Chapter 193: Chapter 0183 Calm Professor Ye_2
Could Yang Ping’s presence be to learn from Professor Ye on how to handle unusual intracondylar or extracondylar bone fractures that occur during four-link reconstructions?
“Xiao Yang, I need your help to arrange some things at home,” Professor Su instructed.
Yang Ping complied. If Professor Su was giving orders, what else could be said? They would have to be carried out.
“What do we do? Continue with the operation? Or wait and reassess in three months?” Director Guan took the opportunity to ask.
Generally, in such situations, the course of action would be to proceed with a fracture operation. Fix the fracture and in three months, when the bone has healed, proceed with ligament reconstruction. Continuing with the operation now doesn’t merely increase its complexity. There’s hardly any bone left to drill a tunnel into, and even if there was space, much of it would be dead ends where a good tunnel cannot be drilled. Surgery would fail to achieve the desired effect.
Such an operation doesn’t merely consist of ligament reconstruction. The results need to be ensured too. It’s like filling out an exam paper. It’s easy if you’re not striving for marks, and simply filling out the paper. But if you’re seeking high scores, just completing the paper won’t suffice.
“Proceed! The patient is under general anesthesia, right?” Professor Ye sought confirmation once again.
“They’re under general anesthesia!” the anesthesiologist responded.
Professor Ye rested briefly as the doctors below the platform moved the C-arm machine for imaging. Everyone made way, leaving room.
“Like I always say, every surgical step is crucial. We, as surgeons, tread on thin ice. Look, even a moment of negligence can result in a complication. If the operation had to be stopped at this point, how would we face a patient who is left with a bone fracture? How would we explain our actions? Not only the recovery time is delayed, impacting the patient’s schedule, but a new problem is also introduced.” Professor Ye’s tone was reasonable, it was a reprimand rather than a scolding.
“C-arm machine, push it properly, lift it higher, come in from this side!” Chen Ge, in a bad mood and stifling his anger, vented it on the young doctor pushing the C-arm machine.
Although Professor Ye had a temper, he was not prone to lashing out. Distinctly stern, he would scold people if they didn’t meet his standards.
“Chen Ge, what are you doing?” Director Guan attempted to stop Chen Ge as he saw that Professor Ye’s expression wasn’t promising.
Sure enough, Professor Ye lost his temper. He glared at Chen Ge. As it was Chen Ge who had caused the problem, everyone else was left to clean up his mess while he was berating the junior doctors.
If it wasn’t for Professor Su’s presence, Professor Ye would have scolded the younger doctors outright. But since Professor Su, Chen Ge’s senior and a guest, was present, it would be inappropriate to reprimand his junior doctors in front of him.
Everyone left the operating room after imaging was completed and re-entered to inspect that the drill bit had been entirely removed without residuals.
“Prepare a cannulated screw. We usually use it for femoral intracondylar or extracondylar fractures. Let’s use it to fix the fracture for now.”
As the C-arm machine was rolled out, Professor Ye returned to his chief surgeon’s position and everyone else assumed their proper roles.
In the case of an intra-articular fracture, some pieces even retain cartilage. It requires much skill to set these pieces: the fracture needs setting, the screw’s location cannot interfere with the next ligament reconstruction tunnel, and neither the head nor the tip of the screw can protrude.
This step of fixing the fracture using arthroscopy is no easy task. Professor Ye used a grasper to grab a bone fragment; the grasper is small and unless one is highly skilled, it’s impossible to grab such a large fragment. He caught it firmly in one go, put it back to its original position, loosened the grasper before the fragment could fall, and at once used the closed grasper’s end to secure the fracture. The procedure resembled acrobatics.
To fix this fragment, it couldn’t be drilled from the inside. Because the intercondylar notch is a curved notch, a kind of hole, some positions are dead ends. So this fragment, located at a dead end, could only be drilled from the outside.
Drilling from the outside encountered the same issue that Yang Ping faced while drilling a tibial tunnel: a thick wall had to be penetrated to hit a target on the other side.
The only difference was that Yang Ping’s target was a point, while Professor Ye’s was a circle. Whether a point or a circle, both were extremely challenging!
From the outside, he punctured the skin and muscles with the K-wire and positioned it against the bone cortex. After contemplating for a moment, he then repeatedly adjusted the K-wire’s access point and angles, intermittently observing his hand’s drill and K-wire from outside, and then the screen displaying the fragment being held by the grasper.
After many adjustments, the drilling started. The K-wire passed through and struck the bone fragment from a perfect spot. How impressive! Everyone couldn’t help being stunned, almost applauded.
As this fragment was relatively small, one screw was enough to secure it. The screw could only be driven from the outside in. After measuring, a partially threaded cannulated screw was selected and driven in; the fracture was fixed just right, secured with compression. The screw tip entered the subchondral bone and didn’t protrude.
His first-rate skills in the nation were unquestionable. Most experts would consider this situation a major disaster, promptly surrendering and being forced to abandon the operation. But he effortlessly continued, and from the look of his skills, he had reached a pinnacle.
This task of hitting a circle behind a wall, such a level of technic to drive a K-wire, is rarely accomplished by even a few in the nation, fewer could achieve it in one trial.
His skills as a senior brother were indeed remarkable. Director Guan observed his procedure with great admiration. Chen Ge was left with his head hanging low, receiving occasional glares from Professor Ye and Director Guan, didn’t dare to lose his temper.
There were three fragments in all. A similarly sized second piece was fixed with the same technique, using a single cannulated screw by Professor Ye. The third and biggest piece was secured with two screws, all driven from the outside in, the K-wire accurately penetrated in one attempt, correctly located each time.