Joint dislocations are common in orthopedics, especially in trauma surgery, and are a condition that can be encountered on a daily basis. After all, Enshi belongs to the capital of Enzhou Autonomous Prefecture, and the number of people who settle here all year round is not small.

There are always three or four cases of one in 100,000 cases per day, even if they are divided equally by the People's Hospital of Enshi, the People's University of China and the Central Hospital, there can always be one or two in a day or two, right?

Therefore, manual reduction of joint dislocation is not a high-end operation that ordinary doctors cannot reach.

For example, high-end surgeries such as osteotomy and orthopedics, for all people in Enshi People's Hospital, that is the operation and operation method of not being delusional, washing and sleeping early, and not wasting time.

Manual reduction, in the surgical grade classification, is only the simplest level I surgery, even the resident can be authorized by the superior, when on duty in the department routinely, not to mention, standing here are the attending and above.

Xue Tao is a deputy high-level and deputy chief physician, and he has been in the prefecture-level city hospital for a long time, and he has seen dozens of times even rare dislocations.

Zhang Jinchuan is about to be promoted to deputy high school, and even Wang Zhongxing has been in charge for several years, and he can be regarded as a senior attending physician in a prefecture-level city hospital.

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

Principles, continuous traction, muscle relaxation, reduction.

Manipulation, depending on the dislocation, there are commonly used and uncommonly used manual reduction methods.

The quality of the technique is a matter of proficiency and technique. However, what kind of techniques to apply is the depth of understanding of the disease, and it is a problem at the theoretical level and at the cognitive level.

Several people can see that Fang Ziye's method is nothing special, but Fang Ziye's reset method, first top it, and then push it out, this way of choosing is different from them.

Such a choice is cognition and theoretical derivation, which must be Fang Ziye's theory in a certain aspect, which has caused them to reduce the dimensionality, which led to their failure and Fang Ziye's success.

Naturally, Xue Tao and a few people were not budding newcomers like Lan Tianluo, who made a fuss when they saw an accident, but quickly entered their own position.

Xue Tao was first responsible for the physical assessment of the patient's condition after reduction.

At the same time, Zhang Jinchuan, who had known Xue Tao for a long time and was familiar with Xue Tao's temper, hurried to find his family members and said, "Is Zhang Han's family here?" What about family members? I'm going to go below to do a plain film to review. ”

Wang Zhongxing immediately took the patient's emergency medical record book in his hand, lay on the operating table, pouted his buttocks and began to write the doctor's instructions after resetting.

Fang Ziye saw that everyone's eyes were gradually retracted, and he was not nervous, so he relaxed even more.

In the prefecture-level city hospital, compared with Zhongnan Hospital, there are fewer new ones, and they are not students, so ah, everyone will not make a fuss, and if there is anything, it must be hidden.

Fang Ziye himself is a senior resident, with a physician qualification certificate, a surgical practice certificate, and the practice location has been revised to En Central Hospital.

Joint dislocation manual reduction is a surgical procedure that he can routinely operate, and there is nothing to worry about.

While watching Xue Tao doing a rotation examination of the lower limbs there, while asking the patient if he was in pain, Fang Ziye also took out the corresponding postoperative evaluation theory and corresponded one by one.

An operation, whether open or closed, is indispensable in theory from the preoperative evaluation of the surgical indication to the postoperative evaluation of the surgical effect.

The hallmark of successful manual reduction of a joint dislocation is similar to its diagnostic points.

The first point is that the appearance deformity disappears. For example, the patient had an anterior hip dislocation and had an externally rotated abduction rotational flexion deformity. Then after the reduction is successful, the corresponding deformity will disappear.

The second point is that what is written in the textbook is that the length of the limbs is unequal and the lower limbs are shortened, which is actually nonsense, but it is descriptive language and does not have much reference value. People are abducted and externally rotated, can it not be shortened?

However, Fang Ziye knows that the shortening mentioned in this knowledge point is the full length of the shortening, and it is necessary to measure the superimposed distance from the femoral tuberosity of the affected limb to the heel, which will be shorter than that of the healthy side.

All graduate students in the department must master it, and it cannot be swept away.

After reduction, the shortening disappears, which is an indication of success.

The third point, limited activity and pain, this sentence is actually nonsense, the pain level of joint dislocation, that is not tolerated by ordinary people, and the limited activity it brings is inevitable.

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

When he first arrived and came to an unfamiliar field, Fang Ziye had to be cautious and meticulous.

There is no master Deng Yong here, and the old professor Li Guohua gives him 100% support, so Fang Ziye can only be cautious by himself, and Fang Ziye's only reliance is his theoretical knowledge and the indications in the guide.

Others, who meet for the first time and don't know their henchmen, can't be easily trusted.

After watching Deputy Chief Physician Xue Tao constantly rotate his lower limbs, and the patient's pain was not aggravated, Fang Ziye's heart was relieved, but his expression was tight.

Even though Fang Ziye is not a master's student majoring in joint surgery and sports medicine, Fang Ziye also knows that the current examination done by Xue Tao is disorderly.

In fact, after the joint dislocation manipulation is successfully reduced, the physical examination to be done should not only check the passive activity of the patient, but also check whether there is soft tissue damage to the femoral labrum.

In order to advise the patient on the need for further treatment of soft tissue injuries at a sports medicine specialist.

If you go around the hip joint like this, you can't check the labrum.

However, Fang Ziye did not understand this point, but after Xue Tao finished the examination, he said sincerely: "Teacher Xue, I will also take a look, I have rarely been in contact with the physical examination of the patient after the recovery of the patient's activity after the successful reduction of the joint dislocation technique." ”

Xue Tao nodded.

After the reset was done, the pressure he had put on this patient was relaxed, but when Fang Ziye said this, Xue Tao's heart was rolling, and the world was really not worth it.

Fang Ziye is so young and has no experience, but he can solve problems for patients through theory and very ordinary operations.

The word TM's talent doesn't make sense.

"It's okay, it's okay."

Xue Tao comforted the lying youth: "Brother, this is a new doctor in our department, his skills and level are very high, but his experience is a little shallow, give him a physical examination, anyway, you are comfortable now." ”

When the young man heard this, he said, "Thank you, doctor, for now you are finally comfortable." ”

"As long as you don't play with my life, my one hundred and twenty-nine pounds will make trouble at will."

"I don't know if you can understand the pain, but the pain is really uncomfortable, and although it still hurts a little bit, I think this may be the most comfortable time in my life."

"I've never felt so good that it doesn't hurt, I'm going to squint for a while, give me half a minute, I'll give up my position." The young man spoke with a little more confidence, and he collapsed there, not wanting to move.

Fang Ziye was not polite, and while thanking the patient, he started the examination. It seems that Fang Ziye is playing with his lower limbs around the patient from side to side, and it may occasionally be because the range of motion is too large, so that the patient who is slightly tired from pain occasionally sighs a few times, and it is not to blame that the drunk Fang Ziye makes him hurt.

In fact, Fang Ziye is performing hip flexion-adduction-internal rotation test (FADDIR), labral flushing/extrusion test (LST), internal rotation and extrusion test (IROP), anterior fear test (AAT), posterior fear test (PAT), abduction-extension-external rotation test (AEER) and other related tests.

The results of the test made Fang Ziye's heart sink.

Because it is not very good, FADDIR, LST, IROP, AAT are all positive, only the rear fear test is negative, AEER is still positive and negative is undecided.

This indicates that the patient has a very large degree of labral injury, and it is necessary to undergo an MRI to confirm the diagnosis, and whether further diagnosis and treatment are required.

Fang Ziye got up and clapped his hands: "The joint reduction has been dealt with, the range of motion has been restored, the pain patient, the problem of joint dislocation, and then a re-examination of an X-ray, it is basically okay." ”

"However, your injury has been a bit long, and the degree of dislocation is quite special, so you may still have to do an MRI to see if there is any soft tissue damage."

"Really, Director Xue?"

When Xue Tao heard this, he immediately understood what Fang Ziye meant, it is estimated that Fang Ziye is also experienced, and if he fails to reduce it many times, it is easy to cause labrum damage, so it is very safe to check one to determine the diagnosis.

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

"Okay." The young man nodded.

In the end, he can find car insurance for reimbursement, even if he doesn't reimburse, he has to do it, and he can't not solve it because of a few hundred dollars, and then there are still problems.

The emergency medical record book was mainly written by Wang Zhongxing, and Fang Ziye did not snatch the medical records or overstep the bounds.

Division of labor and cooperation is the best way, but Fang Ziye still smiled and suggested: "Doctor Wang, do you recommend that the teacher of sports medicine come and have a look." ”

"Huh?" Wang Zhongxing was stunned when he heard this.

Then he said, "Our department is also sports medicine?" ”

This time, it was Fang Ziye's turn to be stunned.

The trauma center is the sports medicine specialty in the hospital, so Xue Tao has no awareness of this at all, at least when he examines the body, there is no rule to follow at all, and Fang Ziye did not find the trajectory of any of the examinations he has done.

"Then maybe just write one and let him go to the outpatient clinic for a review, right?" Fang Ziye himself is not a sports medicine specialist, so it is not good to force it too much, but it is definitely a good thing to suggest it like this.

The patient himself said: "Sports medicine is right, I know that athletes are often injured after being injured, so I will see this specialty, and I will go to Chongqing to see it when the time comes." ”

"Thank you, doctor." The young man opened his eyes this time and looked in the direction of Fang Ziye, and couldn't help but feel a little more respectful.

It seems that Fang Ziye can mention the suggestion of sports medicine, as if it is a profession.

However, Zhang Jinchuan, who went out, came back at the moment, and said depressedly: "You don't have any family? ”

"Yes, I was passing by, and I was going to take a car to Chongqing, and I was not accompanied by my family."

"Anyway, there is no big problem with my body, so I didn't call to worry my family."

"Doctor, thank you, I'll just go and check it myself, I've survived all the difficulties before......" The young man got up from the bed, with a smile on his face, and the bitterness and pressure of a middle-aged man were in his smile.

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

If there is no fracture and the dislocation is reduced, it is possible to walk directly, as long as it is not overly weight-bearing.

Seeing this, Li Yuanhong helped him to the direction of the nurse's station, he went to the nurse's station in an orderly manner, and waited for Li Yuanhong, who came over to give medical advice temporarily, and confessed, he kept nodding......

And Xue Tao and Wang Zhongxing didn't ask Fang Ziye how he was reset before.

Let's take care of the patients outside first.

This time, it was an aunt who came in with a relatively simple fracture and partial displacement, she should be a local in Hui'en City, and her family was notified after she was injured, and there are currently two people accompanying her, it should be a sister and a daughter.

After the three of them came in, Xue Tao and Wang Zhongxing began to receive patients and watch films.

Fang Ziye, on the other hand, did not interfere anymore, and stood aside in a proper manner, while taking care of what he had just gained.

"+49 knowledge points!"

"+14 knowledge points!"

The two almost explosive knowledge points immediately made Fang Ziye's eyes tighten.

Soon, Fang Ziye suddenly understood.

The income of 49 points of knowledge should be received during the manual reduction treatment, and this time the joint dislocation is much more difficult than the lateral elbow dislocation done when I was on duty before, and the lateral reduction of the elbow joint at that time got 30 points of knowledge points.

This anterior hip dislocation that Xue Tao and others have reset several times and has not been reset, and the reduction is successful, even if it is the 'assistant master' position, the income is 49 points, which is not too outrageous.

And the remaining 18 points, of which 6 points, Fang Ziye estimated that he did a physical examination for the patient, got the diagnosis of labral injury and joint instability caused by hip capsule injury, and suggested that he go to sports medicine for a doctor, and obtained the knowledge points.

The other 12 points are the knowledge points that were previously recommended for some fracture patients to be hospitalized for surgery.

Clinical is the largest source of knowledge, and it is not an exaggeration.

In less than ten minutes, 63 points of knowledge points earned, which TM. How can other places keep up?

In addition, after the previous knowledge of plaster casting, Fang Ziye added X-ray reading and returned 81 points of blood.

Fang Ziye watched Xue Tao and Zhang Jinchuan doing simple fracture manual reduction, and had no intention of letting himself help, while doing calculation problems boredly.

What if this panel is wrong? Although it's wrong, there's no way, but it's also a joy to watch cute knowledge points consume and get into the account.

1245.3 (before arriving at the hospital) -469.4 (plus X-ray consumption) + 81.8 (today's earnings).

857.7 points.

Bingo, it's impossible to be wrong, it's a little too boring.

"Alright, Dr. Zhang." Fang Ziye hurriedly replied that Zhang Jinchuan asked him to come over to help with the plaster.

Xue Tao is the deputy chief physician of the deputy high school, and the respect he deserves is still to be given, he has completed the manual reduction of a simple fracture, although the speed is very fast, but with a small job, there is no need to let him toss, let Xue Tao also rest a little.

In addition, plaster is also a 0.1-0.2 knowledge point income, do I have 800+ knowledge points, do I look down on 0.0 tenths?

No way.

I want 0.01, and I continue to do it in the practice room for six minutes, which is 0.01.

With this plaster finished, Fang Ziye really gained 0.2 knowledge points, and he smiled beautifully.

Seeing this scene, Xue Tao seemed to see himself back then, but he was a master's student at that time, but Fang Ziye was a doctoral student: "Does Dr. Fang like clinical practice very much?" ”

"If you don't engage in scientific research, you can only engage in clinical practice, and I believe that 90% of PhDs will not go to the laboratory at all." Fang Ziye did not hide his true thoughts in his heart.

Naturally, this is not Fang Ziye's most real idea, although there are a lot of knowledge points in clinical practice, and it is interesting, but who doesn't have a dream of a scientific research boss?

There is a good saying, all clinical trials are just tools for scientific research theories, and all the surgeries, operations, and drugs you are doing now are the results created by your predecessors, and you just use these results to apply them.

No matter how awesome it is, it's a high-level tool person, unless you can have something unique and original.

"It's very honest."

"Dr. Fang, I see that your operation level is also quite strong, why don't you try this dislocation?" Xue Tao didn't like the title of doctor, because they originally had a doctor, but it was too scary.

Zhang Mingcan likes the director of the doctor so much, and he gave him to the directors of other departments, so he knows what a big psychological shadow this doctor has brought to the people in the department.

But Xue Tao likes clinical practice very much, and he also likes to discuss and learn with colleagues and young people who like clinical practice.

"Director Xue, I think you can try." Fang Ziye didn't thank him, but replied relatively calmly.

Zhang Jinchuan, on the other hand, saw that Wang Zhongxing had written the medical record book, so he said, "Brother Tao, let Wang Zhongxing take this patient to Yuanhong for a re-examination of the medical order." ”

"Wang Zhongxing has nearly 20 plasters over there, and he is quite tired."

In the manual reduction operation room, there are two people who are almost the same, and if it weren't for the previous patient with anterior hip dislocation, it would be impossible to gather four or five doctors at once.

Where are there so many people in the department?

Wang Zhongxing was a little moved, but he also looked at Xue Tao.

Xue Tao nodded: "Go, take a good rest, and order a meal for us." ”

"Okay, the best package." Wang Zhongxing nodded immediately, and then led the patient out of the operating room without hesitation at all.

Mature doctors will not be entangled in today's situation of full patients, simply and decisively.

Rest when it's time to rest, and be unambiguous when it's time to do things, instead of being moved to tears.

(End of chapter)