Surgical treatment of thoracic trauma with multiple rib fractures is now accepted by more and more doctors and patients.

The aim of the program is to speed up the recovery of patients after surgery, further shorten the length of hospital stay, reduce postoperative complications and mortality rates, and achieve satisfactory results.

Therefore, the internal fixation of rib fracture is generally carried out within 4h~5d after the patient is admitted to the hospital, using pure titanium claw-shaped rib bone plate, which is generally operated on the surface of the chest wall.

Postoperatively, a thoracostomy drainage tube is routinely placed, and some patients are treated with a ventilator to assist breathing, and extubation is selected at the right time.

In the patient at present, two of the right sternum were broken, and no contusion of the lung tissue was found on chest x-ray, because the fracture site could be directly fixed without the need for a drain.

Surgery begins.

Ventilating the patient's lungs with the healthy side in the decubitus position,

According to the chest x-ray, the right third and fourth rib space is selected for incision.

No. 3 scalpel.

Cut the skin, subcutaneous tissue, superficial muscles of the chest wall layer by layer, all the way to the surface of the ribs...

Exploration to determine the fracture site,

Cut the periosteum at the broken end of the rib with an electric knife, and peel off the periosteum at the distal end to avoid damaging the blood vessels and nerves under the costal margin.

Remove the muscles that are embedded at the fracture end, and pull the ribs with forceps for anatomical reduction...

Choose a pure titanium claw-shaped rib bone plate that matches the rib line, make a suitable arc, and stick it to the surface of the broken end...

Clamp the encirclement arm of the 4 rib plates with a plate pliers, so that the enveloping arm is buckled into the upper and lower edges of the ribs, so as to achieve the effect of encircling compression and internal fixation...

Seeing that Huang Youdao is skillful and extremely stable.

Li Xiyang was also relieved.

Just looking at the other party's methods, it is definitely at the senior level.

There are not many senior directors in their thirties, looking at the whole Renhe.

Since there was no accident on the other party's side, Li Xiyang put away his attention and completely focused on his operation.

Abduction of the affected limb on the side table of the hand surgery...

Perform dorsalal radial incisions on the wrist...

The proximal end begins at the 6-distal end above the radial styloid process and reaches the radial carpal joint posteriorly to the dorsal "L" shaped incision...

The extensor support band was cut between the extensor carpi radialis longus and pollicis longus tendons, and the extensor carpi radialis longus and brevis tendon was pulled to the radial side, and the extensor pollicis longus tendon was pulled to the ulnar side, fully exposing the dorsal radial articular surface and the fracture end.

Fracture reduction is then performed under direct vision,

When reducing the length of the distal radius and its palmar inclination and ulnar declination...

After placing the second bone plate, Huang Youdao glanced at the time,

Hey, it's only been 50 minutes.

Generally, for rib fracture fixation of this degree, the standard completion time is one and a half hours.

Huang Youdao himself is a genius outside the bones, and it only takes 1 hour to complete.

This time it was 10 minutes faster, and Huang Youdao was naturally very happy.

Thinking that it should be difficult for these emergency doctors to see a scalpel as fast and steady as themselves, he glanced at everyone happily.

Well?

Strangely, no one lost their eyes on him.

Even the most idle anesthesiologist in the operating room is staring at another surgical area with relish at the moment.

Huang Youdao frowned slightly, and then looked over there as well.

But it's okay not to look at it, and when I glanced at it, my jaw almost didn't drop.

What the hell, this kid's arm reset is almost over!

….

How is this possible!

You know, if the standard completion time of his sternal reduction is 1 and a half hours, then the left arm injury of the patient in front of him will take at least 3~5 hours to complete.

But it's only been a long time, and the special mother's 1 hour hasn't arrived!

No way, this kid must have cheated.

Huang Youdao simply stopped the operation in his hand directly, and stared at Li Xiyang's field area without blinking.

I thought to myself, I must reveal it

Wear evidence of this kid's cheating.

But

When he saw Li Xiyang's operation with his own eyes, Huang Youdao was so shocked that he opened his mouth wide.

No. 5 bone forceps,

After adjusting the articular surface of the distal radius to achieve anatomical reduction, the titanium alloy metal plate screw internal fixation was performed...

According to the location of the fracture line, an oblique "T" plate of appropriate length is selected and placed on the dorsal side of the distal radius.

When placing the metal plate, it should be noted that the distal end should be 2-3 near the radial articular margin.

For fractures where the distal radius is comminuted and cannot be fixed by plate nails, external fixator fixation is performed after reduction...

If the fracture end is relatively stable after reduction, the wrist joint can be fixed at 45° in volar flexion with an external fixator...

At this moment, in Huang Youdao's eyes, Li Xiyang's manipulation has broken through the limit of the operator.

fast

It's outrageous!

The key is that every step is so accurate, as steady as an old dog!

At this moment, he suddenly understood.

When the previous director informed him, he specially explained that he must let himself cooperate with Dr. Li.

At first, he just thought that this was to let him come over to show off the operation and cheer up the prestige outside the bones, but now he realized that this is to make himself perform better, don't embarrass the bones!

, it's too a slap in the face!

"Doctor Huang, hurry up over there, I'll have to do a nephrectomy on the patient later!"

Li Xiyang had already reduced all the broken bones of the patient's left limb, and suddenly found that Huang Youdao was not over yet, and said in a deep voice.

The corners of Huang Youdao's mouth twitched, and he said busily, "Oh oh, oh, yes, yes, yes!"

Huang Youdao's face was pale, and he didn't dare to delay.

Perhaps stimulated by Li Xiyang, the operation in his hands turned out to be more skillful than before.

It's just that he doesn't dare to compete with Li Xiyang anymore no matter what, and he is pure and humiliating.

Seeing that the other party quickly completed the stitching, Li Xiyang's face softened slightly.

When the patient's left arm and sternum are all reduced, the next step is the final nephrectomy.

But soon the first conundrum came.

Because of the position of the kidneys, it is necessary to adjust the patient before the operation, or it will be very troublesome to do without surgery.

But now the problem is, if it's just an ordinary nephrectomy, then with conventional surgery***,

It is to turn the patient's body sideways and turn the side of the kidney that needs to be removed in a direction that can be seen.

However, because the patient had an injury to his left arm and two broken ribs, the patient was bound to put pressure on the broken bone that had just been reduced.

In fact, the left arm can be placed with a special position to avoid secondary injury.

But the sternum injury is troublesome.

Because no matter what kind of ***, it will put pressure on the sternum.

It has just been reset, and the pressure has been under pressure for a long time, and it is difficult to guarantee that it will not break again or even puncture the organs.

….

Li Xiyang was silent, thinking about the plan.

At this time, Qian Min asked, "Doctor Huang, do you have any good ideas?"

Dr. Huang shook his head, he is a bone surgeon, and he is very good at connecting bones, so this nephrectomy will not work.

But

"I think it's best to use the lateral position of the kidney to ensure that the patient lies on the side***, otherwise the difficulty of the operation will be greatly increased."

Qian Min nodded, that's right.

"But what about the patient's injury?"

Huang Youdao shook his head, he couldn't help it.

For a moment, there was silence in the operating room.

The crowd was helpless.

Suddenly, Li Xiyang, who had been silent, spoke.

"Just do as Dr. Huang says!"

When Huang Youdao heard this, he was a little panicked,

Hurriedly said, "Doctor Li, I'll just say it casually, and the patient's sternum..."

Li Xiyang raised his hand to interrupt, "Since anything will cause pressure on the sternum, then put your hand."

Just hurry up!"

Do it quickly?

Although Huang Youdao is not good at nephrectomy, he also knows how a nephrectomy can take an hour or two.

According to his calculations, the time limit for the patient's chest to withstand half of the body pressure should be 20 minutes.

It's impossible!

Li Xiyang smiled at him, "How do you know if you don't try?"

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