Kiryu Kazusuke, who possessed the skill “Fracture Anatomical Reduction—Perfect,” had an almost intuitive sharpness when it came to the spatial relationships between bones.
The distal dorsal displacement written on the emergency report was only the most basic surface finding.
The real devil was hidden in the shadows.
His gaze locked onto the lateral film, on the small bone at the center of the wrist, shaped like a crescent moon.
The lunate.
A normal lunate, on a lateral view, should look like an upside-down cup, supporting the capitate above it while seated below in the lunate fossa of the radius.
But the lunate on this film did not have its “cup opening” facing squarely toward the capitate. Instead, it was tilted slightly toward the palmar side by several degrees.
Takigawa Takuhei and Tanaka Kenji had not noticed it. They had probably assumed it was merely an issue with the projection angle, or a change in positioning caused by the fracture.
But in Kiryu Kazusuke’s eyes, the problem immediately became clear.
Volar intercalated segment instability.
This meant that the ligament connecting the lunate and the triquetrum had already ruptured.
If it was not repaired, then even if the radial fracture healed, the patient’s wrist joint would rapidly degenerate because of this tiny instability, ultimately leading to severe traumatic arthritis.
At that point, forget attending tea gatherings—even holding chopsticks would hurt.
More importantly, this kind of instability absolutely could not be treated with simple cast immobilization.
In fact, if the cast was applied in the wrong position, it could even worsen the dislocation.
For someone like Mrs. Ando, who cared so much about quality of life, this would be an utterly unacceptable disability once the cast was removed.
When that time came, what would she do?
A wealthy, idle noblewoman who cared so deeply about the quality of her life would absolutely take the diagnosis to a law firm.
A medical lawsuit would be inevitable.
And the media loved nothing more than news like “University Hospital Misdiagnosis Leaves Noblewoman Disabled.”
When that happened, Tanaka Kenji, who had made the initial diagnosis, would not escape responsibility; Takigawa Takuhei, who had reviewed it, would not escape responsibility; and Imagawa Ori, who signed off on it, would be even less likely to escape.
Mrs. Ando was becoming somewhat impatient.
Her gaze moved among the several doctors before finally landing on Kiryu Kazusuke, who was staring at the viewing box.
Was it not just a simple fracture?
Either put on a cast or do surgery—could they not just give her a clear answer?
“Doctor, are you finished looking?”
She covered her nose slightly. Although there was no strange smell in the room, it was a gesture.
Tanaka Kenji was just about to speak and agree, intending to say they could arrange it immediately.
“Please wait a moment.”
Kiryu Kazusuke’s voice rang out. He spoke quickly, directly cutting off the words Tanaka Kenji had been about to say.
“Why?”
Imagawa Ori turned around and looked at him with her phoenix-like eyes, waiting for him to continue.
As a specialist, she had realized there was something off about the film and had formed a preliminary judgment.
But she was still not entirely certain.
Kiryu Kazusuke took a ballpoint pen from the pocket of his white coat and asked, “Ando-san, does the tea ceremony demand a high degree of precision in hand movements?”
“Yes, yes.” Mrs. Ando nodded repeatedly.
The tea ceremony placed extremely high demands on ulnar deviation and palmar flexion of the wrist. In particular, when whisking tea and turning the bowl, flexibility of the wrist joint was very important.
“All right, thank you, Ando-san.”
Kiryu Kazusuke turned toward the viewing box, held the pen in his hand above the lateral film, and drew a circle in the air over it.
“So I’m a little concerned about the position of this lunate.”
“The reduction of the radius looks fine, but here, the projection angle—doesn’t it seem to be tilted just slightly toward the palmar side?”
“What if it’s VISI—volar intercalated segment instability—caused by ligament laxity?”
“Then direct cast immobilization may not provide enough support to counteract that tilt.”
“If it ends up affecting Mrs. Ando’s ability to pour tea after healing, that would be truly regrettable.”
He had carefully considered his wording before saying all this.
First of all, in front of the patient, he was only a junior resident.
Second, this was not a crisis on the operating table. He still had to give everyone a way out. After all, this was not his patient.
The moment they heard the term “VISI,” the expressions of Takigawa Takuhei and Tanaka Kenji changed at once.
This was a relatively obscure diagnosis in the field of hand surgery, something generally only doctors who specialized in hand surgery would pay attention to.
But they understood the consequences.
If they truly treated it as an ordinary fracture and applied a cast, immobilizing the wrist in ulnar deviation, then a few months later, the patient would develop persistent wrist pain and weakness.
Missing VISI and causing the patient to lose wrist joint function—that was an absolute medical accident.
Compensation would start at ten million yen.
The two of them moved closer to the viewing box and stared carefully at the spot Kiryu Kazusuke had circled.
The angle of tilt was indeed very small.
But once it was pointed out, it was like the elephant in the room—impossible to unsee.
Imagawa Ori stared at the film for a few seconds, and the doubts in her mind finally settled into place.
So that was it.
The reason she had felt something was awkward was the tilt of the lunate.
She had not noticed it earlier because this was an extremely concealed associated injury. If one did not deliberately suspect it, one’s attention would easily be drawn away by the obvious fracture line.
But now, with Kiryu Kazusuke’s reminder,
it was like obtaining a key clue in a puzzle game—the once chaotic image instantly became clear.
In a normal carpal alignment, Gilula’s three arcs should be continuous and smooth.
But the patient’s lunate was flexed palmarly, while the capitate was extended dorsally.
A typical VISI deformity.
There was an extremely high possibility of lunotriquetral ligament rupture.
She turned her head and looked deeply at Kiryu Kazusuke.
Last time, he had discovered a hidden ligament tear during surgery. This time, he had found carpal instability on preoperative imaging.
This could no longer be explained by mere good luck.
Although Mrs. Ando did not understand terms like VISI or lunate, she understood the key phrases “affect pouring tea” and “regrettable.”
“Doctor, is what he said true?”
She put down the fashion magazine in her hand, and her expression turned somewhat ugly.
“It’s very possible.”
Imagawa Ori turned slightly, her finger gently tapping the film on the viewing box.
“But this is only an inference based on the position of the bones.”
“X-rays can only show bones. Soft tissue cannot be seen on them.”
“To be absolutely safe, we still need to arrange an MRI scan for you so we can clearly see the condition of the ligaments.”
“This is also to ensure that your hand can recover to its most perfect state.”
When facing a VIP candidate like Mrs. Ando—suspicious and difficult to deal with—a doctor’s subjective judgment alone was not enough.
There had to be ironclad evidence.
Without imaging evidence to support the diagnosis, if the intraoperative findings differed from the preoperative prediction, it could very easily turn into a medical dispute.
“If that really is the case, then… then what should be done? Will I need surgery?”
Mrs. Ando’s breathing grew slightly quicker, and the expression on her face visibly became tense.
“We need to see the exact condition of the soft tissue and confirm whether that ligament is ruptured, and how completely it is ruptured.”
At this point, Imagawa Ori paused, her tone becoming a little heavier.
“If the MRI confirms a ligament rupture, then surgery is necessary.”
“Because without surgery, a ruptured ligament cannot be repaired with a cast alone.”
“We must treat the distal radius fracture while also using internal fixation to reconstruct the linkage mechanism between the lunate and the triquetrum.”
“Only then will your wrist be able to lift a tea bowl again.”
An extra chapter. Thank you all for your support.