, three heads and six eyes finally looked in the direction of Wu Xie...
Chapter completed!