Imagawa Ori’s question was standard practice for a senior physician assessing a junior physician’s thinking before surgery.
Takigawa Takuhei pushed up his glasses and stared at the films for a long while.
His lips moved a few times, as if he were trying to organize his words, but in the end he only stammered, “This… the articular surface is severely comminuted. It needs… open reduction and internal fixation with a plate…”
His answer was vague. Clearly, he had not come up with a complete plan.
Although he had thought about it very seriously, his mind seemed to have gone a little blank. After thinking for a while, all he could do was recite the textbook answer.
But even a medical student could have given that answer.
Imagawa Ori looked at him with dissatisfaction. “Specifically? Choice of approach, reduction sequence, fixation strategy?”
Takigawa Takuhei looked troubled. “The approach… uh, we can use the conventional combined anteromedial and anterolateral approaches… For the reduction, first reduce the larger fragments…”
As he spoke, his voice grew softer and softer, and his gaze began to dodge.
“Then…”
Then he could not go on.
A conventional plan was simply not enough for a complex comminuted fracture like this, especially when it came to dealing with the collapsed articular surface. He had no clear idea at all.
The air in the medical office seemed to stop flowing. Takigawa Takuhei even felt it was becoming difficult to breathe.
Kiryu Kazusuke stood to the side, completely unmoved inside.
The “volar levering, dorsal support” plan he had proposed backstage yesterday was precisely the optimal solution to the current predicament.
He very much wanted to speak up and repeat that perfect plan.
But seeing that Imagawa Ori was already beginning to look somewhat impatient, he swallowed his words back down.
“I understand.”
Imagawa Ori frowned and cut off Takigawa Takuhei’s stammering.
She thought of the surgical plan Kiryu Kazusuke had described last night. Clear in logic, simple, and easy to execute.
By comparison, the difference was immediately obvious.
But she did not say anything more. She simply turned off the lightbox, took down the fluoroscopy films, and put them back into the file bag.
“Dr. Imagawa…”
Kiryu Kazusuke was just about to speak and confirm with her about his being the first assistant.
But the pager at Imagawa Ori’s waist went off.
She lowered her head and glanced at it. “I have other patients to see. That’s all for now.”
With that, she quickly left the medical office.
She did not even give Kiryu Kazusuke a chance to finish speaking.
“We should get ready to scrub in too.”
Takigawa Takuhei came over and patted Kiryu Kazusuke on the shoulder. Although he had not been able to answer Imagawa Ori’s question, he did not seem to take it too much to heart.
…
Nine o’clock in the morning.
Kiryu Kazusuke handed over Suzuki Shinya’s medical records, imaging materials, and preoperative preparations with the nurse.
After that, he and Takigawa Takuhei pushed the patient out of the ward together.
As soon as they entered the operating room area, they could smell the strong scent of disinfectant. On the white information board hanging in the corridor, all of today’s operating room arrangements were written in black marker.
Kiryu Kazusuke stopped and glanced at it.
[Surgical Procedure: Open Reduction and Internal Fixation (ORIF) for Comminuted Distal Radius Fracture]
[Patient Name: Suzuki Shinya]
[Primary Surgeon: Imagawa Ori]
[First Assistant: Takigawa Takuhei]
[Second Assistant: Kiryu Kazusuke]
Huh?
Still second assistant?
This arrangement caught Kiryu Kazusuke completely off guard. But he had already received “Surgical Incision Suturing,” which meant Imagawa Ori had agreed to let him serve as first assistant.
So what was going on now?
“Kiryu-kun?”
Takigawa Takuhei, standing beside him, seemed to notice something was off and asked.
“It’s nothing.”
Kiryu Kazusuke took a deep breath and suppressed the emotions churning inside him.
Now was not the time to make a scene.
Takigawa Takuhei followed his gaze and saw that he was looking at the surgical staffing arrangement. Naturally, he assumed Kiryu Kazusuke lacked confidence in this complicated surgery.
“For this surgery, Dr. Imagawa is the primary surgeon, I’m first assistant, and you’re only second assistant. Just watch carefully from the side and learn.”
“You don’t need to worry too much either. Just do a good job with the retractors.”
So he patted Kiryu Kazusuke on the shoulder and offered a few words of comfort.
Kiryu Kazusuke knew he had misunderstood something, but he did not explain further.
The two of them steadily pushed the patient into Operating Room Three and completed the final handover with the circulating nurse and anesthesiologist.
In front of the scrub sink.
Cold water washed over Kiryu Kazusuke’s arms as he scrubbed his hands, forearms, and up to three inches above his elbows again and again with the disinfectant brush.
Imagawa Ori was Imagawa Ori, and the patient was the patient. Whether or not he was the first assistant, this was still a surgery.
Medical ethics were his final bottom line.
After scrubbing in, he entered the operating room, put on a sterile surgical gown, and donned sterile gloves.
The circulating nurse tied the straps behind him.
He took the povidone-iodine gauze ball handed over by the nurse and began disinfecting the patient, draping, and applying the surgical film.
By then, it was almost ten o’clock.
Beside the operating table.
Takigawa Takuhei, serving as first assistant, stood opposite the primary surgeon’s position, while Kiryu Kazusuke, as second assistant, stood to the right of the primary surgeon’s position.
The scrub nurse had already arranged all the surgical instruments neatly on the instrument table, and the circulating nurse confirmed the patient’s information and surgical site one final time.
Everything was ready. They were only waiting for the primary surgeon.
A few minutes later, the door to the operating room slid open, and Imagawa Ori walked in.
She had already completed her surgical scrub and disinfection. With both arms raised in front of her chest, the circulating nurse immediately stepped forward to help her into a sterile surgical gown and sterile gloves.
She walked to the primary surgeon’s position and stood there, sweeping her gaze over everyone present.
“Let’s begin.”
Imagawa Ori’s voice came through her mask, muffled.
“Scalpel.”
She extended her hand, and the scrub nurse immediately slapped a scalpel into her palm.
With one clean, decisive incision, she opened the skin.
Imagawa Ori’s technique was indeed beyond reproach.
Her anatomical planes were clear, and her movements were fast, precise, and ruthless, almost without any unnecessary motion.
The electrocautery in her hand gave off a sizzling sound. Wherever it passed, tissue separated, blood vessels coagulated, and bleeding was controlled to a minimum.
Afterward, she incised the subcutaneous tissue, exposing the deep fascia.
As first assistant, Takigawa Takuhei was responsible for the retractors and suction. His task was to provide Imagawa Ori with a clear surgical field.
His performance was fairly standard, without any major mistakes.
Kiryu Kazusuke stood in the second assistant’s position. His work was even simpler: mainly supporting the limb and occasionally handing over gauze, like an outsider.
The surgery proceeded in an orderly manner.
Imagawa Ori separated the muscles step by step, exposed the periosteum, and revealed the comminuted distal radius.
The situation was just as terrible as the CT images had shown. The articular surface had shattered into multiple fragments, like a piece of porcelain smashed to pieces.
Reconstructing such an articular surface was no different from playing an extremely complex three-dimensional puzzle within the space of a few square inches.
After the hematoma and embedded soft tissue at the fracture ends were cleared away.
“K-wire, 1.2 millimeters.” Imagawa Ori set down the electrocautery. “Prepare for temporary fixation.”
The scrub nurse handed a long, slender steel pin and a hand drill to the first assistant, Takigawa Takuhei.
This was one of the most critical steps of the surgery.
The main fracture fragments had to be temporarily fixed in their reduced positions with K-wires, creating the conditions for the subsequent internal fixation with plates and screws.
Takigawa Takuhei took a deep breath and accepted the instruments.
Following the teachings he remembered from the textbook, he found the insertion point at the radial styloid and placed the tip of the K-wire against the bone surface.
“The angle is wrong.”
Imagawa Ori reminded him coldly.
Takigawa Takuhei froze, then hurriedly adjusted the insertion angle and began turning the handle of the hand drill. The K-wire slowly drilled into the bone.
However, his tactile sense was too poor, and his force was uneven.
Suddenly, there was a soft click.
The tip of the K-wire slipped. It failed to fix the target bone fragment successfully. Instead, it scraped past the edge of the fragment and drilled into the adjacent soft tissue.
The first attempt failed.