top student at medical school

Chapter 357 Dimensional Reduction Attack!

Fang Ziye wasn't lying. His open reduction and internal fixation technique for fractures had already reached level 4. Last year in Enshi, Fang Ziye felt that he might be able to handle fracture surgery training, so he leveled up the corresponding skill points early on.

I only added 3 points to it at the time. I think I added 4 points later because I was going to perform surgery on a patient with a pelvic fracture.

On that occasion, the department heads were kept in the ward by Wu Xuanqi, who is now at Tongji Hospital, and entrusted Shen Tao, who was not particularly skilled in simple fracture surgery, to perform the operation...

After processing his emotions for a long time, Yuan Weihong slowly said, "It seems that Shen Tao still has a lot to hold back about me."

Shen Tao from the Provincial People's Hospital is a good friend of Yuan Weihong. After returning to Wuhan, he met with Yuan Weihong many times. Although he had mentioned Fang Ziye's excellence to Yuan Weihong in his daily life, he still held back, perhaps to avoid discouraging Yuan Weihong's Daoist aspirations.

The operating room's sensor door opened, but because there were people at the door, it remained open for a long time.

This was a split-stage surgery, and the anesthesiologist and circulating nurse were temporary replacements. The anesthesiologist then shouted out, "Are you an orthopedic surgeon? If so, come in!"

"Let's open the stage early and leave work early!"

The anesthesiologist was also quite young. He spoke with a polite tone, urging people on as if afraid of offending anyone, suggesting he was a relatively young attending physician.

Yuan Weihong, Fang Ziye, and Jie Han went in together. After entering the operating room, they saw the patient lying on the operating table, still seemingly adrift as if his body and soul were separated.

Seeing that Yuan Weihong wasn't in the mood to make arrangements, Fang Ziye took the initiative and said, "Jiehan, you lift the leg, I'll disinfect and drape the table. Let's start the operation as soon as possible, the anesthesiologist is urging us..."

Fang Ziye had no idea how turbulent his master Yuan Weihong's emotions were at that moment, but he knew that his teacher definitely needed to calm his chaotic state of mind.

Upon hearing Fang Ziye's words, Yuan Weihong snapped out of his daze. Seeing that Jie Han and Fang Ziye were already performing their respective duties, Yuan Weihong remembered that he also needed to go out and disinfect his hands first, then put on a sterile surgical gown and help with disinfection and draping.

In this surgery, there was no scrub nurse on duty, so Yuan Weihong also had to act as the scrub nurse before the procedure to help lay out the sterile surgical drape.

Disinfecting and draping is a very basic procedure in orthopedics, and all three of them were very familiar with it, so they quickly completed the necessary preparations before starting the procedure.

Fang Ziye took the initiative to stand in the assistant's position, clearly giving Yuan Weihong a lot of face.

To be frank, I am skilled enough in open reduction and internal fixation of fractures, but I still have to give face, so I had to have Yuan Weihong perform the surgery, after all, he is my mentor.

However, after pausing for a moment, Yuan Weihong took the initiative and said, "Ziye, how about this, you take the lead in the surgery, and I'll see what kind of surgery you're capable of?"

Yuan Weihong handed a curved tray containing scalpel blades and toothed forceps to Fang Ziye.

Upon hearing this, Fang Ziye's mind stirred, and he said, "Master, I'm the chief surgeon. If I'm performing fracture surgery, the order of operations might be different from that of other teachers."

“Isn’t that how it is? At most, you would use manual traction to reduce and fix the shape while the patient is under anesthesia, and then cut and pry to reduce it, right?” Yuan Weihong said.

Suddenly, as if she had thought of something, she looked at Fang Ziye seriously again, her eyes darting around: "Your manual repositioning technique..."

Last time, Zhongnan Hospital performed a limb-sparing surgery on a patient with severe injuries. The patient is currently hospitalized and the prognosis is not very good.

However, the poor surgical prognosis did not prevent Yuan Weihong from hearing someone say that Fang Ziye's manual reduction technique was very impressive, and that it seemed to be based on some of the concepts of a very famous old Chinese medicine doctor in Enshi.

"Hmm!" Fang Ziye nodded.

Immediately afterwards, Fang Ziye went to the X-ray reader and determined the location of the fracture, the specific type of fracture, and the current displacement status on the patient's X-ray.

I walked to the patient's right lower limb, stretched out both hands, held the tibial plateau with my left hand, and pinched the patient's ankle with my right hand.

Fang Ziye's right hand seemed to be using very little force, and after a slight "crack" sound,

The deformity caused by the double fracture of the mid-shaft of the tibia and fibula in the patient's right lower limb has disappeared.

This was the first time that Yuan Weihong and Jie Han had a direct and intuitive experience of the clinical effects of Fang Ziye's manual reduction of fractures after returning from abroad.

Instantly, both of them looked up slightly, utterly shocked.

As a trauma surgeon, the visual standard for assessing whether a fracture has been reduced is the complete disappearance of lower limb deformity, just like it is now.

However, those who can be moved into the operating room of Zhongnan Hospital are basically those who are eligible for surgery. Fractures that are not eligible for manual reduction are basically those that are difficult to reduce manually.

However, Fang Ziye simply snapped his leg, and the deformity of his lower limbs disappeared.

"Show me one?" Yuan Weihong asked.
Fang Ziye nodded upon hearing this: "That's fine, Master. The effect of this repositioning technique will be more clearly displayed under the C-arm fluoroscopy."

Unlike Enshi Central Hospital, which requires circulating nurses to assist with fluoroscopy, Zhongnan Hospital's orthopedics and spinal surgery departments jointly employ three dedicated intraoperative fluoroscopy technicians who are solely responsible for using the C-arm fluoroscopy machine.

Their job is to handle the relatively detailed tasks such as the turnover of the C-arm machine, X-ray imaging, instrument operation, and instrument maintenance.

After the circulating nurse called the person over using the panel phone in the operating room, the fluoroscopy technician didn't need Fang Ziye and others to explain how to perform fluoroscopy on the front and sides during the operation. He only needed to roughly indicate the location of the fracture.

The young man called "Brother Xiong" pushed the small C-arm machine into the operating room and completed the anteroposterior and lateral fluoroscopy in about two minutes. Without even looking at the results, he said, "Brother Wei, I have to rush to the spinal surgery department for fluoroscopy. This trip is just a temporary measure during the operation, so I'll need fluoroscopy again after the operation. Keep calling."

"Okay, Xiong-ge, wait a moment, I'll continue to check the fluoroscopy results." Yuan Weihong didn't have time to look at Xiong-ge's expression, he was focused on the fracture reduction image on the C-arm monitor.
The fracture line is almost hidden, and the fracture ends are well aligned. If it weren't for the fact that the fracture type itself is an unstable fracture, it would be very easy for it to shift, and there would be no stress angle.

Yuan Weihong really wanted to ask the circuit breaker to bring over a plaster cast so he could just get it fixed and be done with it.

Fang Ziye only glanced at it before roughly determining his skill level. Although he hadn't performed manual reduction in the operating room for a long time, which is the temporary auxiliary manual reduction during surgery for complex fractures, his skills were still quite good this time.

After waiting for Yuan Weihong for more than twenty seconds, and realizing that Yuan Weihong had already judged the quality, Fang Ziye placed his hands flat on his chest and said softly, "Master, it's done."

"You still need intramedullary nailing?" Yuan Weihong asked, tilting his head.

Fang Ziye turned his head to look at Jie Han, who was eager to try.

The treatment principles for fractures are reduction, fixation, and postoperative rehabilitation.

The most crucial factor affecting the overall quality of surgery is the reduction of the fracture, followed by secure fixation.

Generally speaking, it is difficult to completely dissect a whole surgical procedure.

However, Fang Ziye's technique this time was exceptionally good, effectively breaking down what should have been an integrated surgery into two very simple and delicate procedures.

Manual reduction of fractures is a Class I surgical procedure, which can be performed by ordinary resident physicians.

Placing internal fixation devices for fractures is not a standard surgical procedure. It is a local component of open reduction and internal fixation of fractures. Any assistant who can work on the procedure can perform it under the guidance of a superior.

It falls into the category of hooks and screws.

This is essentially a game-changer for unstable fractures, allowing Yuan Weihong to guide his junior colleague Jie Han through subsequent surgeries if he has sufficient experience in operating fracture instruments.

In fact, Fang Ziye could have easily jogged along and fixed the intramedullary nail in five, six, seven, or eight minutes, and even inserted the sealing screw.

There's no need for that. Fang Ziye doesn't really need the knowledge from one or two fracture surgeries anymore. He should give way to his lovely junior brother Jie Han, who wants more opportunities to practice.

Senior brother, you must be magnanimous.

Jie Han looked intently at Yuan Weihong. If Yuan Weihong agreed, Jie Han could finally enter the world of his first relatively formal surgery.

Intramedullary nail placement!
Many resident physicians who go to prefecture-level city hospitals are performing internal fixation device removal surgery. The purpose of the removal surgery is simply to dismantle the device, either for aesthetic reasons or other reasons, as a surgical cleanup for the treatment purpose.

Where can I find a place to insert an internal fixation device?
Yuan Weihong's lips twitched beneath his mask: "So that's what you mean by 'different order'? You didn't want to go on stage at all, did you?"

Fang Ziye shook his head and quickly explained, "Master, what I mean is, you can step down and rest for a bit. I can take care of the rest of the operation with Junior Brother Jie Han."

"Master, you've been working hard all day in the operating room next door..."

Jie Han nodded vigorously.

My senior brother is invincible, my senior brother is awesome, my senior brother brings me miracles.

If this surgery were still the traditional method of making an incision, repositioning, and fixing simultaneously, then Yuan Weihong would definitely not allow Jie Han to perform the subsequent internal fixation device placement.

"Fine, then I'll step down." Yuan Weihong said helplessly.

There's no way to fix it!
There's nothing to teach; the students are more skilled than the teachers. How can I possibly mentor them?

I thought I could still see where Fang Ziye's skills were lacking, but Fang Ziye's surgical level, with the combined benefits of open reduction and internal fixation of fractures and manual reduction, has shifted from a treatment objective to a teaching objective.

Yuan Weihong began taking off his clothes and leaving the operating room right outside the door.

Xiong Ge pushed the C-arm machine away. He was just a worker and wouldn't meddle in the quality of clinical treatment. If Zhongnan Hospital needed him to do quality assessments, it would have collapsed long ago.

Meanwhile, the anesthesiologist who was sheltering from the radiation at the door was completely dumbfounded.

"What do you mean? The surgery is almost over?" Zhongnan Hospital has very few fracture surgeries, and he, who has not seen much of it, was stunned on the spot.

The tour guide was also taken aback, raising an eyebrow slightly.

Who is Yuan Weihong? "Beihai Yiye," he nodded, his tone hesitant as he spoke to the junior anesthesiologist, whose seniority was clearly lower than his own: "Yeah, weren't you urging us to hurry? This surgery is fast enough, isn't it?"

The anesthesiologist's eyes immediately flashed with fear, thinking he had unintentionally offended some 'big shot'. He quickly smiled broadly, his eyes like those of a beauty consultant: "I didn't mean to rush you, teacher, my name is Xiao Zhou..."

Yuan Weihong left happily.

(End of this chapter)