Fifth Vital [EN]: Chapter 489

490. 35 Degrees Outward from the Side

Even elevators have over ten different types.

Right now, they needed a lift for the head of a large bone, but since this wasn’t a room primarily for orthopedic surgeries, they didn’t have the right equipment.

So, he grabbed a commonly seen long forceps (about the size of two adult palms, scissor-shaped tongs).

“Okay, use this to get under the Y-shaped bone head and gently lift it up. Do you understand?”

“Yes, you mean like this, right?”

“Right. Be careful the drill doesn’t damage other structures while cutting the bone.”

“Yes, Doctor.”

The tool used to cut the bone moves very quickly about 2cm from side to side, like a saw.

However, its driving force isn’t a sharp blade like a real saw, but vibration, so it doesn’t cause serious damage even if it touches other muscles.

But blood vessels and nerves are exceptions, so the bone is lifted up.

As Tae-kyung applied the saw and cut through the bone, hazy bone dust scattered.

It was similar to sawdust flying around when cutting wood in a woodworking shop.

To remove the dust, Lee Chan-hee sprayed saline solution with a syringe between the cuts.

Thud-

The head of the femur, about the size of a child’s fist, fell off.

“Rongeur, please.”

The human femur is close to a large sphere, and it fits into the socket inside our pelvic bone. However, the artificial bone is a different size from the bone we used to have, so a connecting part of the appropriate size must be inserted into the pelvic bone.

Of course, to do that, small blood vessels, periosteum [the membrane covering the bone], and other unnecessary tissues in the area to be inserted must be torn off with that tool.

Scrape- scrape-

As he tore off the tissues attached to the bone, some bone fragments were also torn off. The unique sound of bone scraping echoed in the operating room.

After Tae-kyung trimmed it with a rongeur, he lifted a tool about the length of an adult’s forearm and about 2cm thick.

At the end of it was a round drill.

When Tae-kyung started the machine, the round drill spun quickly.

It was a machine for trimming the area to be inserted into the pelvis for the artificial joint. From here on, it was purely a matter of feel.

How much to grind with that machine, how much to insert, and at what angle to cut was purely a matter of intuition.

Textbooks said 35 degrees outward from the side and 15 degrees forward from the front and back. But that was just theory learned in class, and it varied from patient to patient in the operating room, so the surgeon had to judge well.

And that judgment was very important.

If this direction or depth was wrong, the patient would live with asymmetrical feet and walk with difficulty for the rest of their life.

Or maybe they wouldn’t be able to walk properly at all. So, this process had to be taught by someone who knew it well.

Or it had to be someone who could match symmetry and fully understand human gait [a person’s manner of walking].

Tae-kyung inserted a long instrument about 80cm into the patient’s pelvic bone socket and then started the machine.

-Whirring – Wheeeing

At the same time, the sound of bone grinding mixed with the sound of the machine, creating a dissonant sound.

It wasn’t a joke, if you closed your eyes and just listened to the sound, it was literally like being on a construction site.

Tae-kyung and Lee Chan-hee moved mechanically, like construction workers moving tools.

If someone saw them, it would look like they were just making holes in the pelvis without thinking, but Tae-kyung was carving the socket with accurate sensation, judging the direction and depth.

Tae-kyung removed the machine, checked the socket where the head of the femur had been, and repeated the digging several times before putting the machine down.

“Hmm! Good…….”

A look of satisfaction briefly crossed Tae-kyung’s serious face as he rummaged around and took out a silver hemispherical object.

The inside was empty and the diameter was about 5cm, which was quite large.

It looked like a helmet used in World War I. He fitted it into the socket he had dug out earlier.

“Doctor, it fits perfectly.”

“That’s because the standard specifications are matched.”

Lee Chan-hee said, amazed, seeing the artificial joint fitting perfectly into the patient’s bone, and Tae-kyung replied indifferently.

It wasn’t wrong, but it was only half right.

It wasn’t easy to get it right the first time because the direction and surrounding bone space had to be considered.

“Oop!”

“Huh?!”

At that moment, Lee Chan-hee was surprised and exclaimed without realizing it when he saw something in Tae-kyung’s hand.

Because Tae-kyung was holding a large hammer the size of an adult man’s arm. It was really like a long, large hammer that you could see on a construction site.

It was so heavy that even Tae-kyung couldn’t lift it easily.

This hammer was a tool for hammering the helmet-shaped tool into the socket.

Afterward, it was fixed with screws, but a hammer was needed to set the position once before that.

He fixed the long silver pillar tool to the socket together with the helmet and hit the end of the pillar with an appropriate force with the hammer.

-Clang -Clang -Clang -Clang

It looked like he was just hitting it mindlessly, but it wasn’t at all. It was a job that required adjusting the strength.

Of course, it shouldn’t be too strong.

The reason was simple. The patient’s precious pelvic bone could be destroyed.

Tae-kyung put it in to the appropriate depth, removed the pillar, and picked up the drill again.

He then naturally and quickly drove in two screws to fix it.

Doctors who have performed pelvic surgery are extremely rare among doctors. So, doctors who know the horror of pelvic surgery are also rare.

The pelvis is full of the first branches of the aorta [the main artery carrying blood away from the heart], the very large 8-lane road of blood vessels that starts from the heart, and blood vessels that are virtually indistinguishable from the aorta are constantly present everywhere.

Therefore, you have to be very careful.

Even a slight damage to these blood vessels can immediately kill the patient.

Also, the blood vessels here are absolute nerves for sexual function and lower body movement, so damage can have a significant impact on life.

It is the job of driving a 5cm screw with a drill between such places.

Therefore, of course, you must know all anatomical structures perfectly.

The anatomical structure mentioned here means that you must know all the individual diversities in addition to the obvious structures.

Using CT and MRI angiography [imaging techniques to visualize blood vessels], all blood vessels and vascular diversity are memorized and understood before surgery.

During the minute or so it took to drive the screws into the patient lying on the surgical bed, these things came to Tae-kyung’s mind like a photograph.

“Okay, now the pelvic bone is done…….”

With those words, Tae-kyung slightly tilted the cut femur to make it visible. Then, he took out a thin, long iron skewer about 50cm long.

It was really a skewer. Then, he put the skewer against the inside of the femur, grabbed the handle, and stabbed it in.

Then, the fatty components inside the bone pushed out redly with blood.

When it didn’t go in well, he tapped it with a hammer to stab it to a certain depth.

The inside of the bone is weaker than you think, so you have to be careful because hitting the hammer too hard can break through the bone.

-Thump – Thump

After that, after making a small hole, an artificial bone is inserted to connect the pelvic bone and the cut femur.

It looks like an eagle’s claw and has a round thing at the end that fits into the pelvic bone socket.

When this part was inserted along the hole just made, the bone marrow and blood gushed out.

“Suction!”

“Yes, Doctor.”

Secure the field of vision by spraying suction and N/S (normal saline) [a sterile solution of salt and water, used for irrigation].

While inserting the bone, apply appropriate force and consider the angle of the leg and pelvis.

Tae-kyung hammered while delicately changing the angle.

In fact, the weight of the hammer was heavier than he thought, so his shoulder was starting to hurt.

“Ugh…….”

He was straining his shoulder because he was adjusting the direction while delicately controlling the force with a large, heavy hammer.

“Phew!”

The sound of a construction site continued to echo in the operating room, and after about 5 minutes of fighting, he put it in.

Then, with all his strength, he pushed the head of the artificial bone into the socket.

-Click

“Ah, it’s done. Okay! Chan-hee, move aside.”

“Yes, Doctor.”

Tae-kyung moved under the leg where Lee Chan-hee was to check if the connected leg was functioning properly.

Then, he carefully checks whether there is any abnormality in the movement of the pelvic joint back and forth and side to side, and whether it falls out again.

The verification process is important.

Replacing a problematic hip joint with an artificial joint is to allow the patient to use it well as before.

But if the joint that has been fitted with difficulty does not move well, it is useless, so you must carefully check whether everything moves smoothly.

“Doctor, it moves well.”

“I see. Good. This is enough.”

Tae-kyung, who had been looking around carefully here and there, was finally showing a satisfied expression when suddenly…

Beep-

The operating room door opened suddenly.

The operating room door had never been opened in the middle of a patient’s surgery.

Tae-kyung and the staff looked at the door with puzzled eyes.

“Director!”

It was Nurse Lim Jeong-sook who came into the operating room. Nurse Lim Jeong-sook was wearing a mask and surgical gown.

Although she was wearing a mask, anyone could tell that Nurse Lim Jeong-sook’s expression was unusual.

“I’m sorry for the sudden intrusion. I came urgently because of a patient in the emergency room. It seems like a hit-and-run TA (traffic accident) [TA stands for Traffic Accident] patient fell to the floor, and currently, Teacher Choi and Teacher Jung are seeing the patient, but the patient’s condition is not good.”

“What exactly is the condition?”

“That’s…….”

Nurse Lim Jeong-sook’s quick and detailed explanation continued, and Tae-kyung listened intently and gave orders.

“It’s the final stage of the surgery. There’s suturing left, but I’ll go as soon as it’s finished.”

“Yes, Director. I understand.”

Nurse Lim Jeong-sook, who heard the order, immediately left the operating room with the word understood.

The staff’s expressions were not good after Nurse Lim Jeong-sook left.

All the medical staff gathered in the operating room had heard about the patient’s condition that Lim Jeong-sook had conveyed.

Our hospital did not have as many patients who went to their deaths due to poor conditions compared to other hospitals.

Whether it was due to good luck, the efforts of the medical staff, or both, that was the case anyway.

Perhaps because of that, it was true that they did not feel good when such patients came in once in a while.

“The surgery is not over yet, so let’s focus on Lee Jeong-bon’s surgery.”