The entire room fell silent for a second.
Minamura Shoji opened his mouth, wanting to retort, yet found he couldn’t summon a single counterargument.
The C-clamp was indeed a new technique introduced in recent years, specifically for emergency pelvic fractures.
But he was only a specialist trainee. He had only seen professors use it once or twice at most; he had never handled it himself. In his panic just now, he had even completely forgotten it existed.
Although Doctor Inoue didn't understand orthopedics, he had grasped the logic.
“Then hurry up!” Doctor Inoue roared.
“If orthopedics can’t handle this, I’ll open the abdomen directly. At worst, if he dies on the table, at least I’ve done my best!”
This statement left Minamura Shoji hanging over the fire.
If he didn’t operate and the patient died, it would be the First Surgery Department’s responsibility. But if he did operate and failed, it would still be the First Surgery Department’s fucking responsibility.
Minamura Shoji glanced at the blood-soaked patient, then at Kiryu Kazusuke standing beside him.
Let him do it?
No.
This was a high-risk procedure that had to be completed by a senior physician. If the pin deviated and pierced the iliac wing, or went straight into the abdominal cavity and ruptured a major blood vessel, that would be a catastrophic medical incident.
When that time came, as the one who had approved a resident to operate, his career would be over.
“I’ll do it.” Minamura Shoji gritted his teeth and made the call. “Go get the C-clamp! Kiryu, you’re assisting. Handle the positioning.”
He had never done it before, but he understood the principles.
As long as Kiryu Kazusuke could find the exact entry points, all he needed to do was hammer the pins in with force.
“Understood.”
Kiryu Kazusuke raised no objection.
In the emergency center of his previous life, the C-clamp had long been standard equipment. He could insert it with his eyes closed.
But now, he was merely a resident and had to obey his superiors.
As long as they could save the patient, it didn’t matter who performed the procedure.
…
Operating Room No. 3. Under the shadowless lamp, two teams rapidly assembled.
This was an extremely rare combined surgery.
On the left side of the operating table stood the First Surgery Department team: Minamura Shoji as the lead surgeon, Kiryu Kazusuke as first assistant.
On the right stood the Second Surgery Department team: Doctor Inoue as the lead surgeon, accompanied by another resident.
The anesthesiologist stood at the head of the table, staring nervously at the monitors.
“C-clamp ready.”
The scrub nurse opened the sterile pack, revealing the massive metal frame.
“Begin.”
Minamura Shoji took a deep breath and accepted the C-clamp.
His gloves were slick with blood; his palms were drenched in sweat.
This device required fluoroscopic guidance to operate, but there was no time to wheel in the C-arm machine for calibration. He could only rely on surface anatomical landmarks for blind insertion.
The so-called “blind procedure.”
This placed extremely high demands on a doctor’s anatomical knowledge.
Minamura Shoji’s hands were somewhat stiff. He groped around the patient’s bruised and bloodied hip for a long time but couldn’t determine the precise entry point.
The patient’s pelvis was already shattered. Combined with subcutaneous emphysema and hematoma, the normal bony landmarks had become blurred and indistinct.
“The anterior superior iliac spine is here.”
“That’s a subcutaneous hematoma, not bone. Two centimeters down is the anterior superior iliac spine.”
Kiryu Kazusuke’s fingers pressed steadily against a point on the patient’s left hip.
Minamura Shoji’s face burned, but there was no time for that now. Following his finger, he indeed felt the hard bony protrusion.
“Here’s the greater trochanter of the femur. The midpoint of the line between them, moved posteriorly, is the entry point.”
Kiryu Kazusuke’s fingers moved rapidly, pressing two clear dimples into the skin.
“I know!”
Minamura Shoji said impatiently, masking his unease.
He raised the hammer, aimed at the tail of the positioning pin, and struck. The first blow drove the pin tip through the skin and against the bone surface.
Kiryu Kazusuke confirmed from the side: “Position centered, angle perpendicular.”
Thud. Thud. Thud—
With dull striking sounds, the steel pin penetrated the cortical bone and was firmly driven into the ilium.
The other side was handled in the same manner.
Kiryu Kazusuke’s positioning was extremely precise, while Minamura Shoji only needed to be a relentless hammering machine, gradually ceasing to think.
“Attach the compression bar!”
The massive C-shaped frame arched over the patient’s abdomen, connecting the pins at both ends.
Minamura Shoji began turning the compression knob.
As mechanical force transmitted through, the originally loose and wildly splayed pelvis was forcibly compressed inward and closed.
The sound of the fracture ends grinding against each other set one’s teeth on edge.
The anesthesiologist shouted in pleasant surprise: “Blood pressure is recovering! Eighty over fifty!”
Pelvic volume decreased, the tamponade effect took hold, and the massive retroperitoneal hemorrhage was temporarily suppressed.
“Our turn! Open the abdomen!”
Doctor Inoue had long since grown impatient. The moment the C-clamp was secured, his scalpel sliced open the patient’s abdominal wall.
Blood gushed out instantly.
“Suction! Hurry!”
The abdominal cavity was filled with dark red accumulated blood; the spleen was already mangled.
Doctor Inoue moved with blinding speed, lifting out the spleen, clamping the splenic pedicle with hemostats, ligating, and resecting.
The entire process was remarkably swift.
As long as the active bleeding in the abdominal cavity was resolved, the patient’s life was halfway saved.
However—
Just as everyone believed the situation was under control.
Beep beep beep—
The cardiac monitor suddenly emitted an urgent alarm.
“Blood pressure is dropping again! Sixty over forty! Heart rate one-fifty!” The anesthesiologist’s voice suddenly changed pitch. “The pressors are maxed out! Plasma is running wide open! But we can’t get it in!”
Minamura Shoji frowned. “What’s happening?”
Doctor Inoue was irrigating the abdominal cavity: “The spleen is out, the liver is fine, the mesentery is fine, there’s no more bleeding in the abdomen!”
Everyone’s gaze turned toward the First Surgery Department.
If there was no bleeding in the abdominal cavity, then the retroperitoneum was still hemorrhaging.
“Impossible!” Minamura Shoji denied flatly. “The pelvis is fixed, the C-clamp position is perfect. The venous plexus should be compressed!”
Kiryu Kazusuke stared at the retroperitoneal area that was continuously oozing blood.
“Could there still be arterial bleeding?”
The C-clamp could only compress venous plexus bleeding by reducing pelvic volume.
But if a branch of the internal iliac artery—such as the superior gluteal artery or the internal pudendal artery—was ruptured, this kind of high-pressure arterial jet bleeding simply could not be stopped by external compression.
Blood was frantically pouring into the retroperitoneal space, stretching that thin membrane taut like a balloon about to explode.
“We have to stop the bleeding!” Doctor Inoue urged anxiously. “First Surgery, think of something, fast!”
However, Minamura Shoji’s mind was completely blank.
Think of something?
Arterial embolization?
Too late. The patient couldn’t even be moved out of the operating room.
Open the abdomen to explore the retroperitoneum?
Once the retroperitoneum was incised, the pressure would release and blood would spray to the ceiling. There would be no finding the bleeding point.
Ligate the internal iliac artery?
Searching for blood vessels in that mess of mangled flesh and pooled blood was no different from suicide.
This was a dead end.
This kind of critical care management beyond standard protocol was entirely outside his capabilities.
From the side, Kiryu Kazusuke said in a low voice: “Pack it.”
“What?” Minamura Shoji whipped his head around.
Kiryu Kazusuke explained at breakneck speed: “Perform preperitoneal packing.”
“Make a midline lower abdominal incision without entering the peritoneal cavity. Go directly into the prevesical space.”
“Pack large gauze pads anterior to the sacroiliac joint and in the lateral bladder fossae—three on each side. Apply direct physical pressure to the pelvic vessels.”
“This is currently the only damage control technique that can substitute for interventional embolization.”
“Preperitoneal packing?” Minamura Shoji had never even heard the term. “Stuffing gauze in can stop the bleeding? What if it gets infected? What if it compresses the bladder?”
His first reaction wasn’t whether the method would work, but that it violated protocol.
It wasn’t in the textbooks, and the professor had never taught it.