A fracture is not simply a broken bone as we are accustomed to imagine. It has its own definition in medicine!
——
Disruption of bone integrity and continuity.
Therefore, we can boldly infer that as long as the continuity and integrity of the bone are interrupted, it can be considered a fracture.
This is different from what we imagine, as the name suggests, that the two things are separated very simply and rigorously.
The broken ends of the fracture are irregular, and there is a lot of residual blood and broken bone fragments. If these bone fragments are not cleaned, they will form compressive tissue between the broken ends of the fracture.
Failure to achieve a perfect anatomical reduction is a bit like if there is mud on the soles of your shoes, you will feel an uneven feeling when walking on the road.
This is definitely not possible.
To clean these bone debris, you need to use the tool in the operating room, a bone peeler, also called a bone stripper. As the name suggests, it can separate the bones so that the debris in the middle can be cleaned.
It's similar to how we clean the mud stuck to the soles of our shoes and regain the normal feeling of walking.
Moreover, bone stripping can remove bone fragments and can also assist in the reduction of fractures with force!
However, after the instrument nurse removed the bone and brought it to the operating table, although some of the fracture debris was cleaned up, trouble arose during the reduction process.
First, there is the medial tibial insertion point. The medial muscle group composed of the semitendinosus, semimembranosus, and tibialis endometrium originating from the ischial tubercle pulls the broken end of the medial tibial platform and raises it.
The muscle strength of the lower limbs is not small, so the tension is very tight.
And you can't use violence, otherwise, the fractured fragments that are originally separated may break when you use brute force, so why do you want to do a bullshit surgery?
If fracture reduction is the key point of the entire fracture surgery, then how to achieve this kind of muscle pulling fracture displacement is the key point of fracture reduction.
At this time, you need to use clever methods to resist muscle stretch!
Cai Dongfan continued to pry for a while, but the pulled fracture fragments were still not obedient.
He raised his head and said, "Luo Yun, take another bone peeler and press it for me!"
What Cai Dongfan wanted to do was to press the broken ends of the fracture fragments to counteract them so that the fracture fragments would not shift under the pull of the muscles.
Luo Yun frowned slightly and said, "Director Cai, this fracture is not big. If you press against it, it may break."
Although he rejected Cai Dongfan's opinion, Luo Yun still said it. The entire operation does not belong to Cai Dongfan alone. If an accident occurs during the operation, it is the entire team that will increase the workload!
"Yeah!" Cai Dongfan pondered for a while and took a few deep breaths.
"It would be nice if I could fix it with a Kirschner wire first, so that the whole bone would bear the force." Cai Dongfan said to himself.
This is a kind of temporary fixation during surgery. Various fracture surgeries will use K-wires for temporary fixation during surgery.
This is also the reason why after Zhou Cheng obtained perfect open reduction and internal fixation of fracture, he also obtained the (perfect) skills of K-wire internal fixation of fracture reduction!
This is a whole, a downstream skill.
"Xiu, please give me two K-wires to try." Cai Dongfan still thinks it's better to be on the safe side. Otherwise, if the fractured fragment breaks again, the workload will be much greater than it is now!
Cai Dongfan called the traveling nurse.
For an operation, the most complete configuration in a tertiary-level hospital is the circulating nurse, who is responsible for prescribing various new instruments or consumables during the operation.
Nurse washing hands and passing instruments to surgeon.
An anesthesiologist is responsible for anesthesia.
Then there is the team of surgeons, who are responsible for the operation. There are also some workers who are responsible for cleaning the operating room, delivering the surgical kit for the next operation, etc. Each of them performs his or her own duties to make the connection between a patient's operation and the operation more smooth.
Smooth!
"Okay, Director Cai." The circulating nurse naturally respects the opinion of the chief surgeon.
She knows some orthopedics, but she is definitely not good enough to advise Cai Dongfan on surgery. Moreover, temporary Kirschner wire fixation of fractures is a normal operation!
Just after Cai Dongfan got the Kirschner needle and was about to inject the Kirschner needle, he suddenly said: "Yan Jun, change positions with you and Zhou Cheng. I will first inject the Kirschner needle in the direction from inner to outer."
"You need to fix the insertion point of the K-wire for me."
During surgery, temporary fixation of K-wires generally requires two K-wires to be inserted crosswise.
What we are doing now is a medial fracture. It is best to use the first Kirschner wire from the inside down to the outside, along the direction of the tibial plateau fracture, to nail the fracture fragments to the big tibia first.
During the process of K-wire injection, someone needs to develop the needle entry point, and preferably also assist in fixing it.
This is a good operating opportunity.
Cai Dongfan still gave it to his student, Du Yanjun.
Zhou Cheng was also very obedient. He first asked Du Yanjun to take over the hook he pulled, then walked around from behind Du Yanjun back to back and came to the top of Du Yanjun, and then Du Yanjun went to Zhou Cheng's previous position.
move!
Zhou Cheng is still right about the small details of sterility in this kind of surgery.
Every surgical operation requires a strict aseptic concept, otherwise you will be killing yourself and looking for trouble.
After Zhou Cheng arrived at the spot where Du Yanjun was standing before, he sighed slightly in his heart, covered his face with a mask, smiled bitterly, and then decided to help Cai Dongfan.
Because if Cai Dongfan is like this and forcibly nails the Kirschner needle to a larger tibia in an air-free state, it will actually be the same as when he asked Luo Yun to hold it down before.
In fact, the best way now is to find a suitable point and remove the tension from the medial muscles where the insertion point is on the inner side of the tibia.
Muscles are like rubber bands, but if the rubber band is not stretched, it has no pulling power.
Previously, Zhou Cheng stood below the surgical site, and the medial muscles started from the ischium and ended on the inner side of the tibia. The muscles ran above the surgical site. Even if Zhou Cheng wanted to help, he was powerless. But now that he is in this position
, then of course I have to help.
So, while Zhou Cheng used his right hand to pull the hook, he silently placed his left hand on a very clever position on the patient's inner thigh, then pressed it down and then slid it down slightly.
In an instant, the increase in friction brought about by Zhou Cheng's downward pressure with the fingers of his left hand smoothed the patient's muscles that were originally pulling on the fractured fragments.
Follow the shape of the muscles and stroke like this.
A magical scene occurred. The tip of the fracture, which had been pried very high, now retracted its 'tail' very docilely, and steadily joined the large army of tibia.
Seeing this scene, Cai Dongfan's pupils immediately shrank, and he didn't even have time to think about why this happened.
But this is very conducive to the progress of the operation. He shouted almost without thinking: "Don't move, keep this posture, I will inject a Kirschner needle first. Don't move."
The opportunity for surgery is fleeting.
Therefore, Cai Dongfan didn't have time to let Du Yanjun reveal the needle insertion point to him, and directly drove the Kirschner wire in with an electric drill.
Du Yanjun was very embarrassed at the time. He held the blood vessel clamp in his hand and opened it in the air. It was like a lonely man...
I was at a loss: Master, where did you say you would let me fix the needle insertion point for you?
After the first Kirschner needle nailed the fracture fragments in the direction from the inside to the outside very well, the three heads and six eyes invariably looked in the direction of Zhou Cheng...
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