To be honest, Takigawa Takuhei’s heart was a jumble of emotions.
He was thirty-four this year.
Among those who had started alongside him, some had long since obtained their specialist qualifications, while others, unable to endure the suffering, had switched to becoming general practitioners. Only he was still struggling bitterly in First Surgery.
It wasn’t that he didn’t work hard.
He worked harder than anyone—arriving earliest every day, leaving latest, fighting to take on every dirty and exhausting task.
When the professor lectured, his notes were the thickest.
But the world of surgeons was cruelly results-oriented.
Clumsy hands were the original sin.
His hands were not deft enough, and his mind was not quick enough. On the operating table, he was always half a beat slow, unable to grasp the professor’s techniques that “could only be understood intuitively and not conveyed in words.”
But he simply refused to accept it.
He could not accept that after struggling through medical school, he would end up only able to go to some rural clinic and prescribe antihypertensive drugs to old men and women.
Today, he had been dealt another blow.
A resident who had only graduated half a year ago had explained the logic of the maneuver to him in just a couple of casual sentences.
“Senpai, don’t let go.”
Standing opposite him, Kiryu Kazusuke did not give him much time to wallow in self-pity, and reminded him.
The fractured ends had already been anatomically reduced, and the tension of the soft-tissue hinge was perfect.
However, if temporary fixation was not performed immediately, the moment he released the forceps, the tension from muscle contraction would instantly spring the bone open again, and the reduction they had just achieved would be wasted.
“Ah! Right!”
Takigawa Takuhei came back to himself and hurriedly responded.
But he soon discovered an awkward reality: both of his hands were occupied by the reduction forceps, and he had no free hand to take the electric drill.
If Professor Nishimura or Associate Professor Mizutani had been on the table, this would be the moment to loudly scold a resident into coming over to take the forceps.
“Operate one-handed. Place a K-wire for temporary fixation.”
Kiryu Kazusuke spoke up again to remind him.
Having just obtained “Fracture Anatomical Reduction—Perfect” from Imagawa Ori, he was confident that he could rely entirely on muscle tension to maintain the reduction, without even needing forceps.
But Takigawa Takuhei could not.
He was an ordinary man, and had to rely on instruments.
“Understood!”
Takigawa Takuhei took a deep breath, shifted his left hand to grip the handle of the reduction forceps, and freed his right hand.
“K-wire, 1.5 millimeters, electric drill.”
The scrub nurse slapped the electric drill loaded with a K-wire into his palm.
Although the final fixation would be with a plate and screws, for safety’s sake, a K-wire first had to be used for temporary fixation to free the reduction forceps and make room for the plate.
Takigawa Takuhei picked up the electric drill and began drilling the first distal locking hole.
With perfect reduction as the foundation, the remaining internal fixation work was purely carpentry.
No matter how inadequate he was, he would not mess up even this.
The first K-wire passed obliquely through the proximal cortex, crossed the fracture line, passed through the butterfly fragment, and finally nailed into the distal cortex.
The feel was very solid.
Takigawa Takuhei then inserted a second K-wire, forming crossed fixation with the first.
Now it was stable.
Takigawa Takuhei released his left hand and removed the reduction forceps.
The fracture ends did not move in the slightest, still maintaining perfect anatomical alignment.
Only then did he let out a breath of relief.
“Next, the plate.” Some confidence returned to Takigawa Takuhei. “Distal fibula anatomical plate, seven-hole.”
In 1994, when locking compression plates were not yet widespread, the AO-standard one-third tubular plate or dynamic compression plate was used.
These plates were not pre-contoured, and required the surgeon to bend them by hand during surgery according to the shape of the bone.
Takigawa Takuhei took the plate-bending forceps.
Following the curve of the fibula, he began to bend the plate with force.
Once, twice.
He compared it against the bone surface, felt that the curve was insufficient, and bent it again.
“About right.”
He placed the plate against the lateral side of the fibula and clamped it with bone-holding forceps.
Then he began drilling, measuring depth, tapping, and screwing in the screws.
Throughout the entire process, Kiryu Kazusuke merely stood quietly in the first assistant’s position, holding a retractor and responsible for exposing the field, without saying a word.
But inwardly, his thoughts were elsewhere.
The plate’s pre-bent curve was slightly insufficient, and the distal fit was a little poor.
It could be forced into a tight fit by locking it down with screws, but that extra tension would prolong postoperative swelling by another two days.
The entry point for the first proximal screw was a bit too anterior.
Although it would not affect fixation strength, it might irritate the peroneus longus and brevis tendons, leading to postoperative pain.
His hand was unsteady when tapping, and the thread purchase was poor.
To prevent screw loosening, postoperative rehabilitation training would have to be delayed by at least two weeks.
There’s still a lot of room for improvement, Senpai Takigawa.
But Kiryu Kazusuke did not speak up to correct him.
First, although these flaws existed, they were all within an acceptable range.
It met the so-called standard of “functional reduction.” As long as the bone healed and the patient could walk, the surgery could be considered a success.
He himself could pursue ultimate perfection, but if he used that standard to demand it of an assembly-line surgeon like Takigawa Takuhei, that would be nitpicking.
Second, when all was said and done, he was only the first assistant.
Unless the primary surgeon’s actions would cause a serious medical accident, the first assistant had no right to point fingers at the primary surgeon’s technique on the operating table.
That would be overstepping.
Earlier, guiding the reduction had been salvaging the situation. If now he even tried to interfere with placing screws and applying the plate, wouldn’t that be looking for trouble?
Of course, Takigawa Takuhei had no idea he had been criticized so thoroughly.
He was immersed in the thrill of the surgery progressing smoothly.
Bzz—
The final screw was tightened.
The C-arm was pushed over for fluoroscopy, and a clear image appeared on the screen.
The length of the fibula had been restored, the rotational deformity corrected, the joint surface was smooth, and the plate fit well.
If one insisted on measuring with a ruler, perhaps one would find that the physiological curve of the fibula had been straightened ever so slightly, and that the tip of the lateral malleolus was half a millimeter too high.
But in Takigawa Takuhei’s eyes, this was perfection.
This was the most beautiful fibular fracture surgery he had ever performed in his career.
“Beautiful!” He could not help praising himself. “Kiryu-kun, look at this reduction. It’s absolutely superb.”
Kiryu Kazusuke forced a smile and echoed, “It really is quite good.”
“Then next, the medial malleolus?”
“Good! The medial malleolus!”
Takigawa Takuhei turned around and began treating the tibial fracture on the medial side.
Compared to the comminution of the lateral malleolus, the fracture line of the medial malleolus was relatively simple—a transverse fracture.
All they had to do was reduce the bone fragment and then insert two cannulated screws.
But before he began, Takigawa Takuhei subconsciously asked, “For the medial malleolus, we can just directly put in two 4.0 cannulated screws, right?”
Kiryu Kazusuke glanced at the fluoroscopic image on the C-arm.
“No.”
“Look here. Although the fracture line is simple, it was caused by vertical shearing force.”
“If you only use cannulated screws, the shear resistance won’t be enough. When the patient bears weight postoperatively, the fracture fragment will shift proximally.”
“A plate is necessary.”
“Use a T-shaped buttress plate for anti-glide fixation.”
This concept did indeed exist in the textbooks, but in actual practice, for the sake of convenience, everyone usually just dealt with it using two screws.
Takigawa Takuhei froze for a moment, then immediately nodded. “I’ll listen to you.”
The next procedure was not difficult.
Incise the skin, separate the subcutaneous tissue, expose the medial malleolus fracture end, reduce it, and apply the plate.
Takigawa Takuhei’s movements became much faster.
When the final suture was tied and cut, the wall clock pointed to five-thirty in the afternoon.
“Good work.”
Takigawa Takuhei took off his surgical gown and looked at the stable vital signs on the monitor, letting out a long breath.
This was definitely the fastest bimalleolar fracture surgery of his entire career!
One hour and ten minutes.
This bimalleolar comminuted fracture surgery, which had originally been expected to take at least two hours and might even drag on into the evening, had actually ended now.
Moreover, the reduction quality after previous surgeries could only be described as passable.
But today…
Looking at the image on the C-arm screen that could be called a perfect reduction, the excitement in his heart was beyond words.