Chapter 203

Fang Ziye ran into the restroom, pulled a fair amount of tissues, and dabbed at the bloodstains on his face without wiping.

It wasn't that he disliked the patient's blood being dirty, but it would affect his vision and facial expression; likewise, this mask could no longer be used.

After dabbing several times, Fang Ziye then started rinsing, then used tissues to wipe clean. And he looked at himself in the mirror.

The young man inside looked slightly fatigued, and his eyes also carried a bit more of the aura of growth.

Fang Ziye had no time to think about other things; only the instructions Teacher Deng Yong gave before he came to Enshi, his understanding of them had deepened a layer now.

To sum up, the world is big, there is prosperity and also complexity; the real world does not only have those ivory towers he has currently contacted, the student phase experienced only the pure side under the relative protection of teachers and schools.

Money temptations, a person in the jianghu, unable to control oneself...

Sometimes, some things, some people, are hard to judge right or wrong from the surface.

Some things that happen in reality are even more fantastical than in TV dramas and movies.

Thinking a step deeper, Fang Ziye then looked up at the ceiling.

The sentiments of Teacher Deng Yong and Professor Duan Hong were not entirely without reason.

In Eastern Han, doctors' status is not high; to be a pure doctor is very difficult, unless.

But that step is still a bit too far; Fang Ziye doesn't plan to keep it in mind.

These past few days he encountered many things, met many people, the reversals and gaps were also quite large, even many places were unclear and incomprehensible to Fang Ziye.

But it's also good to be muddle-headed; not understanding might also be a kind of blessing.

Do well oneself, help if able, do whatever operations one can do, do one's best, exert a bit of effect — that is all one can do at present.

Fang Ziye went down to the operating room doorway again, found the operating room administrator and requested a new set of scrub suit and cap and mask, put them on properly, then returned to the scrub station at the operating room doorway and began washing and disinfecting hands again.

This was Fang Ziye's fifth handwashing in a short time; hand sanitizer on the skin stung slightly, but sterile principle must still be strict — if going on stage, must wash and disinfect hands, otherwise it would bring a devastating strike to the patient.

After putting on the sterile surgical gown and two layers of sterile surgical gloves again, Fang Ziye squeezed in beside Teacher Deng Yong at the first opening.

The person who yielded a spot to Fang Ziye was Minzu University Hospital's Director Fu Qianjin.

He stepped back a few steps, then said: "Teacher Deng, Professor Duan, manpower is sufficient here, I can't help much either; there are still matters at the hospital, I'll head back first!"

"Thank you for your hard work, both Professors."

Fu Qianjin is Minzu University Hospital's Trauma Surgery Director; with hospital matters, he certainly had to rush back.

However, Fu Qianjin's explanation — only Enshi Central Hospital's Director Zhang Mingcan thanked him; whether Deng Yong or Duan Hong, both were carefully searching for fracture fragments in the pelvic blood and flesh pile, simply had no leisure to pay attention.

At the same time, even Minzu University Hospital's Doctor Wu Xuanqi was at this moment carefully performing some bony impaction separation movements — actually the flexible application of manual reduction in comminuted fracture impaction.

Commonly seen fractures are actually all typical, relatively regular; fractures that can be described and classified, even if complex, are merely local comminuted fractures.

But Huang Kai's fracture, because it was a fall from height injury, caused a destructive fracture of the lower half of the limb combined with soft tissue injury; in the pelvis, one could even see femoral fracture fragments.

To describe it as bone and flesh connected is not an exaggeration at all.

Director Zhang Mingcan only thanked Director Fu Qianjin, then nothing else, returned again to the lower leg and knee joint area, meticulously performing debridement technique.

However, Huang Kai's lower leg and knee joint now are merely conceptual lower leg and knee joint; skin and flesh connected, bones long gone without trace, vessels and nerves also a complete mess.

Therefore, how to handle the subsequent surgery is still a tangled mess at this moment.

Even the most basic debridement stage hasn't been finished yet.

After Fang Ziye approached the operating table, what Teacher Deng Yong assigned him to do was count the fracture fragments turned out from the blood and flesh, placed in a square tray, mixed together.

"You strive to classify these bones."

"For now, can only classify by long bones and irregular bones; how much bone mass can be preserved in the end." Deng Yong said.

"Okay, Master!" Fang Ziye turned and went to the sterile instrument table where the instrument nurses were.

Surgery is like emergency handling — all actions follow command, find your position, do well the task divided to you, that is the greatest help, not just showing off prowess on the operating table.

Fang Ziye only roughly scanned; he could roughly discover the bone fragments in the tray came from quite many sources.

There were ilium, ischium, sacrum, coccyx.

Certainly also femur, tibia-fibula, and foot-ankle irregular bones, scattered without any pattern.

What Fang Ziye needs to do now is first classify these fracture fragments according to the most basic systemic anatomy divisions — for example long bones and flat bones, etc.

This does not belong to routine fracture treatment procedures, but for Huang Kai's current condition, it is very necessary to do this.

Picking bone types has no special skill; can only rely on individual basic skills and understanding of bone shapes and bone types.

Easiest to distinguish are the sacrum and coccyx.

Because the shape is relatively special — oracle bone script structure with holes. Even after shattering, they still retain the most basic shape.

Fang Ziye carefully picked these bone pieces one by one into another square tray.

In the operating room, five or six instrument nurses, n such trays, inside placed various tissues, also spare and extra trays, so Fang Ziye had enough space to separate.

Then long bones.

Long bones are also relatively easy to find; if not distinguishing whether femur or tibia-fibula first, then just seeing those with medullary cavity surface, directly process as long bones.

Fang Ziye also didn't spend a very long time; he finished classifying.

Then ilium, ischium such flat bones, and foot tarsals, metatarsals and other irregular bones.

This is a bit difficult for a person.

Foot bones are very numerous, and all are comminuted fractures, lost their original shapes; after flat bones comminute, extremely difficult to distinguish —

If it were one month ago, asking Fang Ziye to do this, Fang Ziye would probably directly throw away what was in his hands.

However, Fang Ziye has a fellow trainee named Lan Tianluo; Lan Tianluo, when doing pure data modeling for manual reduction and new fracture classification, collected a large amount of detailed data about bones.

Including their shape classification, volume size, length width height, axes and other basic measurement data — the most basic data in the basic anatomy field.

In clinical practice almost no application significance, because during surgery you expose inside, whatever size it is, that's the size; whatever shape it is, that's the shape.

But in the process of manual reduction fracture modeling, without enough real patients as data sources, if you still need to distinguish fracture stress magnitudes, you can only model and analyze based on these basic data.

Ordinary basic anatomy teachers wouldn't do this, but Lan Tianluo did; and Fang Ziye as initiator also carefully read and even memorized quite a lot about these basic data matters.

Although no new skill formed like Basic Anatomy (New) or Bone Anatomy (New), ultimately Fang Ziye does have a certain impression of these things.

This is purely and fundamentally basic skills.

For example, the metatarsals, which belong to the long bones, five in total, from medial to lateral are the 1st to 5th metatarsals in sequence; their shape and arrangement roughly correspond to the metacarpals, but they are thicker and larger than the metacarpals.

With the proximal talus as the base, articulating with the tarsal bones, the middle is the body, the distal end is called the head, articulating with the base of the proximal phalanges. Each metatarsal can be divided into three parts: base, body, and head...

This is content that many orthopedic doctors memorize and must master, because only then can you identify them.

The foot also has tarsal bones, phalanges, etc.

However, ordinary orthopedic doctors focus on the angles between bones, not on size or diameter; after all, different people have different sizes.

But this kind of thing, his fellow trainee paid attention to, and even did statistics; if Fang Ziye remembers correctly, when Lan Tianluo calculated the diameters of the femur, tibia, fibula, and phalanges, in adult males the diameter ratios would have a certain fixed proportion.

Then, in such a situation, how to distinguish small long bones like phalanges and fibula becomes easier to handle.

Moreover, even for the femur and tibia, with irregular fractures, as long as there is a curved surface, its size can be determined.

"Hand me the vernier caliper!" Fang Ziye thought of these things and asked the instrument nurse.

On the operating table, generally there is no ruler.

But orthopedics has them, especially during fracture surgery, when screw length needs to be measured.

Besides the screw's own model, there is usually also a vernier caliper, and also a depth gauge for the screw channel.

"Vernier caliper? Here!" The instrument nurse was puzzled, but she was an orthopedic specialty nurse, she knew what Fang Ziye wanted; it was precisely because she was a professional specialty nurse.

Knowing that now was far from the fixation step, she didn't know what Fang Ziye wanted to do.

But even with doubts in her heart, right now she didn't dare show off her rich experience or anything!

During ordinary surgery, chatting and laughing, cracking a joke, boasting about being awesome, ordinary instrument nurses and circulating nurses can do it, even bully new doctors a bit, but when it truly reaches a critical moment.

Even if it's a standardized trainee, at a special time asking them for something, it must be given; task division must be clear, this is the most basic quality.

Fang Ziye wasn't on the operating table, so what he did, no one paid attention to at all.

No one paying attention didn't mean Fang Ziye wouldn't do it; on the contrary, Fang Ziye had to complete his own task even better.

First, broadly classify the fracture fragments, then distinguish their proximal and distal ends.

If fracture fragments can be perfectly pieced together to distinguish proximal and distal, that's best; if not, then you have to measure the ratio of medullary cavity to bone diameter.

And this ratio, throughout the entire lower limb, each has its own differences, and is also one of several indicators for judging the quality of fracture reduction.

Fang Ziye just had poor aptitude, he wasn't incompetent, so when applying things flexibly, he wouldn't box in his own thinking.

Fang Ziye did it silently.

Just as he was about to finish sorting and cleaning all the extracted bone pieces, he silently sat by the sterile instrument table, waiting for newly extracted bones, then sorting them into different trays.

The instrument nurse finished watching, swallowed several mouthfuls of saliva, looked at Fang Ziye, and asked in a low voice: "You have this skill, go play building blocks with kids, a whole kindergarten would probably be played to tears by you."

She was joking, even dared not speak loudly, could only use the lowest voice to speak with Fang Ziye.

Fang Ziye also raised his head slightly without ceremony: "Thanks for the praise."

"Can you pry it open? Want Ziye to come?" Just then, Professor Duan Hong suddenly asked Wu Xuanqi who was operating.

"Call him, I feel a bit unstable, the bone fragments down there are uneven, the force magnitude is hard to assess." Wu Xuanqi on the operating table was doing the bone prying work in the debridement that Fang Ziye operated on before.

Hearing this, without waiting for chubby Duan Hong to call actively, Deng Yong, after a green-clothed person actively made way, turned back to look at Fang Ziye: "Ziye, come over—!"

Deng Yong's words weren't finished, he abruptly turned back, and saw the things arranged in the tray before Fang Ziye.

The sound stopped immediately.

Then blurted out from the heart the national quintessence: "Holy—crap—!"

Spoken from the heart, although the voice was very low, it was still caught by the green-clothed person beside him.

Fang Ziye was assigned to classify bone fragments, everyone knew, but most attention was on the operating table, blinking felt like wasting time.

Sterile instrument tables were all behind them and behind their buttocks; the eyes in their buttocks couldn't possibly have vision; except the instrument nurse, no one discovered what Fang Ziye did.

The instrument nurse also didn't dare joke or speak loudly in such a scene, could only secretly appreciate, then joke secretly with Fang Ziye.

Therefore, in Professor Deng Yong's holy crap sound, several people turned back to look, immediately felt holy crap general, this situation instantly became unsolvable.

"Master!" Fang Ziye stood up very calmly, hands clasped before his chest, walking toward the operating table direction.

He heard Professor Duan Hong's inquiry and invitation, naturally wouldn't put on airs.

"Come over!" Professor Deng Yong wasn't a child anymore.

Encountered an accident, a low holy crap was fine, quickly suppressed it, psychological quality, extremely strong.

Then, Zhang Mingcan beside Professor Deng Yong also made way.

Because Zhang Mingcan knew, the debridement and bone removal at the pelvic position operated by Wu Xuanqi and Professor Deng Yong together, had another difficult problem.

And this gap made way, just enough to accommodate him turning to go toward the sterile instrument table direction, seriously looked, seriously startled, scalp also seriously numbed.

Could this be the strength of doctors inside Zhongnan Hospital, then Professor Deng Yong and them, are really almost becoming gods?

Such messy fracture fragments, unexpectedly not only could Fang Ziye distinguish them, even proximal and distal ends could be distinguished, and there was even a trend of reassembling into the original bone shape.

This is really too shocking.

A broken mirror is hard to make round again.

A mirror is only a relatively planar structure, comminuted fracture is a cubic structure!!!

Professor Duan Hong and Wu Xuanqi, fundamentally had no curiosity about whose general Professor Deng Yong was holy crapping at before, just seriously waited for Fang Ziye to once again use manual reduction technique beyond ordinary imagination, to perfectly extract another wedge-shaped 'bone chisel' fragment.

Only then breathed a sigh of relief, surveyed the surgical field, discovered the extraction of fracture fragments could finally come to a conclusion, then asked: "Deng Yong, who do you want to screw?"

Fang Ziye was slowly releasing force, letting go of Huang Kai's remaining two pieces of ischium and ilium connected to autologous muscle, bones that didn't need removal, then silently took the retractor from Professor Deng Yong's hand, freeing Deng Yong.

Deng Yong at this moment, took a deep breath, had no time to mind Duan Hong's words.

But hurriedly questioned Fang Ziye: "So, what you said before to Professor Li Guohua, that giving you more clinical operation opportunities, your improvement would be greater than in the training room, wasn't you blowing your own horn, but real?"

Self-praise, displaying one's own capability and aptitude, this is a negotiation tactic.

Everyone, including Professor Li Guohua, thought Fang Ziye was Wang Po selling melons, wanting to peddle himself; they also didn't hope Fang Ziye would really, after going down to the countryside, truly improve rapidly as Fang Ziye said.

As long as he could progress normally, then complete grassroots work experience in advance, so that subsequently he could quickly promote professional title.

After all, Fang Ziye's progress speed was already fast enough, fast enough that it couldn't be any faster; any faster and it would make people completely unable to accept it.

Previously, Fang Ziye's progress speed was, at the very least, difficult to accept.

Fang Ziye, in his silence, also understood his Master's meaning, and nodded lightly: "Master, there's definitely a boasting component to it as well."

"However, the improvement in recognizing osteophyte foundations was inspired by the trigger point provided by Senior Brother Wu Xuanqi, and then it was my Fellow Trainee who collected the data and conducted the modeling!"

"After all, in the basic principles and biomechanical analysis of reclassifying fracture classification and matching different manual reduction techniques, the bone's own shape and properties are very important data; I merely selected some important data and brought it over to splice together."

After hearing Fang Ziye's words, Duan Hong handed the retractor and suction device in his hands to Wu Xuanqi, and then placed the bone holding forceps in the kidney dish.

Clenching his hands before his chest, he stepped back a few paces, dragging his chubby body, and deliberately ran to the sterile operating table; after seeing the things inside the tray and the spliced bone pieces, he fell silent on the spot.

Five seconds later, his expression complex, he tilted his head and asked: "Deng Yong, why not let Ziye come over to my place to boast? I can allow him to boast."

"Go to hell~" Deng Yong almost instantly exploded with profanity.

This Fang Ziye could still go to your place?

Even if Fang Ziye is boasting, he's still quite dear to me; if he's not boasting, then can you still snatch him away? I haven't died yet?

"Not boasting is even better. We'll be honest people ourselves." Deng Yong said in a low voice to Fang Ziye, then had Fang Ziye stand by his side and began debridement to manage the muscles inside.

(Chapter End)