Subluxation of the radial cephalic head is a very common "minor problem" in children. In fact, such a small problem does not cause serious consequences. And the main reason for its occurrence is somewhat speechless - in most cases, the subluxation of the radial microhead is caused by the parents pulling the child's hand too hard.

There are two main reasons why children aged 2~4 years old are prone to this kind of dislocation, the first is because the radial head of the elbow is not fully developed before the age of 5, so the annular ligament is relatively loose. This relaxation creates an innate condition for the subluxation of the microcephalic head of the radial head.

The second reason is that parents are accustomed to "holding their children". Many parents feel that holding a child with one hand is a form of protection when they are walking or going up and down stairs. In this way, it is convenient for parents to quickly exert force when the child falls and pulls the child who is about to fall back to prevent injury.

But what parents don't know is that this rapid upward and backward lifting is the main cause of subluxation of the small head of the radial head. What's even more unfortunate is that children at this age have a very low tolerance for pain, and the pain caused by subluxation will greatly cause children to be irritable, resist and cry. And when they cry in pain, they can't clearly tell in words what part of them is injured.

So the parents got into a dilemma. Unless you have the relevant knowledge, it is indeed difficult for parents to realize that their child has dislocated in the first place. Sometimes some children are brought to the doctor by their parents more than two days after they have a dislocation. Prolonged dislocation leads to ligament damage and edema of the surrounding joints, leaving doctors with no choice but to undergo surgery and K-wire reduction. In the end, the child was scarred, and the parents slapped themselves in distress.

Fortunately, Zhuang Zihao's child's father seemed to understand things quite well, and he rushed to the Fourth Central Hospital with the child in his arms. The little nurse who received the patient was taken aback by this look, the pediatric outpatient clinic and the emergency department were on the ninth floor, so Zhuang's father was directly pointed into the emergency room and met Sun Lien.

"What's going on?" Sun Lien already has a complete understanding of the child's condition, the situation is not dangerous or dangerous, although it stands to reason that it should be sent to the pediatric department on the ninth floor for treatment, but today's Sun Lien is a little too full, so he decided to deal with it directly - anyway, it is only a matter of tens of seconds before and after the manual reset.

"I took my kids to play in the children's playground in Sun City. "Daddy Zhuang wiped the sweat from his head," he said, sliding his feet as he climbed the slide. I happened to be holding his hand, and subconsciously pulled ......" Father Zhuang's expression was very apologetic, "and then I felt that the movement in my hand was not quite right, as if his arm had suddenly stretched out a little." ”

Sun Lien found a chair and motioned to Zhuang's father to put Zhuang Zihao's children on the stool. He asked Zhuang Zihao, who was holding his left arm, "Little friend, come, can you play a little game with your brother?"

After Zhuang Zihao came out of his father's arms, he seemed to be calmer because there was no longer a constant pain in the affected limb, he nodded timidly, and then looked at Sun Lien, waiting for the little game to begin.

"Learn from my brother. Sun Lien faced Zhuang Zihao and gently raised his right hand. Children have no concept of left and right, and it is difficult for them to understand the reversed relationship between left and right of mirror images. So when doing this small check, Sun Lien chose to switch left and right. "Raise this arm......" He watched Zhuang Zihao's movements and nodded with satisfaction, "Can you touch your head?"

The child tried, but his arm was only slightly raised and straightened a little, then stopped, and then shook his head vigorously at Sun Lien.

"What about that?" Sun Lien asked as he stretched out his arm flat and spun it again, "Can you move?"

This time, Zhuang Zihao's child didn't even have the interest to try, and he began to cry again.

"Doctor, what's going on?" Father Zhuang was anxious, he looked at the young Sun Lien, and felt that the doctor in front of him, who might be a few years younger than himself, was very unreliable.

"It should be a subluxation of the small head of the radius, don't worry, it's not very serious. Sun Lien nodded towards Father Zhuang, "I'll give you a list, you go and take the child for an X-ray first, as long as there are no other problems, a reset will be done quickly." ”

Father Zhuang nodded, the child has a bone injury, and it must be right to do an X-ray. He took the X-ray examination sheet prescribed by Sun Lien, turned around and took the child out of the emergency room - the admission registration was still done by the little nurse at the door, and Zhuang Zihao's situation was indeed not very good, so Zhuang's father took the child to line up.

"It's okay to do this directly, right?" Xu Yourong looked at the departing Zhuang Zihao and his father's back and asked in a low voice, "It's just a matter of spinning, isn't it easy?"

"Then we have to rule out other possible bone injuries first. Sun Lien spread his hands, Xu Yourong was indeed different from him. has been working outside the gods for a long time, and she is not as good as Sun Lien with this common injury. "Reduction can only be done if there is a fracture of the lateral condyle of the humerus, a fracture of the radial microcephaly, or a fracture of the same site. Otherwise, what if I make a mistake and start doing it directly, and the reduction is not successful, but the bone crack is pressed into a fracture?"

Sun Lien himself knew that Zhuang Zihao must be a subluxation of the radial small head, after all, the status bar has already made it clear. It's just that Feng Chujie's lesson made him firmly understand a truth - the treatment of diseases still needs evidence. The status bar is just a hint, although for himself, the hint on the status bar is basically equivalent to conclusive evidence. But other doctors don't think that way, and patients don't think that way. He can only make a diagnosis after examination and solid evidence.

"It's quick to take an X-ray anyway. Sun Lien smiled at Xu Yourong, "Lin Lan's inspection has been arranged?"

"It's arranged. Xu Yourong nodded, "However, the people in the laboratory department said that this kind of genetic testing has taken a long time." It will take about a day to come to a conclusion. ”

"It doesn't matter. Sun Lien has no opinion on this, "Anyway, in her current state, even if she is diagnosed immediately, she can't have surgery." It doesn't matter if the test result is a day or two late. ”

Xu Yourong continued to whisper, "The police have arrived. ”

"Police?" Sun Lien was stunned, he didn't react to what the police were here for.

"Gao Yan's treatment has stopped. Xu Yourong explained, "The police came and waited to get the death notice. ”

Gao Yan's treatment stopped, and Sun Lien was actually a little depressed. After all, counting Zhou Xiufang and Gao Yan, this is already two consecutive deaths. Especially after Zhou Xiufang passed away, Sun Lien still wanted to save Gao Yan emotionally. After all, Gao Yan is almost equivalent to the last patient in Zhou Xiufang's life who gave diagnostic advice, and the family members of such patients finally chose to give up treatment, which really made Sun Lien feel uncomfortable.

Xu Yourong had just finished explaining the matter to Sun Lien, and Xiao Guo, the nurse on the side, also walked over slowly. After watching Xu Yourong walk away, he whispered to Sun Lien, "Brother Sun...... I may be in trouble. ”

"Trouble?" Sun Lien was in a lawsuit, "What did you do? Which patient's ribs were broken?"

"No, isn't it......" Xiao Guo said in a low voice, "Mrs. Zhou left before...... I posted it in the circle of friends first. ”

"Huh?" Sun Lien still didn't understand what Xiao Guo was talking about.

Guo Yu was in a hurry, and he explained in a whisper, "That's it...... It was I who first told the outsiders that Mrs. Zhou was gone. As a result, many people gathered in the hospital. Guo Yulai raised his eyelids and glanced at Sun Lien worriedly, "Brother Sun, am I in trouble?"

"It turned out to be you kid!" Sun Lien was still strange before, after all, it was understandable that reporters rushed to the hospital, but where did those ordinary people, those Zhou Xiufang's students, friends, colleagues, patients, and even patients' families know? Zhou Jun was busy moving Zhou Xiufang's case records from his home at that time, and he didn't have time to notify outsiders, let alone post any obituaries.

Nurse Xiao Guo sighed, "Brother, what should I do?"

"What else can you do? What else do you want to do?" Sun Lien was a little angry, the patient's situation must be kept strictly confidential. Xiao Guo privately posted a circle of friends, which is tantamount to directly leaking the patient's situation and **. Although he was very sure that Zhou Jun would not blame Xiao Guo for this, after all, this was a very serious disciplinary issue. "Delete it quickly! Then find Director Liu to admit your mistake!" Liu Tangchun has always protected calves, as long as Xiao Guo has the right attitude, he will be scolded by Lao Liu at most.

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Xiao Guo went out to find Liu Tangchun and admitted his mistake. Sun Lien waited in the rescue room for the X-ray pictures of Zhuang Zihao's children. There is no obvious abnormality above, and there are no fractures in the lateral condyle of the humerus and the radial cephalic head, and the evidence is conclusive that this is a simple radial cephalic subluxation.

Looking at Zhuang Zihao's children, who were holding their cartoon hats and sitting on the stool and still crying, Sun Lien sighed. "I'll do a reset for the child first, and it won't hurt immediately after the reset is done. ”

Father Zhuang nodded hurriedly, in order to make it easier for Sun Lien to operate, he also specially pulled out the cartoon hat that Zhuang Zihao was holding in his arms and put it on the platform in the duty room.

"If you press the child on the seat, just press the shoulder, don't push too hard. Sun Lien commanded, in fact, he just wanted Father Zhuang to have something to do, so as to distract him, and at the same time use his father's contact to ease the vigilance of Zhuang Zihao's children.

Sun Lien straightened Zhuang Zihao's elbow to 90°, held Zhuang Zihao's elbow with his left hand, pressed his thumb on the small head of the radius in front of Zhuang Zihao's elbow, and pinched Zhuang Zihao's left wrist with his right hand. The thumb of his left hand squeezed up hard, while his right hand pressed down hard, and at the same time, his right hand pinched Zhuang Zihao's wrist and rotated it back and forth.

"Click" Sun Lien's left thumb came from a clear bouncing sensation, which was a sign of successful resetting.

The pain at the moment of joint reduction made Zhuang Zihao cry again, Sun Lien quickly let go of his hand, and in the last step, he glanced at the state bar on Zhuang Zihao's head, and the state of "radial cephalic subluxation" had disappeared.

The child cried a few times, as if he felt that crying alone was not enough to express his dissatisfaction, so while crying, he jumped off the stool and stretched out his hands to his father for a hug. The movement of reaching out was smooth and natural, and it seems that the reset was indeed successful.

"It's okay, I'll open a bill for you, just go out and pay the bill. Sun Lien nodded to Father Zhuang, who was very grateful, "Remember, the child's arm must avoid strenuous exercise in the next week, otherwise the reset arm may be dislocated again." Also, don't pull children's arms like this in the future. ”

Zhuang's father hugged the child, bowed and thanked him, and took the payment slip out of the rescue room.

Sun Lien was packing up his things, and when he turned his head to look, he found that Zhuang Zihao's children's hat was still on the duty desk and had not been taken away. He picked up his hat and went out to return it. It turned out that there was no Zhuang Zihao and Zhuang's father in the crowd at the payment window in the rescue hall.

"Where did you go?" Sun Lien scratched his head, and the little nurse next to him who let people into the emergency room at the beginning pointed to the door, "He went out with the child just now." ”

"Went out?" Sun Lien was a little puzzled, what was this person doing when he didn't go to register to change the triangular scarf, and went out with the child?

The little nurse looked at Sun Lien, who was stunned, and asked in a low voice, "Doctor Sun, is it ...... Did the patient evade the bill?"8)