Chapter 57

Everyone, grab some fruit and pastries, have a drink, and take a short break.

Song Zimo clapped his hands on the podium, while Zhang Lin shouted, “Brothers, quiet down! Quiet down!”

The shout worked. Everyone stopped talking and returned to their original positions.

It wasn’t always like this, hardly anyone paid attention to Zhang Lin in the past. However, now he is deemed more important as he is associated with Yang Ping and Song Zimo.

“Shall we start the discussion?” Song Zimo softly asked Director Tian, mainly to show respect.

Director Tian nodded, and Song Zimo announced, “Now it’s time for the discussion. Everyone can ask questions, and Doctor Yang will answer them. Don’t be shy, ask freely. There’s a prize for anyone who flusters him.”

“What’s the prize?” someone asked loudly.

“You won’t have your active case files checked for a month,” Song Zimo replied.

That prize had enough weight, even though it didn’t beat not having to write case reports for a month.

After speaking, Song Zimo sat down next to Yang Ping in the front row: “It’s your turn now.”

Yang Ping stepped onto the podium, and everyone applauded enthusiastically, wave after wave.

When you have skill, your aura naturally radiates out.

With a few directors absent, everyone was more relaxed and spoke more boldly.

Director Tian was young and didn’t intimidate anyone.

These youngsters loved to seek advice from Director Tian if they had any problems. If they made a mistake, they would quietly ask him for help.

Dr. Jin stood up first, “Doctor Yang, I would like to ask, your method of stress diversion is indeed ingenious, but one question, how do you ensure that the bone fragments do not break under stress, and that the steel cables do not snap?”

“Yeah, why are you so confident in the steel cables? If they snap, everything collapses, and the patient will have to have a second surgery. The family will be irate,” another doctor whispered.

Yang Ping responded,

“The tensile stress, compressive stress, rigidity, strength, and elastic modulus that the human bone tissue can withstand all have documented data. These data vary by age and body part. There are also data on the fatigue resistance of steel cables, the number of daily steps a person takes, and the weight of the patient. By combining all these data and doing some calculations, you can estimate how long the steel cable can last. As long as the steel cable holds up until the fracture heals, it’s fine.”

“I understand, we medical people worship Hippocrates, and now we have to worship Newton and Gauss,” Dr. Jin joked.

A graduate student raised his hand, saying, “What if the fracture shifts because the patient started weight-bearing too soon? The patient might sue you. Even if the recovery is not as good because of delayed weight-bearing, it would still be better than being sued.”

Yang Ping appreciated the student’s honesty, saying, “With hip fractures, early mobilization is unquestionable. If full weight-bearing is not achievable, partial weight-bearing is an option; if even partial weight-bearing is not achievable, supporting the patient to walk without weight-bearing is possible. If the patient continues to lie down after surgery, the advantages of surgery are lost, and the disadvantages of both surgery and conservative treatment are accumulated. Like neither being able to outrun a horse or a Benz. As for lawsuits, I haven’t done any relevant data comparison to see whether there are more lawsuits from early weight-bearing or late weight-bearing.”

“Confidence comes from experience and data, not blind faith,” Yang Ping added.

The graduate student was satisfied with the answer, indeed, there is no rule that delaying weight-bearing can avoid lawsuits.

“According to a multi-center retrospective study, there is no significant difference in average lifespan between people who ride airplanes and those who don’t!”

Some hotshot in the corner casually dropped this comment, talking with a candy in his mouth, his words weren’t very clear.

It turned out to be a PhD from spinal surgery, an elegant and high-class remark. Once he opened his mouth, everyone could tell, his educational background must have started from a master’s degree.

“Teacher Yang!” a standardized training student asked shyly.

“How did you manage to remove that bone fragment embedded in the muscle so effortlessly? In my experience, we’ve encountered such fragments many times. If they’re not critical, we give up. If they must be anatomically repositioned, we can only do it by cutting open the area.”

Song Zimo suddenly remembered that he had forgotten to explain the concept of stress diversion.

“You can just call me Doctor Yang or Senior Brother Yang. Performing minimally invasive repositioning on this bone fragment is challenging. Firstly, you need to understand which muscle the fragment has penetrated, and if there are any essential nerves or blood vessels nearby. Secondly, you need to understand the fragment’s depth within the muscle, whether the fragment has formed a barb, and if it can slide out smoothly. Lastly, you need to understand if any muscles are attached to the fragment. If so, you must understand which muscles are attached and the different positions and motions each muscle group performs. This fragment has penetrated the psoas muscle and the iliopsoas muscle attached to it. During the limb’s external rotation, the psoas muscle is extremely tense and pushes the fragment out. Meanwhile, the iliopsoas muscle relaxes, and with just a slight lever motion, the fragment is freed.”

It turns out that extracting a bone fragment requires such sophisticated anatomical knowledge.

“This surgery is really mentally taxing,” a standardized training student sighed.

Everyone turned to look at the speaker, who was a man with a mature appearance, showing signs of baldness, and many white hairs.

Based on his hairstyle, he seemed to hold the rank of Associate Chief Physician, but in reality, he was just a standardized training student.

“Any other questions?” Song Zimo asked everyone.

It seemed like everyone had understood, and there were no more questions.

Seeing that there were no more questions, Director Tian commented, “Doctor Yang, your last humerus distal comminuted fracture case, the repositioning and fixation you did was remarkable! I replicated your approach and used Kirschner wires and steel wires to build a model. The model has the ability to self-stabilize, and when I simulated elbow joint flexion and extension movements, the model demonstrated a certain self-tightening ability during movement. Generally, our structures are loose, but yours is a complete dynamic stable structure.”

Thinking about the child who had his screws removed, Dr. Jin said, “That child’s two screws have been removed. If his symptoms really go away, I’ll treat you to a meal and we can talk more.”

“If there’s nothing else, let’s end the meeting,” Song Zimo announced.

Everyone saw that there were refreshments left, so they helped themselves and continued chatting.

“I need to go back and review anatomy, physiology, and pathology. Really, the last patient with an infection, we couldn’t get it under control with antibiotics. We used medication based on antimicrobial susceptibility tests, but neither switching antibiotics nor increasing the dosage worked. We had a nephrology consult, who said that the use of drugs to accelerate kidney excretion had prevented the antibiotics from accumulating and maintaining effective concentrations in the blood. Following the consultant’s advice, we discontinued the drugs promoting kidney excretion, retested antimicrobial susceptibility, and selected sensitive drugs. It worked, the infection was gradually controlled over a few days.”

“Exactly, the surgery can be performed like this—I had no idea until today. It was truly an eye-opener.”

While talking and eating, the conversation carried on among two graduate students and several standardized training students.

Professor Zhang appeared at the door, with a nurse trailing behind him. Tian Yuan, Yang Ping, and Song Zimo all stood up.

Originally, Professor Zhang planned to address everyone before the meeting ended. However, seeing the clear and simple animation demonstration on the screen, he changed his mind.

The younger generation has their own language and methods. There wasn’t any need for him to step in, so he just listened at the door for a while.

“You all should accumulate more cases and conduct mechanical analyses on these internal fixation structures. In the future, you might be able to publish a book—’The Study of Orthopedic Internal Fixation Structures’. It would specifically discuss the design of these stable structures.”

Professor Zhang suggested to Tian Yuan and Yang Ping before leaning on his cane and returning to the ward.

And so, Saturday came to an end.

Su Yixuan messaged Yang Ping via WeChat, notifying him that she had left a couple of slippers in his surgery room’s shoe cabinet since his slippers were torn.

Sunday was rather calm. The system didn’t release any tasks; it was very quiet.

Yang Ping calculated his points and found he was still short of 10,000 points to purchase pelvic fracture training. The gap was a little wide.

Only after completing the pelvic fracture training could he relax a little.

If he had to perform a pelvic fracture surgery right now, he might not be able to handle it.

Although his surgical skills had reached the master level, practice is essential for improving surgical proficiency.

Pelvic fracture surgery is something he must master as soon as possible.