If it were merely ordinary good luck, Takigawa Takuhei might have blundered his way into a decent surgery.
But ask him to clearly explain the principles behind it?
If he could explain it properly, he wouldn’t still be nothing more than a specialist trainee after all these years.
And on the schedule for that operation, the first assistant was Kiryu Kazusuke.
Once all the impossibilities were ruled out, only one possibility remained. Needless to say, it had to be his handiwork.
“Enough.”
Imagawa Ori stuffed the X-ray films back into the bag, cutting off Takigawa Takuhei’s endless chatter.
That was about enough.
Did he really think she was some clueless junior resident?
“Arrange early rehabilitation intervention.”
“Yes!”
Only then did Takigawa Takuhei shut his mouth, still not quite satisfied.
The next patient was in Room 612, a single room.
Though it was not one of those extravagantly luxurious VIP suites, it was still a high-end private-pay ward. Those who stayed here were usually middle-class patients with a certain degree of financial means.
This patient had been admitted through the emergency department yesterday afternoon and assigned to Tanaka Kenji.
A humidifier was running in the room.
On the bed by the window sat a woman in her fifties, dressed in fine silk pajamas. Even during hospitalization, her hair was impeccably maintained.
Mrs. Ando had accidentally fallen while going down the stairs yesterday and landed on her palm.
Middle-class housewives with a bit of money and an extreme fear of death were one of the most troublesome groups in the medical office.
If the slightest thing displeased them, they would file a complaint. Even over trivial matters, they would summon the doctor and question them for half a day.
“Report the history.”
Imagawa Ori stood beside the bed, both hands in the pockets of her white coat.
Tanaka Kenji immediately stepped forward and opened the medical chart folder in his hands.
“Patient: Ando Miyoko, fifty-four years old.”
“Chief complaint: right wrist pain and swelling with restricted movement for one day.”
“History of present illness: yesterday afternoon, while descending the stairs at home, she missed a step and fell, landing on her right palm.”
“Emergency radiographs showed a distal radius fracture on the right side. The fracture line is located at the metaphysis, with typical dorsal displacement.”
“Fortunately, there is no obvious collapse or step-off of the articular surface.”
“Taken together, this is a typical Colles’ fracture.”
“Considering that the fracture ends are relatively stable, the preliminary diagnosis is to adopt conservative treatment: closed manual reduction under local anesthesia, followed by plaster immobilization once satisfactory reduction is achieved.”
It was a perfectly standard diagnosis and treatment plan.
A Colles’ fracture was, clinically speaking, an extension-type distal radius fracture.
The classic appearance of this kind of fracture was dorsal displacement of the distal fragment, resembling an upside-down dinner fork. Thus, in diagnosis, it was also referred to as a “dinner-fork deformity.”
It was one of the common cases in First Surgery.
Tanaka Kenji had been working for more than a year, and handling this was second nature to him.
Mrs. Ando leaned against her pillow, holding a fashion magazine in her left hand. Her gaze fell on the group.
“Doctor, how long will I have to wear the cast?”
“I still have to attend the Hatsugama at my tea ceremony class next month. Wearing a cast would look terrible.”
“Can I not wear one?”
Hatsugama was the first tea gathering of the New Year.
For noble ladies who built their social circles around such things, this was a matter more important than the heavens.
“Mrs. Ando, injuries to tendons and bones take a hundred days to heal,” Tanaka Kenji could only say with an accommodating smile. “I’m afraid next month’s Hatsugama will be difficult to make.”
“The plaster usually needs to remain fixed for four to six weeks. After it’s removed, you’ll still need rehabilitation training.”
“If you don’t wear a cast and the bone heals crooked, your wrist may become deformed in the future, and it may continue to hurt.”
That was the standard answer.
But Mrs. Ando was clearly dissatisfied. She frowned and patted the blanket on the bed with the book in her hand.
“Isn’t there any other way?”
“I heard there’s some kind of minimally invasive surgery nowadays. Can’t I have that?”
“Money isn’t an issue.”
She turned her gaze toward Imagawa Ori, who looked like the highest-ranking person among them.
Imagawa Ori did not speak.
She picked up the X-ray film bag from the bedside cabinet, lifted it, and looked at it against the light outside the window.
The stark black-and-white image of bone entered her eyes.
There was a clear fracture line at the distal radius, but it did not extend into the articular surface. There was slight dorsal angulation, and the overall alignment was acceptable.
It was indeed a Colles’ fracture. Put on a cast, send her home to recover, and that would be the end of it.
Imagawa Ori looked for a while but offered no opinion.
“Takigawa, what do you think?”
She handed the films to Takigawa Takuhei, the specialist trainee beside her.
This, too, was a privilege of a superior physician.
Testing subordinates, while also buying herself time to think.
“Yes.”
Takigawa Takuhei took the films and leaned in to examine them carefully.
First the PA view, then the lateral.
Radial height, volar tilt, ulnar inclination…
He quickly ran through these measurements in his mind. There was nothing particularly special.
This was a typical Colles’ fracture—so mild that it was not even comminuted, just a single intact fragment.
“From the films, although there is displacement at the fracture end, it isn’t severe.”
“The disruption of cortical continuity is relatively regular.”
“And the patient’s bone quality is still fairly good. There is no obvious osteoporosis.”
“I believe Tanaka-kun’s judgment is correct. Conservative treatment is the first choice.”
“As for surgery, although it can allow early mobilization, it will leave a scar after all, and there is a risk of infection.”
“For this kind of extra-articular fracture, it would be somewhat excessive treatment.”
For a seemingly simple borderline case where the surgical indication could go either way, it was better to avoid unnecessary trouble.
With conservative treatment, even if recovery was slightly poorer, the patient could only blame herself for falling badly.
But if surgery was performed and left a scar, or if any complication arose, a troublesome middle-class housewife like this would definitely raise hell.
That, too, was the voice of experience.
“Mm.”
Imagawa Ori responded noncommittally.
“Kiryu, you take a look as well.”
But afterward, she turned sideways and made room for the person behind her.
The atmosphere in the ward instantly became somewhat strange.
Tanaka Kenji and Takigawa Takuhei exchanged a glance, both seeing the confusion on the other’s face.
Was there a problem?
Impossible.
What was written in the emergency report did not differ much from their judgment, and radiology had not called to report any critical findings.
Had they missed something?
But at first glance, there really did not seem to be anything wrong with the films.
It was just that Imagawa Ori had a certain intuition. She kept feeling that something was off somewhere.
As a specialist who had read countless films, when she looked at images, she did not merely look at the bones themselves, but also at the relative positional relationships between them.
On this lateral film, the arrangement of the carpal bones seemed… not quite right?
But for the moment, she could not identify exactly where the problem was.
After all, X-ray films were only two-dimensional projections. Many fine structures overlapped, easily creating visual illusions.
Kiryu Kazusuke did not decline.
After taking the films, he did not hold them up to the window like the others. Instead, he directly inserted them into the viewing light mounted on the wall.
Click.
The switch flipped on, and a cold white backlight lit up.
He stepped forward and stood before the viewing light.
With just one glance, a three-dimensional model of the wrist had already automatically formed in his mind.
On the PA view, the fracture line at the distal radius was indeed very clear.
He looked carefully for another few seconds.
And in his heart, Kiryu Kazusuke had already made the diagnosis.