medical simulator

Chapter 12 What about the fix? !
A fracture is not what we habitually imagine, it is simply a broken bone.It has its own definition in medicine!
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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 imagined as the name suggests, the two things are separated very cleanly and rigorously.

The broken ends of the fracture 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.

This is definitely not possible.

To clean up these bone debris, you need to use tools in the operating room, bone peeling, also called bone stripper, as the name suggests, it can separate the bones so that the debris in the middle can be cleaned.

It is similar to how we clean up the mud sticking to the soles and restore the normal walking feeling.

Moreover, bone stripping can not only remove bone debris, but also assist in the reduction of broken bones!

However, after the equipment nurse took the bone stripper to the operating table, although some debris from the fracture was cleaned away, troubles appeared during the reset process.

First, there is the medial tibial insertion point. The medial muscle group consisting of the semitendinosus, semimembranosus and tibial endometrial muscle from the ischial tuberosity pulls the stump of the medial tibial platform and tilts it up.

The muscle strength of the lower limbs is not small, so the stretch is very tight.

And you can't use violence, otherwise, the fracture fragments that were originally separated may break when you use brute force, so what's the point of doing surgery?

If the reduction of the fracture is the key point of the whole fracture operation, then how to get the fracture displacement of this kind of muscle traction is the key point of the fracture reduction.

At this time, it is necessary to use a clever way to resist the pulling of the muscles!
Cai Dongfan continued to poke for a while, but the pulled fracture fragments were still not very obedient.

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

What Cai Dongfan wanted was to press down on the broken ends of the fracture fragments so that the fracture fragments would not be displaced under the pull of the muscles.

Luo Yun frowned slightly, and said, "Director Cai, this fracture is not big, it might break if you press it backwards."

Although this was a rejection of Cai Dongfan's opinion, Luo Yun still said that the entire operation does not belong to Cai Dongfan alone. If there is an accident during the operation, it is the entire team that will increase the workload!
"En!" Cai Dongfan pondered for a while, and took a few deep breaths.

"It would be great if it could be fixed with a Kirschner wire first, so that the whole bone will be stressed." Cai Dongfan said to himself.

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

This is also the reason why Zhou Cheng also acquired the skills of fracture reduction and Kirschner wire internal fixation (perfect) after obtaining perfect fracture open reduction and internal fixation!

This is a whole and belongs to the downstream skills.

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

Cai Dongfan called for the itinerant nurse.

For an operation, the most complete configuration in a tertiary first-class hospital is that itinerant nurses are responsible for prescribing various new instruments or consumables during the operation under the stage.

Nurses wash their hands and pass instruments to surgeons.

An anesthesiologist, responsible for anesthesia.

Then there is the team of surgeons, who do the surgery.There are also some workers who are responsible for cleaning the operating room, delivering surgical kits for the next operation, etc., and performing their own duties, so that the connection between a patient's operation and the operation stage can be smoother!
"Okay, Director Cai." The itinerant nurse naturally respected the chief surgeon's opinion.

She knew some orthopedics, but she certainly wasn't good enough to give advice on Cai Dongfan's surgery.Moreover, temporary Kirschner wire fixation in fractures is a normalized operation!
Just when Cai Dongfan got the Kirschner needle and was about to inject it, he suddenly said, "Yan Jun, change positions with you, Zhou Cheng, and I will first inject the Kirschner needle in the direction from the inside down to the outside up."

"You need to fix the insertion point of the Kirschner wire for me."

During the operation, the temporary fixation of the Kirschner wire generally requires two Kirschner wires, crossed.

What is being done now is a medial fracture. The first Kirschner wire is best to be nailed to the large tibia along the direction of the tibial plateau fracture from the inside down to the outside.

In the process of inserting the Kirschner wire, a person needs to develop the needle entry point, and it is best to assist in fixing it.

This is a good opportunity to operate.

Cai Dongfan still gave it to his student, Du Yanjun.

Zhou Cheng was also very obedient, first he asked Du Yanjun to take over the hook he pulled, and then walked around from behind Du Yanjun back to back to above Du Yanjun, and then Du Yanjun went to Zhou Cheng's previous position move!
Zhou Cheng can't go wrong with the aseptic small details in this kind of surgery.

Every surgical operation requires a strict concept of asepsis, otherwise it is killing yourself and causing trouble.

After Zhou Cheng came to the place where Du Yanjun was standing before, he sighed slightly in his heart, covered himself with a mask, smiled wryly, and then decided to help Cai Dongfan.

Because if according to Cai Dongfan's way, he forcefully nailed the Kirschner wire to the larger tibia in the state of leaving the air, in fact, it is no different from when he asked Luo Yun to hold it down.

In fact, the best way now is to find a suitable point and relieve the tension of the inner muscle group whose insertion point is on the inner side of the tibia.

Muscles are like rubber bands, but if the rubber band is not being stretched, there is no pulling power.

Before, Zhou Cheng stood under the operation site, while 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 Zhou Cheng wanted to help, he was powerless.But now that he is in this position, it is natural to help.

So, while pulling the hook with his right hand, Zhou Cheng silently placed his left hand on a very clever position on the inside of the patient's thigh, and then pressed it down, then slid down slightly.

In an instant, the increased friction brought about by Zhou Cheng's pressing down on the fingers of his left hand smoothed out the patient's muscles that originally pulled the fractured fragments.

Follow the shape of the muscles and stroke like this.

A miraculous scene appeared, the tip of the fracture, which had been pried very high, retracted its 'tail' very docilely at this moment, and joined the big army of the tibia steadily.

Seeing this scene, Cai Dongfan immediately shrank his pupils, without having time to think about why this happened.

It's just that this is very conducive to the progress of the operation, and he shouted almost without thinking: "Don't move, keep this posture, I will inject a Kirschner wire first. Don't move."

Opportunity for surgery is fleeting.

Therefore, Cai Dongfan didn't have time to ask Du Yanjun to reveal the needle insertion point to him, so he directly drilled the Kirschner wire in with an electric drill.

Du Yanjun was very embarrassed at the time, holding a vascular forceps in his hand, and opening it in the air, it was almost lonely...

I was at a loss: Master, did you ask me to fix the needle insertion point for you?
After the first Kirschner wire nailed the fracture fragments in the direction from the inside down to the outside up, the three heads and six eyes all looked in the same direction as Zhou Cheng...

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(End of this chapter)