Chapter 144

Joint dislocation is very common in orthopedics, especially in trauma surgery — it's a disease type that may be encountered every day. After all, Enshi is the capital of Enzhou Autonomous Prefecture, and the number of long-term residents here is not small.

With an incidence rate of one in one hundred thousand per day, there are still three or four cases; even split among the three hospitals — Enshi People's Hospital, Min Da Hospital, and Central Hospital — there would still be one or two every day or two, right?

Therefore, the manual reduction technique for joint dislocation is not some high-end operation that ordinary doctors cannot access.

For instance, a high-end procedure like osteotomy correction — for everyone at Enshi People's Hospital, that is truly wishful thinking; better wash up and sleep early, don't waste time on such operations and techniques.

In the surgical grading system, manual reduction is merely the simplest Grade I surgery; even a resident physician can routinely perform it in the department while on duty with superior authorization, let alone those standing here — all are attending physicians or above.

Xue Tao is even a deputy chief physician, deputy director level; he has scrambled in prefecture-level city hospitals for a long time, and has seen even rare dislocations dozens of times.

Zhang Jinchuan is about to be promoted to deputy chief, and even Wang Zhongxing has been an attending for several years, counting as a senior attending physician at a prefecture-level city hospital.

Therefore, they all know very well that manual reduction is not high-end; the principles and techniques are just those few.

Principles: sustained traction, muscle relaxation, reduction.

Techniques: depending on the type of dislocation, there are common and uncommon manual reduction methods.

The quality of technique is a matter of proficiency and technical level. But which technique to apply is a matter of depth of understanding of the disease type — a theoretical issue, a cognitive issue.

The several seasoned ones can all see that Fang Ziye's technique has nothing special, but Fang Ziye's reduction method — first a push inward, then a push outward — this choice of method differs from all of them.

Such a choice is cognition and theoretical deduction; this certainly means Fang Ziye has produced a dimensionality-reduction strike against them in some theoretical aspect, leading to their failure and his success.

Naturally, Xue Tao and the others are not rookies like Lan Tianluo who make a huge fuss at the unexpected — "holy shit, holy shit" — but quickly returned to their positions.

Xue Tao first took charge of performing a physical examination assessment on the patient's post-reduction condition.

At the same time, Zhang Jinchuan, who has known Xue Tao for a long time and is familiar with his temper, hurried out to find the family members, muttering: "Are Zhang Han's family members here? Where are the family? Need to go downstairs for a plain film to recheck."

Wang Zhongxing, at the first moment, took the patient's emergency medical record book in hand, leaned over the operating table, butt stuck up, and began writing post-reduction medical orders and precautions.

Seeing everyone's gazes gradually withdraw, Fang Ziye's already un-nervous mood relaxed even further.

In a prefecture-level city hospital, compared to Zhongnan Hospital, there are fewer rookies; none are students, so nobody makes a big fuss — whatever happens, they definitely keep it hidden.

Fang Ziye himself is a senior resident physician, has a medical license, has a surgical practicing certificate, and his practice location has already been corrected to Enshi Central Hospital.

Closed reduction of joint dislocation is a technique he can routinely operate; nothing to worry about.

While watching Xue Tao perform lower limb rotation checks and asking the patient if it hurts, Fang Ziye also brought out the corresponding postoperative assessment theory, matching them one by one.

A surgery, whether open or closed, from preoperative assessment of surgical indications to postoperative evaluation of surgical effect — all are key points in theory, indispensable.

The success marker of closed reduction of joint dislocation is actually quite similar to its diagnostic points.

First point: external deformity disappears. For example, just now this patient's hip anterior dislocation presented with external rotation, abduction, rotation, and flexion deformity. Then after successful reduction, the corresponding deformity disappears.

Second point: textbooks write unequal limb length, lower limb shortening — this is actually nonsense, merely descriptive language, not much reference value. The limb is already abducted and externally rotated deformed, how could it not shorten?

However, Fang Ziye knows that the shortening this knowledge point refers to is total length shortening, requiring measurement of the superimposed distance from the greater trochanter of the affected femur to the heel, which would be shorter than the healthy side; such distance measurement, although only applicable to joint dislocation at the knowledge level, is actually used very extensively in pelvic reconstruction.

All graduate students in the department must master this, cannot just skim over it.

After reduction, shortening disappears — that is the success indicator.

Third point: limited movement and pain — this sentence is also nonsense; the pain level of joint dislocation is not something ordinary people can endure, and the limited movement it brings is inevitable.

If after dislocation the joint movement is not limited, then it cannot be defined as joint dislocation, but rather subluxation or structural insufficiency of periarticular soft tissue...

Newly arrived, entering an unfamiliar domain, Fang Ziye had to be cautious and meticulous.

Here there is no Master Deng Yong this big shot, no Old Professor Li Guohua giving him a hundred percent safety net; therefore Fang Ziye can only be careful on his own, and Fang Ziye's only reliance is his own theoretical knowledge, the indications in the guidelines.

Others, first meeting, unknown hearts — cannot be easily trusted.

And watching Deputy Chief Physician Xue Tao continuously rotating the lower limb, the patient's pain not worsening, Fang Ziye's heart relaxed, but his expression tightened.

Even though Fang Ziye is not a master's student in joint surgery or sports medicine, Fang Ziye also knows that Xue Tao's current examination is completely without method.

Actually, after successful manual reduction of joint dislocation, the physical exam to do — besides checking the patient's passive movement — also needs to check whether there is acetabular labrum soft tissue injury.

So as to advise the patient whether further sports medicine specialty treatment for soft tissue injury is needed.

Circling the hip joint like this, the labrum cannot be examined.

However, this point Fang Ziye did not point out directly, but after Xue Tao finished examining, said sincerely: "Teacher Xue, let me also take a look; I've rarely encountered post-successful-reduction physical exams of patient movement recovery for joint dislocation manual reduction."

Xue Tao nodded.

Reduction done well, the pressure hanging over this patient also slackened; but Fang Ziye saying it like this, Xue Tao's heart was rolling — the human world is truly not worth it.

Fang Ziye so young, no experience, yet able through theory plus very ordinary operation to solve the patient's problem.

TM's "talent" these two words never speak reason.

"No problem, can do."

Xue Tao comforted the lying young man: "Brother, this is our department's new PhD, technique and level both very high, just experience slightly shallow; let him do a physical exam on you — anyway you're comfortable now."

The young man hearing this said: "Thank you all, doctors, now finally comfortable."

"As long as you don't mess with my lifeline, this one hundred twenty-nine jin of mine, you can toss around however you want."

"Don't know if you can understand that kind of pain, but when it hurts, it's truly too unbearable; now although there's still a little pain, I feel this might be the most comfortable moment of my life."

"Never felt not-painting so beautiful; I'll squint a bit more, give me half a minute, I'll yield the spot." The young man's speaking confidence increased slightly, collapsed there, not wanting to move at all.

Fang Ziye then didn't stand on ceremony, thanking the patient while starting the examination. It looked like Fang Ziye circling the patient left and right, front and back, playing with his lower limb; occasionally because the range of motion was too large, the pain-and-fatigue patient would let out a few "aiyo" cries — can't blame Fang Ziye for hurting him.

In reality, Fang Ziye was performing hip flexion-adduction-internal rotation test (FADIR), labrum shear/compression test (LST), internal rotation compression test (IROP), anterior apprehension test (AAT), posterior apprehension test (PAT), abduction-extension-external rotation test (AEER) and other related tests.

The test results made Fang Ziye's heart tighten.

Because not very good — FADIR, LST, IROP, AAT all positive, only posterior apprehension test negative, AEER still undetermined between positive and negative.

This indicates the patient very likely has labrum injury, must do an MRI to reconfirm diagnosis, whether next-step diagnosis and treatment needed.

Fang Ziye stood up, patted his hands: "Joint reduction already handled, range of motion all recovered, pain patient — joint dislocation this problem, recheck an X-ray, basically done."

"However, your injury time is a bit long, and dislocation degree rather special, so you probably still need an MRI, check for soft tissue injury."

"Right, Director Xue?"

Xue Tao hearing this, heart immediately understood Fang Ziye's meaning — estimates Fang Ziye also has experience, multiple failed reductions easily cause labrum injury, so examining to confirm diagnosis is a very safe behavior.

"Take one, brother, also for your body's sake."

"Alright." The young man nodded.

This thing of his, in the end, can all be claimed from car insurance; even if not claimed, he still has to do it — can't leave residual problems unresolved just because of a few hundred yuan.

The emergency medical record book was mainly written by Wang Zhongxing; Fang Ziye did not snatch the medical record or overstep his role.

Division of labor and cooperation is the best way, but Fang Ziye still suggested with a grin: "Doctor Wang, how about suggesting a Sports Medicine teacher come take a look?"

"Huh?" Wang Zhongxing froze at those words.

Then he said: "Our department IS Sports Medicine, isn't it?"

This time it was Fang Ziye's turn to freeze.

The Trauma Center is the hospital's Sports Medicine specialty; Xue Tao completely lacked awareness in this aspect — at least during his physical examination, there was no pattern to follow; Fang Ziye could not find the trace of a single examination he had performed.

"Then how about writing a note for him to follow up at the outpatient clinic?" Fang Ziye himself wasn't from the Sports Medicine specialty, so he couldn't push too hard, but making this suggestion was certainly a good thing.

The patient himself said: "Sports Medicine, right? I know it — athletes often get injured and that's the specialty they see; I'll go check in Chongqing when I get there."

"Doctor, thank you." The young man opened his eyes this time, looking in Fang Ziye's direction, with a few more points of respect.

As if Fang Ziye being able to mention the Sports Medicine suggestion was a kind of professionalism.

However, Zhang Jinchuan, who had gone out, now returned, saying dejectedly: "You don't have any family?"

"Yeah, I was just passing through, planning to take a ride to Chongqing, no family to accompany me."

"My body's not badly hurt anyway, so I didn't call home to worry them."

"Doctors, thank you all, I'll go for the checkup myself; I've endured even harder times before..." The young man climbed up from the bed, face full of smiles, smiles containing a middle-aged man's hardship and pressure.

Immediately after, he picked up the medical record book and limped away.

No fracture; after dislocation reduction, one can walk directly — just avoid excessive weight-bearing.

Seeing this, Li Yuanhong helped him toward the nurse station; he properly went to the nurse station and waited for Li Yuanhong, who had temporarily gone to issue medical orders, and kept nodding...

As for Xue Tao and Wang Zhongxing, the two of them also didn't ask Fang Ziye how exactly he had reduced it before.

Better attend to the outside patients first.

This time, an auntie with a relatively simple fracture with partial displacement came in; she should be a local from Enshi; after injury she notified family, currently two people accompanying her — should be sisters and daughter.

After the three entered, Xue Tao and Wang Zhongxing began receiving and reading films.

Fang Ziye, on the other hand, did not intervene again, standing properly to the side, while organizing his gains from just now.

"Knowledge Points +49!"

"Knowledge Points +14!"

Two almost explosive Knowledge Point gains instantly made Fang Ziye's gaze sharpen.

Very quickly, Fang Ziye realized.

The 49-point Knowledge Point gain should be the closed reduction treatment income credited; this hip joint anterior dislocation was much harder than the elbow joint lateral dislocation he had done during on-duty before — that lateral elbow reduction had only gotten 30 points.

This hip anterior dislocation that Xue Tao and the others had failed to reduce several times, successfully reduced, even as 'assistant primary operator', gaining 49 points, not too outrageous.

The remaining 18 points, of which 6 points, Fang Ziye estimated were from him performing physical examination on the patient, obtaining the diagnosis of labral damage and hip joint capsule damage causing joint instability, and suggesting Sports Medicine consultation, earning Knowledge Points.

The other 12 points were the Knowledge Point rewards from previously suggesting some fracture patients be hospitalized for surgical treatment.

Clinical practice is indeed the largest source of Knowledge Points, not an exaggeration.

In just under ten minutes, 63 points of Knowledge Point income — this fucking... how could other places keep up?

Plus, the previous plaster casting Knowledge Point gains; after Fang Ziye added points to X-ray Reading Technique, he recovered 81.8 points.

While watching Xue Tao and Zhang Jinchuan performing simple fracture closed reduction, with no intention of letting him help, Fang Ziye did calculation problems listlessly.

What if this panel is wrong? Though wrong or not there's no way, but watching the lovely Knowledge Points consume and credit is also a kind of happiness.

1245.3 (before hospital) - 469.4 (X-ray point allocation cost) + 81.8 (today's gains).

Bingo, wrong is still impossible; truly a bit too boring.

"Eh, okay, Doctor Zhang." Fang Ziye hurriedly answered Zhang Jinchuan calling him over to help cast plaster.

Xue Tao is a Deputy Chief Physician; due respect must still be given; he completed the simple fracture closed reduction, though fast, it's a small task — no need to make him fuss; let Xue Tao rest a bit too.

Plus, plaster casting is at least 0.1-0.2 Knowledge Point gain; just because I have 800+ Knowledge Points, would I look down on a few tenths?

Impossible.

Even 0.01 I want; in the training room sustaining for six minutes is also 0.01.

As this plaster cast finished, Fang Ziye indeed gained 0.2 Knowledge Points, smiling smugly.

Seeing this scene, Xue Tao seemed to see his past self — except he was a Master's student then, while Fang Ziye is a Doctoral student: "Doctor Fang really likes clinical work?"

"If I can avoid research and just do clinical, I believe ninety percent of doctors wouldn't set foot in a lab." Fang Ziye didn't hide his true inner thoughts.

Naturally, this isn't Fang Ziye's most true thought either; although clinical has massive Knowledge Points and is interesting, who doesn't have a research big shot dream?

A saying goes well: all clinical work are merely tool persons for theories produced by research; every surgery you do now, every operation, every drug, are results pioneered by predecessors — you just take these results and apply them.

No matter how awesome, you're just a premium tool person, unless you can possess something uniquely yours and original.

"Quite candid."

"Doctor Fang, I see your operation level is also quite strong; how about you try this dislocation?" Xue Tao disliked the 'Doctor' title — because their department originally had a Doctor, but he was too terrifying.

Zhang Mingcan liked that Doctor Director so much he sent him to another department's director — shows how much psychological shadow that Doctor brought to the department.

But Xue Tao likes clinical work, and likes discussing and learning with colleagues and young people who like clinical work.

"Director Xue, I think I can try." Fang Ziye didn't thank him, but answered relatively steadily.

Zhang Jinchuan's side, after seeing Wang Zhongxing finish writing the medical record book, said: "Tao Ge, have Wang Zhongxing take this patient to Yuan Hong's place for follow-up medical orders."

"Wang Zhongxing cast nearly twenty plasters over there, also quite tired."

The closed reduction operating room, two people is already about enough; if not for that hip anterior dislocation patient being too difficult before, four or five doctors wouldn't have gathered at once.

Where would the department have so many people?

Wang Zhongxing was a bit moved, yet also looked toward Xue Tao.

Xue Tao nodded: "Go on, get some good rest, order us all a meal."

"Sure thing, the best meal set." Wang Zhongxing immediately nodded, then led the patient out of the operating room, not hesitating in the slightest.

A mature doctor would not struggle in the current situation where patients are flooding in; they are decisive and straightforward.

Rest when it's time to rest, so that when it's time to work you can be unambiguous, rather than being moved to tears.

(Chapter End)