There are three major complications of fractures, infection, periosciascial syndrome, and nonunion. One is more terrible than the other, the first two are short-term complications and the latter are long-term complications. If you don't do postoperative follow-up, the condition is serious by the time symptoms appear.

In the orthopedic operating room in the early morning, Zhang Fan looked at the patient's examination X-ray, frowning, not that the operation was difficult, but that he couldn't feel the transparency of doing liver tumors.

Orthopedics is the earliest discipline that Zhang Fan came into contact with, and it is also a lot of liver surgery, although the surgery is becoming more and more proficient now, but there is always no sense of transparency, as if something is missing.

"What is the reason? Could it be that the operation is too little, or the operation is not difficult enough?" Zhang Fan's brows did not dissipate, and others did not dare to disturb him.

Actually, this thing is very simple. Where there is oppression, there is resistance, and as long as it is not overpowered, it will definitely sublimate and break through. Liver tumor surgery, although not the most difficult surgery, is not easy.

And the risk of surgery for huge liver tumors is even greater, in this kind of fierce battle. Zhang Fan refueled to use knowledge and refueled thinking.

Suddenly, the knowledge of the liver was forcibly broken. On the contrary, it is a simple orthopedic surgery, which becomes more and more proficient, and it has become a habit, and there is no way to talk about breakthroughs.

"Zhang Yuan, the anesthesia is ready. We're all set. Zhou Chengfu softly reminded Zhang Fan, who was in a daze.

"Oh, okay. Let's get started. Zhang Fan suddenly woke up, let go of the worries in his heart, and concentrated on the operation. So far, the medical community has not yet unified the definition of bone nonunion.

Zhang Fan believes that within three months, if the broken end of the fracture cannot be healed without intervention and treatment, it should be called nonunion. Zhou XX because of diabetes, and Chen Qi wanted to make the surgical X-ray look better, so he peeled off too much soft tissue.

Moreover, the patient also smoked, drank alcohol, and did not have the right amount of strength exercise, which eventually led to nonunion, at which time the middle end of his humerus had atrophied, forming a large number of granulations.

The human body is so strange that if normal tissue cannot grow in a normal place, abnormal tissue will grow. If it is detected a few months later, the atrophy will be exacerbated because of the apraxia of the bones.

Pseudo-joints will appear in a short period of time, and a normal arm has only one elbow joint, and because of the pseudo-joint at the broken end, his arm becomes a three-section stick.

If the time is prolonged, it will be like an infection, and the normal bone will begin to atrophy, and the final result can only be a shortening of the arm. Then he became an arm long and an arm short, leaving a disability in his body that could not be changed.

There are many ways to treat nonunion, there are elongated steel plates, after the original five or six centimeters of steel plates are removed, the broken ends are corrected, the bone is grafted, and then a longer steel plate is put in to strengthen the stability of the fracture and let it recover.

The other is intramedullary nail fixation, which looks directly at the opening from both ends of the long bone and inserts the intramedullary nail for fixation.

There is also external fixation. Just like building a building, a steel frame is erected to fix the fracture.

Because the distance of the broken end of Zhou XX's fracture is not very large, Zhang Fan is ready to use an extended steel plate to fix it. Each of the three fixing methods has its own advantages, and there is no best, only the most suitable.

Incision, on the original incision, Zhang Fan continued to enter the knife, this kind of second operation, there is no way to talk about any hierarchy, because of the operation, the adhesion around the incision is very strong.

Zhang Fan observed the two assistants as he entered. The two cooperate with Zhang Fan, and their techniques are quite skilled. After the incision is opened, black silk threads that have not yet been absorbed continue to appear, some longer and some short.

Although this kind of silk thread can be absorbed, if it is found, it is necessary to try to remove it, after all, the thread is also considered a foreign body. Silk thread absorption, there is a joke in the medical world that is not a joke.

It is said that in the early years, the country's technology was poor, and the silk thread material used was not up to standard, and a person could still grow a black thread in a certain part of the body after 30 years of appendix surgery.

Open the muscle, and the plate has been encased in hypertrophic granulation tissue. What is the situation, it is like a steel plate placed on a plaster mold, and the plaster mud is pressed and overflows. The steel plate attached to the bone is surrounded by this calcified granulation tissue.

"The steel nails of the inner six. Zhang Fan glanced at it and said to the nurse. The screw heads of orthopedic steel nails used to have plum blossoms and cross ones.

Once this type of screw is not exerted properly, there will be a gap in the screw head, and there will be no way to bite when it is removed. That is, there is an unwritten rule in orthopedics.

With a large number of complaints from orthopedic surgeons, the screws of this plum blossom and cross have slowly withdrawn from the clinic, which is the origin of the orthopedic legend: there is no steel plate that cannot be put on, only steel nails that cannot be removed.

Unscrewed the steel nails, Zhang Fan directly bit the steel plate with two Alice pliers, and pulled it hard, and the steel plate was pulled out of the calcified granulation tissue.

The instrument nurse looked at Zhang Fan holding Alice to take the steel plate, gritted her teeth and did not speak. If this were another resident or a general attending doctor, the little nurse would have been unhappy for a long time.

The surgery is in the hands of the doctor, but the instruments are in the hands of the nurse. And because of the violence of orthopedic surgeons, doctors in other departments are very reluctant to use the instruments used by orthopedic surgeons.

After clamping the bones and steel plates with forceps a few times, the very brand-new looking instrument is no longer needed, and even a suture needle cannot be stitched hard.

Unplug the steel plate. "Bone knife!" Zhang Fan began to remove the calcified cartilage tissue on the surface of the bone as soon as he passed the bone knife, and the surface of the bone was like a bony steel plate.

If the density of calcification is relatively high, it is not enough to rely on a bone knife, so you can use a hammer. Like chiseling a stone, it removes calcifications from the bones one at a time.

This operation must be stable and there must be no accidents. Once the hand is slipped, the kinetic energy of the hammer is blessed with the strength of the doctor's arm, which can definitely break the patient's bones.

"Steel, steel, steel!" the sound of a hammer striking a bone knife rang out in the operating room. And it still has to be rhythmic, you can't knock randomly, and the time interval between the last time and the next time should be about the same.

Zhang Fan knocked, and Zhou Chengfu stretched out his ten fingers and pressed the incision. Because of the vigorous knocking, the blood, bone marrow, and fat particles in the wound were like jumping wild with Zhang Fan's percussion. Although Zhou Chengfu had already covered the wound with his hands, there were still yellow fat particles that eloped out with blood.

The operation sheet was dotted with fat particles and blood soaked in the sheet, like a sesame cake, not black sesame seeds, but yellow sesame seeds.

"Curette, start taking the bones, don't take too much. Bring periosteum!" Zhang Fan said to Zhou Chengfu. The bone has atrophied, and if you don't find a way to connect it, it can't heal anymore.

Bone grafting, which must be cancellous bone with periosteum. Because there are a large number of bone progenitor cells in the periosteum, this cell allows the bone to develop and grow, and cancellous bone is like the plug of an old thermos when it is dried. There are a lot of voids in it, rich in various growth factors, which can induce bone growth.

There are few places where there is both periosteal and cancellous bone in the human bone, and there are even fewer places that can be amputated. For example, the iliac spines are a very good bone bank.

"Good. After Zhou Chengfu agreed, he took Xu Xian to the pelvic position. If Zhang Fan's bone smashing knife is considered violent, then taking the bone is directly called berserk.

After cutting the skin and pulling apart the fat and muscle, Zhou Chengfu gritted his teeth and began to take the bone. The bone knife was placed on the iliac spine, and Zhou Chengfu was wearing a mask, if he didn't wear a mask, he would definitely be hideous at this time.

The hardness of the periosteum and bone cortex is very high. With Zhou Chengfu's percussion, the whole body of the bound patient vibrate. It's just "Bang!Bang!" and the blood flowers scattered elegantly. That's it, it's not the roughest in orthopedics.

The bone had been chiseled off by a bone knife, and it was not large, slightly shorter than Green Arrow gum, and the bone was as thick as a matchbox.

After taking out the bones, Zhou Chengfu began to cut them into pieces with scissors. Zhang Fan is using a curette to clean up the granulation tissue at the broken ends, how to describe this thing, it is like using a spoon to dig up the yogurt pot that has little left.

Calcified granulation tissue is chiseled with a bone knife, and white non-calcified granulation tissue is dug with a curette, and this thing must be cleaned up. If it is not cleaned up, there is still a residue at the broken end, and the bone thinks that the place is full of flesh, and no new bones will be released.

"Gauze. After Zhang Fan dug it up, he began to wipe it with gauze. It is important to ensure the removal of granulation tissue. After wiping, the broken end of the fracture at this time is as white as broken ivory chopsticks.

"Zhang Yuan, look at it, is it enough. Zhou Chengfu handed the bone that had been cut into the size of a soybean to Zhang Fan.

"Yes, the estimate is good, it should be enough. Zhang Fan praised Zhou Chengfu, if it was before, Lao Zhou would definitely scoff, but now, Zhou Chengfu is happy, and his eyes have become a line.

Filling, which is to be technical. For example, after a hollow bamboo is broken, it is necessary to fill the soybeans in the middle, and it cannot be spilled, this is the technology.

When I was a child, I didn't play with building blocks well, and I couldn't do this well, Lao Zhou estimated that there were no building blocks to play with when I was a child, and in the end I had no choice but to write articles.

First put the bone crushed bone with the bone cortical periosteum on the base, then the cancellous bone is filled on the top little by little, and the top is filled with the bone crushed bone with the bone cortex and periosteum.

It's not okay to be loose and loose, because the steel plate has to be opened with an electric drill, if it is loose, the steel plate is not on it, and the filled bones have already collapsed.

What is a seam pin, this is a seam pin. After filling the severed ends, they have to be forcibly inserted into the gaps with broken bones with bone cortex, and they must be inserted forcefully, and they must be inserted forcefully.

Then, the missing bone is connected. Then it's about putting the steel plates. The humerus is not a very round pipe, because the first time I put on the steel plate, I have already drilled four or five holes on both sides of the broken end.

The second time you put on the steel plate, you must stay away from these places, otherwise the bone may break when you put the screw on it again, so the original steel plate with only five or six centimeters long has become a steel plate of twenty or thirty centimeters. It is like adding a metal protective plate to the humerus.

The steel plate is long, and the incision will of course be extended. For example, the length of the steel plate is 30 centimeters, and the crossing is 20 centimeters even if it is small. Where the tissue is covered, use a retractor to forcibly pull it apart.

It's like when a person's mouth is opened to the fullest, and then continue to pull it open with a metal retractor until the innermost tooth is exposed.

Installing the steel plate, the humerus is slightly curved, slightly triangular. Therefore, the steel plate must find a surface that can fit a better surface.

After the steel plate was applied, Zhang Fan began to open the hole. Although doctors in other departments laugh at orthopedics and say that a good carpenter can perform fracture surgery, it is actually a joke. This is a job that a carpenter really can't do.

Opening, this kind of steel plate is a pressurized steel plate. The nail hole in the pressurized plate, one of which is a pressurized hole, and the hole is designed with a ramp, which looks like an ordinary hole is elongated. The advantage is that it can play a compressive role, so that the fracture end is tightly aligned and promote healing. The disadvantage is that the pressure hole is the weakest part of this steel plate and is easy to break.

In the process of the doctor's operation, the pressure is also very difficult to grasp, and if the pressure is large, it will lead to a slight osteonecrosis at the broken end, and the force will not work, and it will not play the role of compression. Because each patient's constitution is different, it is difficult to grasp this strength in practical work.

Just this one strength, in a few years, I can't master it. Drilling along the pressurized hole of the steel plate, Zhang Fan observed the connected bones while drilling.

To be honest, this kind of operation, one step forward, must ensure the suitability of the original step, if you take a step forward, the original step has a problem, and it is not good, there is no way to get off the operating table.

When Zhang Fan drilled, he was very cautious. Although he personally inserted it, manpower could not compete with the vibration generated by the electric drill, so Zhang Fan was very careful.

After the hole is opened, the screws are applied. This is also a technical job, not to mention the others, just an angle is very particular, must ensure the verticality of the screw, and the contact surface of the steel plate bone, must be vertical.

Yes, it's a very unreliable feeling, and if you don't feel it, you have to wait for the silk. There is no problem at all, the strength of the screws on the pressurized steel plate, once the occlusion of the screw and the steel plate has a direction problem, it is the slippery wire that cannot run away.

When the stitching was about to be completed, Zhang Fan suddenly raised his head and said to Zhou Chengfu and Wang Pingshan: "Which of you two will take over this sick number?"

Zhou Chengfu hesitated, Wang Pingshan glanced at Zhang Fan, and said directly: "If you don't worry, leave it to me!"

"Okay!" Zhang Fan didn't say much. Zhou Chengfu next to him suddenly wanted to feel that something was leaving him.