Four Kirschner wires formed a temporary internal-external support system.
The shattered articular surface was preliminarily stabilized.
So far, everything had gone smoothly—even more smoothly than expected.
Next came the smaller, free-floating bone fragments.
The anesthesiologist and nurses had all stopped what they were doing, staring at the scene in disbelief.
Was this really something a resident could do?
Was this not a machine that had already performed thousands of similar operations?
“Periosteal elevator.”
Kiryuu Kazusuke put down the hand drill and began clearing a tiny bone fragment attached to a ligament.
He needed to peel the fragment away from the surrounding soft tissue, then place it back into the defect in the articular surface.
It was an extremely delicate maneuver.
Just as he lightly touched the fragment with the tip of the elevator, something unexpected happened.
The fragment did not lift as anticipated.
It merely shifted slightly, and then the entire structure of the articular surface gave an extremely subtle, ominous tremor.
All the bone fragments in the operative field shifted minutely in a chain reaction, like dominoes.
“Occult ligament tear with joint instability.”
Kiryuu Kazusuke’s movements paused.
Imagawa Ori’s brows also knitted together; she, too, quickly identified where the problem lay.
Kiryuu Kazusuke was right.
This was a problem that neither X-ray nor CT could detect.
When the patient fell, it had not only caused a fracture—the ligaments connecting the bone fragments had also torn in a way invisible to the naked eye.
As a result, the overall stability of the wrist joint was far worse than it appeared on imaging.
Conventional reduction methods had already failed here.
Any maneuver to reduce a single bone fragment would be transmitted through the torn ligaments and disrupt other structures that had already been reduced.
This was a deadlock where moving one part affected the whole.
“Stop. I’ll do it.”
Imagawa Ori’s voice rang out.
The only salvage method now was to give up levering, apply a plate directly, and use compression screws to press everything together, sacrificing part of the smoothness of the articular surface in order to preserve the larger structure.
Although the patient’s postoperative joint function would be severely affected, at least it would avoid the worst outcome of total joint collapse.
This was a procedure only she, the chief surgeon, could perform.
Kiryuu Kazusuke ignored her.
He still maintained the posture of holding the periosteal elevator.
“I told you to stop!” Imagawa Ori’s tone sharpened. “I’m taking over the operation now. Step down.”
But Kiryuu Kazusuke still did not move.
He closed his eyes. After two or three seconds, he opened them again.
“Open five 1.0-millimeter Kirschner wires.”
He put down the periosteal elevator and reached out his hand.
The scrub nurse froze. She blinked, then looked toward the chief surgeon.
Imagawa Ori was just about to explode.
“Don’t make noise.”
Kiryuu Kazusuke said in a low voice, without even raising his head.
The moment those words were spoken, everyone stopped moving.
Takigawa Takuhei’s mouth fell open. A resident had actually told the chief surgeon not to make noise?
The scrub nurse also felt as though the world had gone mad, but at the same time, she did not dare move without the chief surgeon’s approval.
Even if he was the first assistant, in the end, he was still only the first assistant.
Kiryuu Kazusuke’s hand waited in the air for several seconds, but the Kirschner wires he wanted never came.
There was no response.
Yet he did not withdraw his hand. Instead, he stared at the floating bone fragments in the operative field and spoke calmly.
“The problem now isn’t the bone. It’s the loss of soft-tissue tension.”
“Give me the wires. I’ll use multi-point anchoring to reconstruct the soft-tissue tension first, then use the pull of the ligaments to let the bone fragments return to position on their own.”
After saying that, he lifted his eyes slightly, his gaze falling on Imagawa Ori.
Imagawa Ori stared into his eyes.
Reconstruct the tension?
It was theoretically feasible, but it required godlike control over anatomy and the use of Kirschner wires.
And the resident across from her—was that possible?
“Bring the wires.”
Kiryuu Kazusuke asked again in a low voice.
“Give them to him.”
Imagawa Ori gritted her teeth.
If they did nothing, this hand would be no different from useless.
If they did it, there might still be a slim chance!
In any case, the worst outcome could not be worse than the current situation.
Of course, that was one thing to say—but if Kiryuu Kazusuke turned out to be merely spouting nonsense in the end...
Although she could not have him directly thrown out of the department, she would never let him get involved in her surgeries again. Not even writing medical records!
The scrub nurse immediately placed five thinner Kirschner wires into Kiryuu Kazusuke’s hand.
Kiryuu Kazusuke picked up the first one.
The index finger of his left hand pressed lightly along the edge of the operative field, confirming the first entry point.
The first wire entered obliquely from the base of the ulnar styloid process. Its target was not a bone fragment, but the region of the triangular fibrocartilage complex (TFCC) of the wrist joint.
The needle tip pierced the skin and, at an extremely tricky angle, precisely entered the edge of the torn ligament.
He did not continue deeper. Instead, he gently levered the tail of the Kirschner wire outward.
This Kirschner wire became a miniature lever, instantly tightening the lax ligamentous structure.
“Second.”
Another wire entered his hand. Kiryuu Kazusuke found another entry point on the lateral side of the radial styloid process.
This time, the target of the needle tip was the radial collateral ligament.
The same movement: puncture, then use the leverage of the wire’s tail to tighten the ligamentous structure on the radial side as well.
In the operating room, everyone held their breath.
What was he doing?
He was not fixing the bones—he was using Kirschner wires to reconstruct the entire ligamentous tension system of the wrist joint.
This was an unheard-of maneuver!
Takigawa Takuhei also craned his neck, trying to see every detail clearly.
Although his own skill was not exceptional, he did have the ability to tell whether someone else’s skill was exceptional—just as a customer did not need to know how to cook.
Imagawa Ori sank into thought.
She understood.
Kiryuu Kazusuke’s idea was not to fix those unstable bone fragments one by one, but to do the opposite.
He first used Kirschner wires to construct a temporary ligament scaffold. Under the effect of this scaffold, all the bone fragments that had shifted because of ligament laxity would be restrained and reduced again by the external tension.
This idea was genius!
But the operative precision it required was simply not something a human could achieve.
The nerves and vessels around the wrist joint were intricate and complicated. Any deviation of even one millimeter could lead to catastrophic consequences.
“Third.”
Kiryuu Kazusuke’s voice remained steady.
This wire entered from the midline of the dorsal side of the wrist joint, targeting the dorsal intercarpal ligaments.
“Fourth.”
This time, it entered from the palmar side, fixing the palmar ligamentous structures.
Four 1.0-millimeter Kirschner wires, from four different directions, constructed a perfect quadrilateral tension network.
Under the effect of this tension network, the articular surface that had already undergone minute displacement miraculously, slowly, and automatically returned to a smooth state.
Those tiny bone fragments were pressed back into their original positions as if by an invisible hand.
The entire operative field went from chaos to order.
“Fifth.”
Kiryuu Kazusuke picked up the final Kirschner wire.
He did not add another new fixation point.
Instead, he used the tip of this wire to gently tap the tails of the four already fixed Kirschner wires, one by one.
“Ding.”
“Ding.”
“Ding.”
“Ding.”
Four crisp metallic collisions rang out in the quiet operating room.
Each tap caused the corresponding Kirschner wire to vibrate with extreme subtlety.
This vibration was transmitted through the steel wire into the ligamentous structures, releasing the excess stress and allowing the entire tension system to reach its final equilibrium.
“Periosteal elevator.”
Kiryuu Kazusuke once again lightly touched that tiny bone fragment with the tip of the elevator.
This time, the entire articular surface structure was as steady as bedrock.
Then he easily levered the bone fragment up and, like fitting in a puzzle piece, embedded it perfectly into the defect in the articular surface.
Perfect.
A perfect reduction in the anatomical sense.
At this point, the art was complete!