After washing their hands.
When the two of them entered the operating room one after the other, the patient had already been anesthetized and was lying quietly on the operating table.
The right ankle had already been disinfected and draped, leaving only the swollen, deformed ankle joint exposed.
The nurses were counting the instruments. The anesthesiologist sat behind the monitor with a manga in his hands, looking rather bored.
It was a routine operation.
There were no important figures involved, and no tense, thrilling resuscitation.
If the chief surgeon had been Imagawa Ori, everyone might have perked up a little, afraid of being scolded.
But the chief surgeon was Takigawa Takuhei?
Then there was no pressure at all.
Everyone was even chatting idly about the cafeteria food at lunch.
“Dr. Takigawa, may we begin?”
The circulating nurse glanced at the clock on the wall and urged him.
She knew Takigawa Takuhei’s technical level quite well, and knew this operation would probably run long again.
So when she left home that morning, she had arranged for her husband to pick up their child from winter cram school at seven.
“Ah, yes. Yes.”
Takigawa Takuhei walked to the chief surgeon’s position, took a deep breath, and held his hands up in front of his chest.
The operation began.
He reached out, and the scrub nurse slapped a scalpel into his hand.
“Skin incision.”
Takigawa Takuhei gripped the handle.
According to the preoperative plan, they would start with the lateral malleolus—that is, the fibular fracture.
The incision was about ten centimeters long, running along the posterior border of the fibula. This step was not difficult; all he had to do was avoid severing the superficial peroneal nerve.
His movements were not exactly fast, but they were proper and by the book.
Kiryu Kazusuke stood in the first assistant’s position, holding two retractors to expose the field.
Watching Takigawa Takuhei operate, he more or less had a sense of things.
His fundamentals were decent, and he was clear on the anatomical planes. He was just too hesitant.
Every cut he made, he would pause for a moment, confirming he had not injured any vessels or nerves before daring to continue. That was what slowed the surgery down.
“Expose the fracture ends.”
Takigawa Takuhei used a periosteal elevator to clear the soft tissue from the fractured ends.
Everything was going smoothly.
Until he saw that the distal fibula had a long oblique spiral fracture, with comminuted ends and a free butterfly fragment lying outside.
The movement of his hand stopped.
The preoperative X-ray had been two-dimensional, while the tangled mess before him was three-dimensional.
The free bone fragment was caught in the muscle, obstructing reduction.
“Periosteal elevator.”
He reached out for the instrument and tried to lever that fragment loose.
But he did not dare use force.
The blood supply to the distal fibula was poor. If he stripped too extensively, the fragment would become necrotic, and then it would turn into sequestrum, leading to nonunion.
But without force, the fragment did not budge at all.
“Tch.”
A fine layer of sweat seeped out across Takigawa Takuhei’s forehead.
The atmosphere in the operating room grew subtle.
The nurses who had been chatting stopped talking. The anesthesiologist also put down the Weekly Shonen Jump in his hands and looked up toward the monitor.
Everyone could tell—the chief surgeon was stuck.
This was awkward.
It had taken him five minutes to cut through the skin, and now he had already spent another ten minutes staring blankly at the bone.
“Dr. Takigawa, do you need help?”
The scrub nurse could not help asking. There was not much respect in her tone; it was more of a helpless “as expected.”
Takigawa Takuhei’s face flushed red.
He wanted to say there was no need, that he could do it himself.
But he really did not know where to start.
The few short words written in the textbook—“clear embedded soft tissue, achieve anatomical reduction”—were, in reality, a great mountain lying across his path.
“Senpai Takigawa.”
Just as he was about to despair, Kiryu Kazusuke’s voice sounded beside his ear.
Takigawa Takuhei raised his head. Through his fogged-up goggles, he saw a pair of eyes utterly without ripples.
There was no mockery, no impatience, and no sympathy.
Only a reassuring calm.
Kiryu Kazusuke sighed inwardly.
Takigawa Takuhei was now a textbook case of “tunnel vision.”
All he could see was that shattered piece of bone, while he ignored the overall mechanical structure.
It was like a beginner at a jigsaw puzzle, clutching one piece and trying desperately to jam it into the wrong spot, forgetting to assemble the border first.
Kiryu Kazusuke said, “Stop. Don’t worry about that broken fragment for now.”
Takigawa Takuhei froze for a moment. “But it’s stuck. If I don’t put it right, the bone won’t connect.”
Kiryu Kazusuke shook his head and held his ground.
With the “Fracture Anatomical Reduction—Perfect” skill, he had seen the crux of the problem at a glance.
“Senpai, it can’t go back because the space has become smaller.”
“And the elevator in your hand will only destroy its blood supply.”
“So we need to change our thinking.”
“Please put down the elevator and switch to a pointed reduction clamp.”
As Kiryu Kazusuke spoke, he signaled for the scrub nurse to pass over the instrument.
Takigawa Takuhei hesitated a little, but still did as he was told, tossing the elevator into the kidney dish and switching to a pair of pointed reduction forceps.
But holding the forceps, he did not know where to clamp.
Kiryu Kazusuke pointed to the area above and below the fracture ends—in other words, the main shaft of the fibula.
“Senpai, imagine this.”
“We’re tidying up a messy bookshelf right now. This broken bone fragment is like a book that has fallen into the middle of the shelf.”
“Right now, the boards on both sides of the shelf are crooked, and the space has narrowed. Of course the book can’t fit in.”
“So no matter how hard you push it, it’s useless.”
“What we should do is use the reduction forceps to clamp both ends of the bookshelf—that is, the upper and lower main bone segments.”
“As long as we straighten the shelf and align the boards on both sides, the space in the middle will naturally open up.”
“That book—in other words, that bone fragment—is still attached to muscle and periosteum. As long as the space is right, it will slide in by itself.”
“That is the function of the soft-tissue hinge.”
The analogy was vivid, like common sense even a primary school student could understand.
Takigawa Takuhei understood at once.
He no longer fixated on that troublesome bone fragment.
He opened the jaws of the reduction forceps.
One tip pressed against the cortex of the proximal fracture fragment, while the other pressed against the cortex of the distal fracture fragment.
He avoided the comminuted area.
“Like this?”
“That’s right. Just like that. Now slowly tighten the forceps.”
Kiryu Kazusuke affirmed from the side.
Takigawa Takuhei took a deep breath, and his palm began to exert force.
The ratchet of the reduction forceps gave off a faint clicking sound as it engaged.
Under the forced action of the metal clamp arms, the two main segments of the fibula began to draw closer, rotate, and align.
The space that had been distorted by the fracture was opened up again.
Click.
An extremely faint vibration of bone rubbing against bone traveled through the instrument and into Takigawa Takuhei’s palm.
And in that very instant.
The butterfly fragment that had originally been caught between the fracture ends, leaving him helpless, slid automatically into the gap where it belonged, following the tension of the soft tissues like a bird returning to its nest.
A perfect fit.
Takigawa Takuhei’s eyes widened as he looked at the operative field through his goggles.
That spiral fracture, which had been like a tangled mess, had now recovered the fibula’s original straight form.
That was it… reduced?
No need for violent prying?
No need for repeated attempts?
Just by clamping the two ends with forceps, the middle had fixed itself?
Takigawa Takuhei instantly lost focus. His mind was like an out-of-control high-speed train, derailing with a clang and tumbling into the abyss.
He had stayed in First Surgery for five years.
From Professor Nishimura to Associate Professor Mizutani, and then to all kinds of senior specialists, he had assisted in no small number of operations.
His seniors always liked to use abstruse German terms to explain the principles of reduction—things like “soft-tissue hinge” and “three-dimensional spatial configuration”—leaving him completely lost.
Once they got onto the operating table, they often relied on experience and feel to try things out.
No one had ever been like Kiryu Kazusuke, using such a simple analogy to thoroughly explain the reduction problem that had troubled him for years.
The scrub nurse was also stunned.
She did not understand surgical principles, but she understood the result.
The chief surgeon, who had just been sweating profusely and making a complete mess of the bone, seemed to become a different person after the resident said a few words.
He finished it that quickly?
She could not help taking another look at Kiryu Kazusuke.
Was this really the resident who ran errands and bought coffee for his seniors in the medical department?