Great doctor starts with adding points

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, it can be boldly inferred that as long as the continuity and integrity of the bone are interrupted, it can be identified as a fracture.

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

The broken ends are irregular, and there are a lot of residual blood and broken bone debris. This bone debris, if not removed, can form entrapped tissue between the broken ends.

Unable to achieve a perfect anatomical reduction, it is a bit like if there is mud on the soles of your shoes, you will have a feeling of unevenness when you walk on the road.

Moreover, the broken ends of the fracture will also be separated, and after separation, they may poke into the muscle or get stuck between several muscles.

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

Now Longyuan probably wants to find out the specific reason, whether it is embedded or trapped by fracture debris...

Soon, the C-arm machine, also known as the intraoperative temporary X-ray machine, 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 indication for surgery is obvious!

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

This is not shown on the plain film.

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

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

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

In the shift, there are muscles to block the horizontal!

The muscle diameter and muscle strength of the lower limbs are not small, and it can be said that the current fracture ends are tied tightly. It has become more complicated than the initial operation!

Lu Junyin and Luo Wei looked at it, and probably understood that this operation might have been an accident during the previous reset process.

As a result, the broken ends of the fracture, which were originally separated and shifted a little, shifted even more, and turned into a complex fracture that is more difficult!

When everyone approached the operating table again.

Long Yuan frowned slightly.

The current situation is quite complicated. Before the operation, X-rays and some CT scans in the hospital could not show this.

Now the fracture is very displaced, it is very difficult to reset, and violence cannot be used!

Otherwise, it was originally a separated fracture. When you use brute force, it may be pulled and broken. If the fracture occurs again, it will be a comminuted fracture.

So this is a fart surgery?

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

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

At this time, it is necessary to use a clever way to resist the pulling of the muscles!

Long Yuan was on the operating table at the moment, and continued to pry for a while, but the pulled fractured ends were like two naughty children, completely disobedient, and just refused to go home.

Long Yuan felt that at this time, if he continued to wait, it would definitely be meaningless, and he had to deal with the problem well.

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

Bone peeling is not only used to peel off fracture debris, but also one of the magic tools for fracture compression.

What Long Yuan wanted was to press down on the broken ends of the fracture fragments, so as to counteract them so that the broken ends would not be displaced under the pull of the muscles. Then he reset it with his hands to pull the severed end out of the muscle and return it to its original position!

Director Lu frowned slightly, and said, "Doctor Long, the broken end of this fracture runs obliquely, and it might break if the pressure is reversed."

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

Then make Longyuan's first surgery show even more embarrassing!

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

"Now the broken ends of the fracture are very separated, and it is easy to break if one side is stressed, and there is compression inside, and it cannot be fixed with a Kirschner wire first so that the whole bone can bear the force." Long Yuan said to himself.

Kirschner wire fixation is a kind of temporary fixation during the operation. A variety of fracture operations will be applied to the temporary fixation of Kirschner wire during the operation.

"Tourist, give me two Kirschner wires for a try." Long Yuan still thinks it's better to be on the safe side, otherwise, after the fractured fragment is fractured again, the workload will be much, much greater than it is now!

"Okay, Doctor Long." Even without mentioning that Long Yuan is a doctor who supports him.

Itinerant nurses naturally respect the opinions of the chief surgeon.

She knows some orthopedics, but certainly not to the point where she can give advice on Longyuan's surgery. Moreover, temporary Kirschner wire fixation in fractures is a normalized 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 the inside down to the outside up."

After Wu Xie came to the place where Luo Wei was standing before, Wu Xie sighed slightly in his heart, covered it with a mask, gave a slightly wry smile, and then decided to help Long Yuan.

Longyuan is now a tentative operation, not a sure operation!

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

Without any particular hesitation, Wu Xie directly changed the manual reduction of fractures from proficient and quick to specialized.

There is only specialization. If there is still no way to solve it after reaching the specialization, then it depends on fate?

Can!

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

If according to Longyuan's example, he forcibly nailed the Kirschner wire to the larger tibia in the state of being out of the air, in fact, it is no different from when he asked Director Lu to press it down.

And now the best way is to find a suitable point, and release the tension of the medial muscle group whose insertion point is on the medial side of the tibia——

Muscles are equivalent to rubber bands, and rubber bands are used to pull hands, similar to springs.

If the rubber band is not pulled, there will be no reaction force of the pull. At this time, Longyuan does not need to rely on the temporary fixation of the Kirschner wire. Manual reduction of fractures can be performed with relative confidence.

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

It's just that most of the open reduction is manual reduction of the fracture under direct vision. The common manual reduction is closed non-fracture manual reduction under direct vision.

Before, Wu Xie stood under the operation site, and the inner muscles started from the ischium and ended on the inside of the tibia, and the muscles were shaped above the operation site. Even if Wu Xie wanted to help, he was a little powerless.

It just so happens that Luo Wei and Luo Wei have changed positions now, and when they are in the second assistant position, Wu Xie naturally wants to help.

"Brother Wei, wait a moment." Wu Xie's voice was very low, he only stopped Luo Wei, and did not disturb Long Yuan's thoughts.

Luo Wei turned his head slightly when he heard the words——

I saw that while Wu Xie was pulling the hook with his right hand, his left hand was silently placed on a very clever position on the inner thigh of the patient, and after pressing down, it only slid down slightly.

In an instant, the increase in friction brought about by pressing down the fingers of Wu Xie's left hand directly smoothed out a large part of the patient's proximal tibial traction and displacement caused by the semitendinosus muscle group, causing the originally divergent fracture to break. At the end, it seems that there is a posture of aligning with the original skeleton.

This is quite amazing!

Lu Junyin was a little dazed on the spot, while Luo Wei froze and looked at Wu Xie without moving his eyes.

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 knowledge of fractures and the thickness of his knowledge, he knew that the current situation was very conducive to the progress of the operation, so he shouted almost without thinking: "Don't move, keep this posture!"

"I'll reset the distal end to form apposition of the fracture ends!"

Opportunity for surgery is fleeting.

Therefore, Long Yuan didn't even think about what needle point to expose to Luo Wei before, and then what Kirschner needle was to be injected.

Throwing the electric drill in his hand lightly, and then grasping the patient's ankle, began to slowly pull.

Then, like a tug-of-war, the fractured end inserted into the muscle at the far end was pulled out from the muscle gap, and blood was seen on the edge of the bone!

After the farthest end left the muscle layer, it returned to the normal position with a bang, and the freedom of being restrained was restored!

Then Longyuan immediately released the pulling force, so that the distal end of the fracture and the proximal end of the fracture controlled by Wu Xie just fit together!

"Hit? Brother Wei? Hit Kirschner needle!" Long Yuan hurriedly ordered, then looked at Luo Wei who was in a daze, and almost cursed.

Kirschner wire can be temporarily fixed ah? I just finished talking, now that our broken bones are joined together, you don't want to deal with it? What kind of mental quality do you have?

Luo Wei was very embarrassed at the time, holding a vascular clamp in his hand, opened and closed twice in the air, feeling lonely, not knowing what he was doing...

That blank look seemed to be saying: Brother Yuan, did you ask me to fix the needle point for you as agreed?

Long Yuan kept himself from being angry: "Brother Wei, the Kirschner wire is temporarily fixed!"

Hearing this, Luo Wei went to hand over the vascular forceps that fixed the Kirschner wires to Lu Junyin, who was on the opposite side, and then picked up the Kirschner wires with an electric drill, and put the first Kirschner wires along the inner and lower sides very well. The fracture fragments were nailed in the outward direction!

Then, the three heads and six eyes finally looked in the direction where Wu Xie was...