Chapter 2114: Chapter 1781: The First Case
"How’s the pelvis?"
Zhang Lin didn’t even lift his head.
The high-speed drill buzzed on the posterior arch of the atlas, bone dust falling like a fine snow. Under the microscope, the vertebral artery groove appeared intermittently. Half a millimeter forward was the medulla, the line between life and death.
His hands were as steady as if welded in the air.
"Director Zhao is doing external fixation, the blood pressure is stabilized," Little Five handed over the rongeur, "but the rear ring fracture is too severe, the external fixation can’t hold, it requires internal fixation, the front ring is best supplemented with a steel plate."
"You go!" Zhang Lin said, "I’ll finish up, Director Wang will assist. Without rear ring fixation, stopping the bleeding is nonsense, the patient won’t make it through the night."
Little Five didn’t move.
He glanced at the monitor: blood pressure 92/58, heart rate 112, blood oxygen 95%, the patient was relying entirely on transfusions, the posterior pelvic ring was unstable, the retroperitoneal hematoma could rupture at any moment, and not even great physicians could save him then.
"Can you handle it alone?"
"Yes!" Zhang Lin raised his head, "Just fusion and bone grafting left, twenty minutes. You go, now, immediately."
Little Five glanced at the operating table again, Zhang Lin’s hands still hovering in the air, maintaining their previous posture.
"Okay!" Little Five turned, "Be careful."
"Don’t worry!"
Little Five turned away, coming to the pelvic area, where Zhao Quan stood in front of the C-Arm machine, arms crossed, frowning deeply, looking like a bewildered intern. Seeing Little Five, he exhaled a breath that seemed to say: finally, you’re here.
"Director Lu, I can’t handle the rear ring."
Little Five didn’t respond.
He walked straight to the display, on the fluoroscopic image, the external fixation barely held the front ring while the rear ring looked like a door kicked open, with the sacroiliac joint separation over two centimeters, the sacral ala hanging, the retroperitoneal hematoma a ticking time bomb, ready to bleed again.
"Blood pressure?" Little Five asked.
"Just raised to 95/60, but it’s unstable," the anesthesiologist responded, "hemoglobin 68, platelets low, coagulation poor."
Little Five stared at the screen, the rear ring unstable, the front ring’s fixation was merely decorative. Any movement from the patient, even slight vibrations from breathing, could cause the fracture ends to rub, tearing blood vessels again.
"Percutaneous sacroiliac screw," Little Five said, his voice low yet each word hit the point, "simultaneously place a steel plate on the front ring, prepare the C-Arm, front entry position."
"Alright!"
The C-Arm machine operator got busy, Little Five stood in front of the fluoroscope, directing the angle adjustments, the robotic arm slowly turning.
Orthopedic surgery fluoroscopy is very time-consuming, especially for simultaneous operations on two sites, both requiring frequent fluoroscopy.
During fluoroscopy everyone momentarily leaves the operating room, and returns once it’s done.
On the screen, the "safety corridor" on the sacral ala appeared, ellipsoid, less than a centimeter wide, nestled within dense bone. On either side are the common iliac veins, the lumbosacral trunk. The screw must pass through this layer of bone, like threading a needle, no deviation allowed.
Percutaneous pin placement, no visual field, no direct sight, only the two-dimensional image and fingertip resistance.
A millimeter off, massive bleeding, the patient dies on the table; two millimeters off, nerve damage, leaving the patient a shell of themselves.
Little Five’s hands were very steady.
Those hands had endured countless late nights in Sanbo Hospital’s training room, drilling through hundreds of cadaveric bones, had assisted Professor Yang Ping in thousands of surgeries. This sense of touch, it’s not innate talent, it’s from perseverance, fingers calloused then blistered from overuse, training until cramps yet persisting, losing sleep over failed cases.
"Advance the pin!"
The guide pin pierced through skin, fascia, muscle. He felt the change in resistance, akin to a pianist feeling the keys’ feedback, constructing a three-dimensional structure in the mind, the pin navigating the "safety corridor," like a ship finding its way in a fog, like a bullet spinning in a gun barrel.
"Head tilt fifteen, outward tilt twenty-five."
The C-Arm rotates, the image shifts. On the entry view, the guide pin’s shadow squarely hit the target, like an arrow in the bullseye.
"Nice!" said Little Five, "Bore the hole."
The reamer followed the guide pin in, bone chips emerging, like wood shavings from a carve. Then tapping, the metal and bone producing a fine rustling noise. Finally screw placement, a six-millimeter sacroiliac screw, with threading, slowly turned in.
The first sacroiliac screw firmly fixed, the rear ring now like a door nailed shut, no longer shaking.
"Another one," Little Five said, "double screws for stability."
The second guide pin entered, the angle trickier, the position higher. Little Five’s wrist subtly rotated, adjusting the pin’s direction. Fluoroscopy confirmed, bored, tapped, screwed. The second screw in place, the rear ring thoroughly stable, like a bridge with two piers.
"Okay, the front ring!"
Fixing the front ring’s steel plate was relatively simple but required full attention. Little Five chose a minimally invasive percutaneous approach, reducing soft tissue dissection, reducing bleeding. The steel plate contoured to the pelvic edge, screws turned in one by one.
Fluoroscopy revealed, the pelvic anatomy restored, the broken curves realigned into a circle. Front ring steel plate, rear double screws, external fixation as support, the entire pelvis re-secured and intact.
"Flush, stop bleeding, drain, close abdomen."
Zhang Lin’s side had also begun flushing the cervical spine.
Little Five glanced at the clock.
The whole time, three hours and seven minutes.
From entering the operating room to now, three hours and seven minutes. Two high-complexity surgeries performed simultaneously, cervical decompression and fixation, anterior and posterior pelvic internal fixation, the patient remains alive, blood pressure stable, nerves undeteriorated.
This isn’t a miracle, this is skill.
When the operating room doors opened, Dean Chen stood outside, yet looked like a father waiting for college entrance exam results.
