Surgery Godfather
Chapter 1244 - 955: Don’t Ask Me for Medical Expenses

Chapter 1244: Chapter 955: Don’t Ask Me for Medical Expenses

The cause of the femur’s disappearance has now been revealed, and what remains for everyone is to learn about this area through discussion. By examining this case, everyone has gained an initial understanding of idiopathic osteolysis. When encountering such a case again in the future, you will at least have a basic concept in mind.

However, this type of case is so rare that a physician may go through an entire career without seeing one. More often, it is understood through reading literature, which encourages everyone to study regularly and read papers, as this is the essential way for a doctor to break through the limitations of experience.

Song Zimo used imaging tools on the tablet to measure the distance of the femoral defect. Since the efficacy of the Ilizarov technique is uncertain for this disease, the only alternative is a method with assured effectiveness—custom prosthetic implantation, using a custom metal to replace the missing femur.

Replacing the missing femur with a metal femur is also conditional. The remaining proximal and distal femur must provide good fixation for the implant, which includes not only temporary mechanical fixation but also long-term, reliable biological fixation.

To achieve this, a certain length of both the proximal and distal ends must remain. Song Zimo measured the remaining lengths and found they just met the requirements, making the method of implanting a femoral prosthesis viable.

Another method—using the Ilizarov technique—is theoretically possible and should be the best option, but it requires a lengthy treatment time. The trouble is that the patient’s family is currently in a dispute with City People’s Hospital, and under these circumstances, no doctor would dare to use a new method, even if it might be highly effective.

At this time, doctors would definitely use conservative treatment methods so as not to get themselves into trouble. The implementation of new methods requires the active cooperation of the patient.

"Can muscle attachment be solved with the femoral prosthesis? If the muscles don’t attach, won’t it still affect the leg’s movement on that side? Just having a scaffold won’t provide the power, right?"

Li Guodong’s thinking was still very active, capable of pinpointing the issue.

Song Zimo’s gaze lingered on the tablet he held: "I’ve just measured, and there are enough muscle attachment points on the remaining proximal and distal femur. As for the attachment points along the femoral shaft, current biologic custom femoral prostheses can provide attachment, though it takes some time to form."

A standardized training student worried about another issue: "The patient already has severe muscle atrophy, and there’s a very apparent thickness difference between the two thighs. The affected thigh is as thin as an arm. Will it be able to recover in the future?"

This graduate student was part of Zhao Wenbo’s group, who immediately explained: "Muscles are plastic and follow the principle of ’use it or lose it.’ He hasn’t walked normally for a year, leading to muscle atrophy for sure. As long as there’s no muscle fiber fibrosis, recovery is possible. With proper standardized rehabilitation training, the muscle volume and strength can both be restored."

"Right, based on the timing, there’s no fibrosis in the thigh muscles yet, and they can still recover in the future. Don’t forget, the fact that bodybuilders can train their muscles so strong is the best proof of muscle plasticity," Li Guodong chimed in.

The current topic didn’t involve traditional Chinese medicine, so Li Guodong and Zhao Wenbo were getting along harmoniously, able to discuss calmly. But if it had involved traditional Chinese medicine, the two of them would be at loggerheads, not resting until a victor emerged.

"Is fibrosis irreversible?"

Someone asked.

"Irreversible; pathologically, it is the replacement of muscle tissue with fibrous connective tissue."

Old Jin answered.

A graduate student had a moment of realization: "Does this mean that some patients with high-level peripheral nerve injuries who undergo nerve anastomosis often have poor functional recovery? And that patients with low-level nerve injuries recover better after surgery? Is this because the higher the nerve injury, the farther it is from its target, and the daily nerve growth of less than a millimeter is too slow, so by the time the nerve reaches its destination, the muscles have fibrosed beyond repair?"

"You’re talking about motor nerves; don’t sensory nerves have targets for their terminal organs too, like sensory corpuscles, and could they also fibrose?" another graduate student said.

Song Zimo immediately dispelled their confusions: "Exactly, the terminal structures innervated by sensory nerves can also degenerate after a long period of lost neural support, and it’s irreversible degeneration. However, compared to muscle fibrosis, this happens much slower, which is why for the same injury site, sensory nerve recovery is generally better than motor nerve recovery. Besides the degeneration of the terminal structures, another factor affecting nerve recovery is mismatch and attrition during growth—the farther from the end point, the greater the attrition."

"I get it now; I’ve been thinking about this issue for a while, but it’s been quite vague. Now I finally understand," the graduate student who asked the question earlier said, feeling relieved.

Through this open discussion, everyone also understood the treatment method for this disease: first, treat bone resorption with anti-osteoporosis drugs to inhibit bone absorption and improve bone density; then, use surgery to implant a femoral prosthesis, restoring the normal function of the femur.

"Does anyone else have thoughts about idiopathic osteolysis to bring up? Dr. Song! Let’s start this weekend’s rare disease awareness session with idiopathic osteolysis."

Yang Ping felt that the discussion was sufficient and it was time to move on to the next topic.

"Alright, we’ll add the topic of idiopathic osteolysis to this weekend’s lecture list. If nobody has objections, let’s discuss the solitary kidney we just mentioned," Dr. Song instructed the graduate student operating the projector to switch the image.

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