Chapter 153

The manifestations and principles of manual fracture reduction are, to a certain extent, largely similar to the manual reduction technique for joint dislocation.

To the extent that Fang Ziye had never seen, on the Panel, a distinction between fracture and joint dislocation manual reduction techniques among the downstream skills of Manual Reduction Technique.

However, Manual Reduction Technique does indeed have its own progression curve——

Leverage Reduction Technique, Rotation Reduction Technique, Compression Reduction Technique……

The proficiency of these downstream skills isn't particularly high, but Fang Ziye feels that his current Manual Reduction Technique proficiency is already sufficient.

Having silently worked out the principles of manual reduction that Huang Haitao spoke of in his mind, he could only figure out and speculate on the corresponding manual reduction approach on his own.

It is equivalent to using anatomical interlock to form internal stability between the fracture and fracture ends, then assisting with Plaster External Fixation for external fixation, to achieve the effect of fixation——this is the most basic principle.

But how to interlock the fracture ends precisely into the corresponding beneficial position, how to apply traction, and how to release the traction force at the right moment so that the fracture ends retract exactly into place——that is the difference in manifestation.

Huang Haitao and the others did not disturb Fang Ziye's thinking; moreover, Huang Haitao did not know what kind of skill Xue Tao meant when he said Fang Ziye's manual reduction had a bit of kung fu.

However, just one minute later, Fang Ziye arrived at the patient's side.

Strangely, Huang Haitao did not find that the patient, upon learning the person performing his reduction had been switched to Fang Ziye, had any opinion of refusal or rejection.

On the contrary, he said: "Doctor Fang, in the end it's still you doing the manual reduction for me?"

Yesterday, when Fang Ziye was performing manual reduction, he stood with the family members outside the Operating Room, watching somewhat enviously those people who could queue up, because these people, after a couple of cracks from reduction, could go home.

But he had to be hospitalized, have surgery, get injections, recover, have blood drawn——all that troublesome stuff.

Now that it was finally his turn, he was actually quite expectant.

Moreover, how many patients did Fang Ziye reduce yesterday? He saw with his own eyes Fang Ziye sending them out of the Department.

Hearing is false, seeing is true; Fang Ziye has real skill in his hands, so he felt no apprehension.

"Mhm, not nervous, there are still several Directors watching nearby; if I can't do it, Director Huang and Director Wu definitely can." Fang Ziye slowly soothed him, while simultaneously seeing that Xue Tao had already reached the fixed position and prepared the counter-traction.

Fang Ziye no longer hesitated, grasped the suitable position for applying traction, and the biceps and forearm muscles of his single hand all bulged up.

Orthopedics, whether joints or trauma, or other sub-specialties, all require a few handfuls of strength.

Fang Ziye isn't tall, has no fatty muscle, but his strength is definitely not small; after all, he has been scrambling in Zhongnan Hospital's Trauma Surgery for over three years.

Moreover, Fang Ziye discovered that his Manual Reduction Technique at Level 3 Proficiency could already operate without relying on all his own strength; Level 4 Manual Reduction Technique even more so——Fang Ziye can utilize the clever force from muscle deformation, misappropriating a portion of strength to use as traction.

This is Fang Ziye's unique discovery; he doesn't know if he misunderstood, doesn't dare to ask, and doesn't know if others do it this way too.

The purpose and direction of traction are actually quite pure: simply to fully distract the displaced fracture, separating the fracture ends.

This process requires strength to distract, but the patient won't feel pain; on the contrary, there will be a sensation of comfortable stretching.

This is where fracture manual reduction differs from joint dislocation manual reduction.

During sustained traction in joint dislocation manual reduction, there is a pain fear sign; but in the fracture manual reduction process, because the fracture displacement is distracted open and the fracture ends separate, pain does not appear——it even disappears.

The patient had originally prepared for suffering, but unexpectedly, after the pain relief, his breathing rhythm gradually stabilized.

Seeing this, Fang Ziye knew that his traction this time was in place.

Then, a scene that made everyone very hard to understand appeared.

Fang Ziye, who was originally using both hands for traction, at this moment actually released his left hand, then used his left hand to touch the position of the patient's fracture ends, while the other hand continued traction, as if effortlessly.

Instantly, everyone's faces changed dramatically!

This scene is truly too inconceivable.

Big Brother, that's the patient's leg; at least respect the saying, the arm cannot twist the thigh——even in the sustained traction phase, you can manage traction with one hand?

Just how strong is the explosive power of the muscles on Fang Ziye's body; can one punch kill a person?

Everyone's first reaction was that Fang Ziye's strength is super huge, an absolute orthopedics promising seedling.

Great strength, in the eyes of orthopedic doctors, is an absolute talent.

But actually it's not so; Fang Ziye at this moment merely cleverly misappropriated a portion of muscle traction force.

The strength he exerted was only four-tenths of his whole-body strength; his four-tenths strength is naturally not small either——lifting fifty or sixty jin is easy——but not as formidable as others imagine.

Naturally, Fang Ziye's focus at this moment is completely not on other people's reactions.

Rather, Fang Ziye is thinking: how to lift a portion of the muscle adjacent to the fracture fragments in the middle of the fracture, use the muscle's force to bounce or compress those displaced fracture fragments not directly connected to the fracture back into their original positions.

Anyway, Fang Ziye doesn't know why he would have this idea, but Fang Ziye just can do it.

So, in others' eyes, Fang Ziye's operation was merely touching the fracture ends a few times, then pressing the surrounding muscles once.

After pressing the muscles, through the elastic muscle's own force making the fracture fragments contact the fracture ends, Fang Ziye began to slowly release the traction force.

The rebound force of joint dislocation is very strong, but the fracture's rebound force is not as explosive and violent as joint dislocation's rebound force.

Therefore, the so-called cracking sound will not appear.

But Huang Haitao, seeing this scene, nearly had his eyeballs pop out.

Anxiety in his eyes, as if he had over ten thousand questions; his mouth opened and closed, but as if he had no strength to utter syllables.

Because shock is not an idiot; his remaining IQ let him know that at this moment, even if he himself were slashed with a knife, he must not affect Fang Ziye's most critical operation step.

So what if he's shocked?

Fang Ziye felt the fracture ends, and after they approximated fairly well, he gradually completely relaxed the right lower limb's force.

The fracture's proximal and distal ends retracted, and under the muscle's retraction force, the middle fracture fragments interlocked together; in this instant, there was slight pain.

"Ouch." The patient's originally relaxed brows furrowed slightly upon feeling the pain, emitting a dull groan.

Not too much; because this instant's pain stimulation is at most like a bee sting, and it's the sting's immediate pain, not the burning pain of bee venom afterward; therefore it is acceptable.

Opening his eyes, seeing Fang Ziye had already unloaded force, Xue Tao naturally also followed Fang Ziye's rhythm, relaxed his force, and asked: "Doctor Fang, this one——is it already reduced successfully?"

Fang Ziye isn't too sure either; because according to his usual understanding, this patient is unsuitable for manual reduction, but if assessed according to the reduction effect of fracture manual reduction——

Fang Ziye hadn't even replied when he was shoved aside by a butt.

It was precisely Huang Haitao, who could no longer endure his own shocked emotions; after seeing Fang Ziye finish the operation, he used his butt to shove Fang Ziye half a body width aside, then immediately went to the patient's right lower limb, and touched the patient's lower limb fracture site.

Movements gentle but forceful, not letting the patient feel extra pain; however, the pressing force was also not small——this is also kung fu wrapped around the body.

This is his unique diagnostic method; Fang Ziye finds it hard to understand.

But just half a minute later, he went from bowing to standing up, then glanced sideways at Fang Ziye, becoming thoughtful.

"Director Huang, how is it?" Wu Guo Nan hurriedly asked.

He felt a slight anxiety in his heart, but it was still alright.

Because Huang Haitao's anxious behavior would make him subconsciously think Fang Ziye had produced a bad result.

However, Wu Guo Nan himself wasn't a pure idiot, completely lacking his own thinking; as a very professional trauma surgeon, he could determine how to evaluate the quality of fracture reduction.

The fracture deformity disappeared, the patient's pain was relieved, and his mood was relaxed — this is the most superficial indicator of good reduction.

Specifically, it still relies on the X-ray plain film to finally confirm.

Huang Haitao thought for a moment: "It should be pretty good, but I can't comment; let's wait for the X-ray examination results?"

As Huang Haitao spoke, his face was full of hesitation and disbelief.

Hearing this, Fang Ziye and Xue Tao both hurried off to apply plaster casts.

The purpose of manual reduction is only reduction and preliminary fixation; to truly fully achieve the absolute principles of fracture treatment — reduction and fixation — external fixation is still needed to assist fixation; otherwise, without plaster assistance, if it displaces again, it becomes another fracture story.

The process of applying plaster casts wasn't slow.

After hearing Huang Haitao's words, Wu Guo Nan still politely asked: "Director Huang, so for now, you temporarily don't need to make corrections; we'll see after the results?"

Huang Haitao looked at Wu Guo Nan very seriously, saw no mockery in his eyes and expression, heard no sarcasm, and only then nodded.

The patient's X-ray re-examination items had already been ordered in the medical orders before reduction, and the examination orders had been given to the patient and family; therefore, the patient only needed to be pushed downstairs by family for X-ray after plaster fixation was complete.

As for the plaster setting time, they only needed to wait outside the operating room.

Xue Tao and Fang Ziye went out together and gave corresponding instructions: "After re-examination, don't wait for results; come up directly. We can view the films directly in the ward. Two hours later, family can print them out."

"You can go downstairs to the X-ray room in five minutes."

"Is it the place where the films were taken yesterday? Doctor, is the reduction pretty good?" The patient's family were his wife and son; the one asking was the wife, while the son helped support his father onto the stretcher, also asking how he felt...

After Fang Ziye and Xue Tao entered again, Huang Haitao, who had been talking with Wu Guo Nan, looked at Fang Ziye with half-belief and asked: "Doctor Fang, during your manual reduction, can you mobilize several muscles around the fracture for use?"

"???" Fang Ziye listened in confusion, casting a puzzled gaze over.

After a few seconds, seeing Huang Haitao still had no intention of explaining, he asked: "Director Huang, can you speak more clearly? I'm a bit unclear on your meaning."

What does mobilizing several muscles around the fracture for use mean? Could it be saying I use a bit of clever force during manual reduction?

I haven't thoroughly calculated this aspect myself.

Wu Guo Nan and Xue Tao, hearing the two's dialogue, looked at each other in dismay; Wu Guo Nan's gaze fixed straight on Xue Tao, and Xue Tao very consciously went to Wu Guo Nan's side, explaining in a low voice the details of Fang Ziye's manual reduction of joint dislocation yesterday.

At the same time, Huang Haitao struggled a bit before explaining: "That is, according to our Traditional Chinese Medicine view, during reduction, the early stage uses the operator's own strength."

"Then one can mobilize a portion of clever force between joints; further, one mobilizes the clever force of muscles as auxiliary force during reduction."

"Some people can mobilize one to four or five, using elastic force or pushing force as the lateral shifting force for fracture fragments during reduction."

"For example, me — currently I can at most mobilize three muscles as assistance on the same patient."

Fang Ziye heard this and was somewhat vague and confused.

He shook his head blankly: "Director Huang, perhaps the realm you understand is too profound; I don't know. I also don't really understand the theories inside Traditional Chinese Medicine; I actually just follow traction, relaxation, reduction, leverage — this kind of modern medical thinking to solve problems."

"What mobilizing muscle force, I don't understand; but I treat muscles as a variant of leverage tools, and after thorough traction, let the fracture fragments be pried into their proper positions."

Inside Zhongnan Hospital, Fang Ziye had never heard such a theory; even Professor Deng Yong, occasionally when doing osteotomy correction, would say that in closed reduction situations, one could use which several muscles, which might become auxiliary points for manual reduction, but there was only experience to summarize, no theoretical support.

Things without theoretical support can only serve as popular science and experience transmission; cannot fully believe, also cannot not believe.

Huang Haitao's expression continued to be doubtful, and beyond the doubt, there were a few more points of melancholy, as if Fang Ziye's appearance made his presence in this ward very awkward.

After the first patient left, the second patient quickly came in.

This time, Huang Haitao slightly restrained his sharpness; he felt Fang Ziye was absolutely not simple, so he let Fang Ziye try directly?

Fang Ziye instantly shook his head like a rattle-drum, explaining in a low voice: "Director Huang, I can't do this; I can't design it now; according to my understanding, this patient should have surgical treatment."

"If manual reduction were possible, I would have suggested it to Director Wu and Director Xue long ago; I wouldn't have waited until now."

Know what you know, don't know what you don't know.

Fang Ziye could suggest patients who cannot have manual reduction go to surgery, and also suggest some patients who can have manual reduction not have surgery; this is equal exchange and suggestion. Director Wu can choose not to follow, but Fang Ziye would still suggest this, fulfilling his duty.

Fang Ziye's words instantly made Huang Haitao become awkward.

But looking closely at Fang Ziye's expression, it also didn't look like mockery. So he again used his own theory to break it down once, asking Fang Ziye if he could do it.

Hearing this, Fang Ziye nodded: "So that's how it is, Director Huang; I can try."

Fang Ziye gradually understood something.

Damn, the manual reduction indications and contraindications I believed in completely became my thinking prison; and this prison, even when my manual reduction reached a very high level, still could not break the cognitive shackle.

But Huang Haitao was different; he, from theory, did not particularly recognize the guidelines, indications, and contraindications that modern medicine follows; so he could effortlessly list some manual reduction methods and routines that are hard to reduce by common sense.

Fang Ziye's operation level had no problem; after designing the corresponding routines and methods, Fang Ziye's side could replicate them.

Not strenuous; the second patient, Fang Ziye also under Xue Tao's assistance, *click-click-click* a few times, reduced it up...

Seeing this, Huang Haitao only felt he had seen a ghost.

Right then he pulled Wu Guo Nan out the door, leaving only Fang Ziye and Xue Tao in the operating room looking at each other in dismay.

Roughly after a few seconds, Xue Tao, not seeing the two directors return, tilted his head to look at Fang Ziye and said: "Ziye, your manual reduction technique, the level is very high; it's not just amazing Director Huang, it's shocking him."

Amazement and shock are completely different moods.

Fang Ziye thought seriously for a moment, while watching his super large-amount knowledge points credit, his mood fluctuations became even more intense.

"Knowledge Points +74!"

"Knowledge Points +81!"

Two patients, two reductions, directly made Fang Ziye's knowledge points surge by 155 points at once — does this count as poking straight into the knowledge points' lair, making knowledge points directly overflow?

Fang Ziye guessed it might be like this.

Moreover, the reason it's like this, Fang Ziye guessed, might be related to the current fracture treatment guidelines.

After all, the manual reduction cases Fang Ziye is doing now are, to a certain extent, products against the guidelines.

Put it this way: following the guideline inward, at most you'll produce standard surgeons; but if you go against the guideline outward, the result becomes extremely polarized — either trending toward a dead end, or toward nirvana and rebirth.

Why does the closed reduction of fractures yield such abundant knowledge points?

Because it's new; the existing recognized theory regarding it may be too shallow, an immature system, a breakthrough point worth going deeper into — every further step could disrupt cognition.

What is knowledge? New cognition is knowledge.

Fang Ziye's heart thumped rapidly —

(Chapter End)