Chapter 43

If it’s an extrajoint fracture, it’s relatively easy to handle because no assembly is needed. However, intraarticular fractures are different. Any irregularities could wear down the joint and once it is worn down, it can cause long-term pain and disability. Intra-articular fractures require surgical reduction, that is, the pieces should be rejoined exactly as they were before the fracture.

If the bone can’t be reassembled, even missing a tiny bit could result in arthritis; if a bigger piece is missing, it could lead to disability.

From intensive training within the system, Yang Ping found that assembling bone fragments followed some rules. The order of the reductions and the distribution of the Kirschner wires mattered the most. The whole process was like solving a Rubik’s cube; there must be a scientific order, it can’t be approached haphazardly.

What appears simple usually requires tremendous effort.

An empty eggshell can be reassembled by hand – believe it or not, Yang Ping did.

The fracture was a mess, large bone fragments that could reflect the original appearance were no longer discernible. Even the largest fragments didn’t give any indication of their original location.

It’s like a house that has completely collapsed, turning into a pile of rubble. Can you still identify which brick belonged where?

Director Han furrowed his brow and Elder Man Zhang didn’t say a word.

A person with great observation skills could find the few leaves they had seen before from thousands of identical ones.

With lots of training, Yang Ping also gained sharp eyes. He carefully held the bone fragments, identifying them one by one. If there were soft tissues adhering to the fragments, regardless of the amount, he carefully preserved them all.

The forceps used to clamp the blood vessels was as delicate as if it was holding eggshells, demonstrating excellent control – strong but not forceful enough to break them.

When all fragments had been identified and their original locations determined, the order in which they would be assembled for reconstruction began to take shape in his mind.

Without a scientific order, one piece could fall off as soon as another was fitted; a piece that fitted well in one position could block the reduction of another piece; just as one piece was fixed, another could be overlooked, and the reconstruction would not be achieved.

“Sharpen the other end of the Kirschner wires too, prepare five like this.”

Little Five did as he was told. Normally, a Kirschner wire is sharp on one end and flat on the other. Now, they needed to cut the other end to be sharp as well.

“Does he really think he can achieve reduction? How could that even be possible?”

“Even with a steel plate, this would be hard to do.”

“Did not do a CT scan.”

“If a CT scan were needed, he wouldn’t dare to perform the surgery.”

“He’s in a tight spot now, how will he back down?”

People started to whisper. They initially intended to watch the surgery. However, the situation now seemed impossible to salvage – it was completely unmanageable. Ironically, as it was proclaimed to be the most severe, the procedure might turn out to be fairly straightforward. It’s likely that they would just open it up and close it back down again.

Some were very disappointed; they had come with great enthusiasm to observe and learn and now this.

Elder Man Zhang, who was leaning on the silicone cushion, removed his glasses and wiped them.

After rinsing the surgical field, the Kirschner wires were ready and fitted into the power drill.

The first bone fragment was put in place, with a Kirschner wire securely fixed in the proximal end of the humerus, allowing the wire to go through the other side of the bone, through the skin, and the bone fragments were aligned perfectly.

What a good eye for this, Director Han secretly praised. This piece was repositioned in one attempt without any prior trial positioning.

The key was used to unlock the power drill’s clamp head and pull it out. It was then reversed to clamp the other end sticking out and slowly retract it until only a little bit of the sharp end was exposed.

The second piece was put in place, again using the original Kirschner wire but in reverse, by drilling it back in; the third piece was attached to the proximal end of the humerus. A Kirschner wire was drilled in diagonally from the opposite side, intersecting the first wire at 60 degrees. The fourth piece was placed in the middle and then drilled in with the rest.

People couldn’t understand why the fourth piece should be placed in the middle. They couldn’t even tell it was in the middle, could they?

Everyone was puzzled. Except for the first few pieces that were already pierced, they couldn’t see where the other fragments were from. It still seemed like a mess.

The fifth piece was attached to an empty gap by the Kirschner wire that was drilled in earlier.

It was like solving a Rubik’s cube where every step affects the other. It must be done according to a certain method, otherwise, it could never be solved. Similarly, before solving it, others might see it as mess – wondering why one red piece was here and why another blue piece was there.

After all the manoeuvres, it still looked messy and chaotic.

Could it be that they would just disregard everything, tie it up with a steel wire and call it a day? Everyone was worried.

Song Zimo was also worried. He thought Yang Ping had been acting a bit reckless recently to have accepted such a surgery.

However, looking at how deliberate Yang Ping was, it seemed like he had everything under control. It didn’t look like blind fumbling at all.

Could it be possible that he actually reassembled all these bone fragments to their original positions?

That would certainly be quite amazing.

When the sixth piece was placed, two Kirschner wires were drilled through it in reverse. The seventh piece was attached to the recent gap, revealing a new gap after which the ninth piece fitted well right into the new gap. The third Kirschner wire was drilled in, not only fixing these two pieces but also drilling through other pieces.

The steel wire pierced through the bone fragments – each puncture perfect, even for minute and thin bone fragments that couldn’t withstand a second puncture, it neatly went through.

Song Zimo was beginning to see the pattern, feeling something indescribable inside.

The lateral condyle had gradually taken shape, like the solution to the first layer of a Rubik’s cube. The tenth, eleventh and twelfth pieces were slotted in diagonally, each piece precisely placed. The fourth Kirschner wire was drilled in just once, fixing the pieces exactly on the most solid cortical part.

The medial condyle began to take shape too, just like the second layer of the Rubik’s cube.

The thirteenth piece was attached, the fourth wire was advanced further, piercing through it. A fifth Kirschner wire was inserted, piercing not only this piece but also several others.

The intact form of the medial condyle was revealed and the articulating surface were also successfully assembled; it was smooth and free from any defects.

A smooth joint surface was formed, without any cracks or steps.

With that, the third layer of the Rubik’s cube was successfully solved.

A small gasp of surprise echoed through the room.

Those previously bored were now paying attention; those who were thinking of leaving early changed their minds and all eyes were now glued to the screen. Some even regretted not paying attention to the details of the previous reductions – they had missed a precious learning opportunity.

A standard tension band was added on each side with a steel wire and another diagonal tension band was added, forming a rigid, three-dimensional triangular structure just like a steel frame in architecture.

The steel wire was tightened and trimmed, the ends processed, Kirschner wires were trimmed and the end bent for placement.

Just like solving a Rubik’s cube, the process might be difficult to understand, but the result was clear.

They had truly reassembled it. Kirschner wires and steel wires composed a marvelous three dimensional stable structure.

The elbow joint was moved a little – it was extremely stable.

Such an impressive procedure!

Only now did people understand that the order of the bone assembly and the drilling of the Kirschner wires had all been planned. Only then could maximization of coverage be achieved, each part locking onto another to finally form a whole. One wrong step, one step missed, and it couldn’t have been done.

An impressive feat indeed!

Amazing! This was the first time Song Zimo had seen anyone use steel wires and Kirschner wires this way.

This wasn’t just surgery; it was like creating a micro self-stabilizing structure with bone fragments and steel wires.

“Second Brother Han, this young man under your tutelage is quite something,” Elder Man Zhang stood up.

“What’s the matter, Old Zhang, won’t you stay till the end?” asked Director Han.

“My prostate can’t hold it in any longer. I need to use the restroom,”Old Zhang stood up to leave.