top student at medical school

Chapter 59 Step by Step (Please add to your favorites and read on)

"Intramedullary nailing, you know the general procedure, right?" Fang Ziye, fully equipped, arrived at the operating table. Associate Professor Xie Jinyuan had already checked and verified all the instruments needed for the surgery onto the curved tray. He handed them to Fang Ziye while asking questions in advance.

This is the last backup plan before the surgery. If you don't know, you can say so; your superiors can give you another chance for free.

Fang Ziye nodded, took a deep breath, and glanced at Professor Deng Yong and Associate Professor Xie Jinyuan: "I won't forget the main procedures, but the operation may not be as smooth."

Just kidding. Internal fixation device removal surgery is the most basic and least valuable surgical procedure in orthopedics. If you can't even remember the surgical procedure, then Fang Ziye's master's degree over the past few years has been a waste.

"Intramedullary nail removal is more difficult than plate and screw internal fixation device removal, but the main step is still exposure."

"This patient's intramedullary nail is a femoral reverse intramedullary nail, so the nail blade is fixed in the intercondylar fossa of the knee joint, and the screws are fixed at the proximal end and the distal end of the femur at the superior margin of the medial and lateral femoral condyles."

"What you need to do is simply remove the blade holding the nut in place, and then remove the screws from the intramedullary nail fixation device," Associate Professor Xie Jinyuan explained briefly.

Fang Ziye nodded again, without excitement or particular nervousness. He held the scalpel in a pen-like grip with his right hand, while his left hand gently touched the scar from the original incision on the lateral side of the patient's patella, demonstrating that he was fully prepared.

"The surgery begins." Professor Deng Yong, however, felt even less pressured. He gave the order, and the circulating nurse and anesthesiologist began recording the incision time.

Fang Ziye didn't hesitate. Following the original surgical incision on the lateral side of the patella, he used a scalpel to cut open the scarred skin, making a clean and swift cut.

One pair of tweezers was handed to Professor Deng Yong, and the other was held in his palm. After Associate Professor Xie Jinyuan wiped the small amount of bloodstains from the first incision with a cotton pad, Fang Ziye and Professor Deng Yong each used tweezers to open one side of the skin and used an electrocautery knife to penetrate deeper layer by layer.

The first incision breaks through the surface of the skin scar; using an electrocautery knife is the real beginning of creating the incision site.

"Don't be nervous. The scar formed by the surgical incision is tougher than normal tissue. The electrocautery cuts slower and takes a little longer, which is fine," Deng Yong said, offering guidance to Fang Ziye, who was a little hesitant to make the incision.

Immediately afterwards, many people in the operating room began to move around to watch.

Fang Ziye gathered his thoughts and began to peel away the layers one by one.

This surgery is very simple. During the exposure phase, there are not many intricate techniques. It all comes down to whether your basic skills are solid. If your basic skills are not solid, the surgical field will be a mess. If your basic skills are solid, the surgical field will be relatively clear.

Fang Ziye's field of study is among the relatively clean-cut group of people.

The incision and hemostasis techniques practiced in the training room were now perfectly executed, resulting in a clean surgical field. Furthermore, when removing the scar, Fang Ziye was still able to precisely control the trajectory of the incision, ensuring it did not deviate from its intended path.

This is the advantage of the cutting technique for cutting tofu or even carving characters. The control over the force and depth of the cut is already so good that it can be done with ease and at a fast speed!

Seven or eight minutes later, Fang Ziye broke open the scar-healing joint capsule, exposing the intercondylar fossa of the femur. He then removed the excess scar tissue as if carving tofu, leaving relatively neat edges.

Fang Ziye breathed a slight sigh of relief and continued to use the electrocautery to rotate the scar near the tail cap of the intramedullary nail fixation device.

This kind of excision is actually a debridement, which is much easier than carving the character "口" in three dimensions. Fang Ziye slid his hand across the screen and then looked at Xie Jinyuan and Professor Deng Yong, realizing the benefits of setting up those standards in the practice room.

At this moment, Fang Ziye fully experienced the meaning of the phrase "great things come from small beginnings."

The first and second assistants were both professors. After Fang Ziye exposed the tail end, they immediately handed over the corresponding follow-up equipment and explained the word "feeding" very clearly.

Next comes a crucial step: removing the end cap screw from the intramedullary nail, also known as the razor blade. This step, which we practiced in the training room, requires special care. If the screw strips or the tooth slips, the two professors might fly into a rage.

Use the screwdriver to connect the screw cap firmly and steadily, increasing the vertical pressure stress on the joint surface. After feeling the screwdriver and the screw tail engage, slowly apply force and increase the force evenly!

Until!

With a crisp "click," everyone breathed a sigh of relief.

The tension in his eyes was concealed as he looked at Fang Ziye.

Fang Ziye dared not be happy or careless. He continued to slide the screwdriver until the screw on the end cap was completely removed, and carefully examined it three times in his palm.

He even twisted it with his thumb and forefinger to examine it carefully, and only breathed a sigh of relief when he found no cracks or breaks in the screw.

"Medical equipment technician, could you please double-check to see if there are any broken teeth?" Fang Ziye described the situation quite professionally.

Stripped threads and stripped teeth are the most feared issues when removing internal fixation devices.

However, these two are different. Stripped threads refer to damage at the joint between the screw and the screwdriver, making it impossible to turn. Stripped teeth refer to damage at the contact point between the screw and the object, causing the screw to be able to be turned but not to move further in or out.

Both are difficult to handle. Even if there is no stripping or stripping of threads, you still need to pay attention to whether the screw threads are damaged or broken, and whether you need to look for any residue.

Otherwise, if something is found to have been left behind after the internal fixation device has been removed, the problem will be even more complicated.

After the transfer, the next step is the more challenging part: removing the intramedullary nail fixation screws. These screws are located on both the proximal and distal ends of the thigh, and are in relatively free positions.

It's possible. The incision location used for internal fixation before is no longer compatible with the current screw fixation location. If you continue to follow the original incision approach, you'll only see something useless; it can only be used as a reference and cannot be used for in-depth exploration.

This requires carefully comparing the patient's skin surface through image review, then blindly piercing the skin surface, and then tracing the intermuscular route, avoiding important blood vessels, nerves, and muscles, in order to reach the screw cap.

Of course, there are also those who are careless and only avoid blood vessels and nerves, cutting straight to the bone to remove screws. There are quite a few of them, but such rough operations are generally not allowed in the orthopedic operating room of Zhongnan Hospital.

Therefore, although there are only five fixing screws, this is the most difficult part. Not only do you need to position them accurately, but you also need to reach the screw holes in the most relatively non-invasive way.

Fang Ziye had already prepared everything outside the operating room. So after removing the screw at the end of the tube, Fang Ziye roughly compared the length of the patient's thigh and murmured, "There are scar-like stripes on the front of the thigh, and one on the lower part of the thigh."

"These two screws should be easy to remove, but the others..."

While Fang Ziye was still pondering, his eyes suddenly lit up.

Why are you trying to figure this out? Internal fixation devices are usually installed where they are typically placed. If it's installed at Zhongnan Hospital, the procedures performed by Associate Professor Xie Jinyuan and others are absolutely standard and there won't be any scars obstructing the way. You just need to walk normally through the intermuscular space.

Just proceed with the original approach and don't worry about the difficulties mentioned in some literature or forums.

(End of this chapter)