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Chapter 144 Cognitive Overwhelming and Massive Recovery (Please Subscribe)

Joint dislocations are common in orthopedics, especially in trauma surgery, and are a condition that can be encountered daily. After all, Eun-si is the capital of Eun-do Autonomous Okrug, and a significant number of people reside there year-round.

Even with an incidence rate of one in 100,000 per day, there are still three or four cases. Even if the incidence is divided equally among the three hospitals—Enshi People's Hospital, Minzu University Hospital, and Central Hospital—there will still be one or two cases every day or two.
Therefore, manual reduction of joint dislocation is not a high-level procedure that ordinary doctors cannot access.

For example, advanced surgical procedures like osteotomy and reshaping are something that everyone at Enshi People's Hospital should avoid even dreaming about, and simply go to bed early to avoid wasting time on such procedures.

Manual reduction is only a simple Level I surgery in the surgical grading system. Even resident physicians can routinely perform it during their shifts in the department after authorization from their superiors. Not to mention, those standing here are all attending physicians and above.

Xue Tao is a senior physician, a deputy chief physician, who has worked in a prefecture-level city hospital for a long time and has seen dozens of rare dislocations.

Zhang Jinchuan is about to be promoted to associate senior physician, and even Wang Zhongxing has been an attending physician for several years and can be considered a senior attending physician in a prefecture-level city hospital.

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

The principle is to maintain traction, relax muscles, and reposition the muscle.

Depending on the type of dislocation, there are common and less common manual reduction techniques.

The quality of a technique is a matter of skill and technique. However, the choice of which technique to use depends on the depth of understanding of the disease; it is a matter of theory and cognition.

Even the seasoned veterans could tell that Fang Ziye's technique wasn't anything special, but his method of repositioning—first pushing it up, then pushing it outwards—was different from theirs.

This choice, based on cognition and theoretical deduction, must have been due to Fang Ziye's superior theoretical understanding in a certain area, which led to their failure and Fang Ziye's success.

Naturally, Xue Tao and the others weren't newbies like Lan Tianluo who would exclaim "Holy crap!" at the sight of the unexpected. Instead, they quickly returned to their positions.

Xue Tao was first responsible for examining and assessing the patient's condition after the repositioning.

Meanwhile, Zhang Jinchuan, who had known Xue Tao for a long time and was familiar with her temperament, quickly went to find the family members, muttering, "Are Zhang Han's family members here? Where are they? We need to go downstairs to get a X-ray for a follow-up examination."

Wang Zhongxing immediately took the patient's emergency medical record, leaned over the operating table, and began writing down the post-reduction instructions.

Seeing that everyone's attention was gradually withdrawing, Fang Ziye's already relaxed mood became even more relaxed.

In prefecture-level city hospitals, compared to Zhongnan Hospital, there are even fewer new recruits, none of whom are students. So, no one is making a fuss about it, and if anything happens, they will definitely keep it to themselves.

Fang Ziye himself is a senior resident physician with a medical qualification certificate and a surgical practice certificate. His place of practice has also been changed to Enshi Central Hospital.

Manual reduction of joint dislocation is a routine procedure he can perform, so there's nothing to worry about.

While watching Xue Tao perform a rotational examination of the lower limbs and asking the patient if they were in pain, Fang Ziye also brought out the corresponding postoperative assessment theories and applied them one by one.

Whether it's an open or closed surgery, the assessment of surgical indications before surgery and the evaluation of surgical outcomes after surgery are all key points in theory and are indispensable.

The key indicators of successful manual reduction of joint dislocation are actually very similar to its diagnostic criteria.

First, the external deformity disappears. For example, in the case of this patient with anterior hip dislocation, there was external rotation, abduction, rotation, and flexion deformity. After successful reduction, the corresponding deformity will disappear.

Secondly, the textbooks state that the limbs are of unequal length and the lower limbs are shortened, which is essentially meaningless; it's just descriptive language and has little reference value. If a person has abduction and external rotation deformity, how can they not have shortened limbs?
However, Fang Ziye knew that the shortening mentioned in this knowledge point was full-length shortening, which required measuring the superimposed distance from the greater tuberosity of the femur to the heel of the affected limb, which would be shorter than that of the healthy side. Although this distance measurement was only applicable to joint dislocation at the knowledge level, it was actually used extensively in pelvic reconstruction.

All graduate students in the department must master this knowledge; it cannot be merely skimmed over.

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

Thirdly, the limited range of motion and pain. This is actually redundant. The pain of a joint dislocation is unbearable for most people, and the resulting limited range of motion is inevitable.

If joint movement is not restricted after dislocation, then it cannot be defined as a joint dislocation, but rather as a subluxation or incomplete soft tissue structure around the joint...

Having just arrived in unfamiliar territory, Fang Ziye had to be cautious and meticulous.

Without a mentor like Deng Yong, or a mentor like Professor Li Guohua to guarantee his safety, Fang Ziye had to be cautious on his own. His only reliance was his theoretical knowledge and the indicators in the guide.

Others, whom you meet for the first time and do not know well, should not be easily trusted.

Seeing that Associate Chief Physician Xue Tao kept rotating the patient's lower limbs without aggravating the pain, Fang Ziye felt relieved, but his expression tightened.

Even though Fang Ziye wasn't a master's student in joint surgery or sports medicine, he knew that the examinations Xue Tao was currently conducting were completely haphazard.

Actually, after a successful manual reduction of a joint dislocation, the physical examination should include checking the patient's passive movements and also checking for soft tissue damage to the femoral labrum.

In order to advise patients whether they need further treatment for soft tissue injuries at a sports medicine specialist.

You cannot examine the labrum by wrapping it around the hip joint like this.

However, Fang Ziye did not point this out. Instead, after Xue Tao finished his examination, he honestly said, "Teacher Xue, let me take a look too. I have very little experience with physical examinations after a patient's mobility has been restored following a successful manual reduction of a joint dislocation."

Xue Tao nodded.

Once the repositioning was done, the pressure he had been under on the patient eased. However, after Fang Ziye said that, Xue Tao's heart was in turmoil. Life really wasn't worth it.

Fang Ziye is so young and inexperienced, yet he is able to solve patients' problems through a combination of theory and very basic procedures.

The word "talent" in TM has never made any sense.

"It's okay. It's fine."

Xue Tao comforted the young man lying down: "Brother, this is a new PhD in our department. His skills and level are very high, but he is a little inexperienced. Let's give him a physical examination. Anyway, you're feeling better now."

Upon hearing this, the young man said, "Thank you, doctors. I finally feel better now."

"As long as you don't mess with my manhood, you can do whatever you want with my 129-pound body."

"I don't know if you can understand that kind of pain, but when it hurts, it's really unbearable. Although it still hurts a little bit now, I think this might be the most comfortable moment of my life."

"I've never felt so good without pain. I want to take a nap. Give me half a minute, and I'll give up my seat." The young man's voice gained a little more confidence. He collapsed there, not wanting to move at all.

Fang Ziye didn't stand on ceremony. He thanked the patient and began the examination. It seemed that Fang Ziye was moving around the patient's lower limbs, moving them back and forth. Perhaps because the range of motion was too large, the slightly tired and aching patient would occasionally groan a few times. It's no wonder that Fang Ziye was hurting him.

In reality, Fang Ziye was conducting tests on the hip joint, including the flexion-adduction-internal rotation test (FADDIR), labral erosion/compression test (LST), internal rotation compression test (IROP), frontal fear test (AAT), posterior fear test (PAT), and abduction-extension-external rotation test (AEER).

The results of the experiment sent a chill down Fang Ziye's spine.

Because the results weren't very good, FADDIR, LST, IROP, and AAT were all positive, only the posterior fear test was negative, and the AEER test was still undetermined as to whether it was positive or negative.

This indicates that the patient has a very high degree of labral damage and an MRI scan is necessary to confirm the diagnosis and determine whether further treatment is required.

Fang Ziye stood up and clapped his hands: "The joint reduction has been completed, and the range of motion has been restored. For the patient with pain, one more X-ray is needed to confirm the joint dislocation."

"However, your injury has been going on for a while, and the degree of dislocation is quite unusual. Therefore, you may still need to have an MRI scan to check for any soft tissue damage."

"Right, Director Xue?"

Upon hearing this, Xue Tao immediately understood Fang Ziye's meaning. He guessed that Fang Ziye was also experienced and that repeated unsuccessful repositioning could easily cause labial damage. Therefore, having an examination to confirm the diagnosis was a very safe course of action.

"Take a picture, bro, it's for your health too."

"Okay." The young man nodded.

In the end, he can get reimbursed by his car insurance. Even if he doesn't get reimbursed, he still has to do it. He can't leave the problem unresolved just because of a few hundred dollars.

The emergency room medical records were mainly written by Wang Zhongxing; Fang Ziye did not try to take them or overstep his bounds. Division of labor and cooperation was the best approach, but Fang Ziye still suggested with a smile, "Dr. Wang, why don't you suggest that a sports medicine teacher come and take a look?"

"Huh?" Wang Zhongxing was taken aback upon hearing this.

Then he said, "Our department is sports medicine, right?"

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

The trauma center is the sports medicine department in the hospital. Xue Tao had no awareness of this at all. At least when he had his physical examination, there was no pattern to follow. Fang Ziye could not find any trace of the examinations he had undergone.

"Then why don't we just write one down and have him go to the outpatient clinic for a follow-up examination?" Fang Ziye himself wasn't a sports medicine specialist, so he couldn't say too much, but giving such a suggestion would definitely be a good thing.

The patient himself said, "Sports medicine, right? I know. Athletes often get injured and need to see a specialist. I'll go see a specialist when I get to Chongqing."

"Thank you, doctor." The young man opened his eyes this time and looked in Fang Ziye's direction, showing more respect than before.

It's as if Fang Ziye's ability to mention sports medicine is a form of expertise.

However, Zhang Jinchuan, who had just left, returned and said dejectedly, "You don't have any family members?"

"Yes, I was just passing through and was planning to take a bus to Chongqing. I wasn't accompanied by any family members."

"Well, I'm not in any major health problems, so I didn't call home to worry."

"Doctor, thank you so much. I can go for the check-up myself. I've already gotten through so many tough times..." The young man got out of bed with a big smile on his face, a smile that contained the bitterness and pressure of a middle-aged man.

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

If there is no fracture, you can walk directly after the dislocation is reduced, just avoid excessive weight-bearing.

Seeing this, Li Yuanhong helped him towards the nurses' station. He obediently went to the nurses' station and waited for Li Yuanhong, who was there to write the medical orders. He kept nodding as he spoke...

Neither Xue Tao nor Wang Zhongxing asked Fang Ziye how he had managed to get back on his feet.

Let's take care of the patients outside first.

This time, an auntie with a relatively simple fracture and some displacement came in. She should be a local from Huien City. She notified her family after the injury, and currently two people are with her, probably her sister and daughter.

After the three entered, Xue Tao and Wang Zhongxing began examining the patient and reviewing the scans.

Fang Ziye, however, did not interfere further, standing obediently to the side while tending to his recent spoils.

"Knowledge Points +49!"

"Knowledge Points +14!"

The two almost explosive amounts of knowledge points immediately caught Fang Ziye's attention.

Soon, Fang Ziye realized.

The 49 knowledge points earned should have come from the manual reduction treatment. This joint dislocation was much more difficult than the lateral elbow dislocation I did during my previous shift, which earned me 30 knowledge points.

This hip dislocation, which Xue Tao and others had tried to reduce several times without success, was successfully reduced. Even in the 'assistant operator' position, the reward of 49 points is not too outrageous.

Of the remaining 18 points, 6 points were likely acquired by Fang Ziye himself after examining the patient, obtaining a diagnosis of labral tear and hip capsule injury leading to joint instability, and recommending that the patient consult a sports medicine specialist.

The other 12 points are the knowledge points reward for previously recommending hospitalization and surgery for some fracture patients.

Clinical practice is indeed the biggest source of knowledge.

In less than ten minutes, 63 knowledge points were earned—that's incredible! How could any other place possibly keep up?
In addition, thanks to the knowledge points gained from the previous plaster cast application, Fang Ziye added points to the X-ray reading post-operative care, recovering 81 health points.

While watching Xue Tao and Zhang Jinchuan perform simple fracture reduction techniques without offering to help, Fang Ziye idly did some calculations.

What if this panel is wrong? Although there's nothing we can do if it's wrong, watching the cute knowledge points being consumed and gained is still a kind of joy.

1245.3 (before arriving at the hospital) -469.4 (X-ray cost) +81.8 (today's profit).
857.7 points.

Bingo, it's impossible for it to be wrong, it's really a bit too boring.

"Okay, Dr. Zhang," Fang Ziye quickly replied to Zhang Jinchuan, who had asked him to come over and help with the plaster cast.

Xue Tao is an associate chief physician with a senior professional title, so he should be given the respect he deserves. He completed the manual reduction of the simple fracture very quickly, but it was a minor job, so there was no need to make him work so hard. Let Xue Tao rest for a bit.

In addition, getting a cast only yields 0.1-0.2 knowledge points. Does having 800+ knowledge points mean I should look down on a fraction of a point?

impossible.

I want 0.01. I'll keep doing it in the practice room for six minutes, which is 0.01.

As expected, Fang Ziye gained 0.2 knowledge points after the plaster cast was completed, and he smiled happily.

Seeing this scene, Xue Tao felt as if she were seeing her younger self, except that she was a master's student back then, while Fang Ziye was a doctoral student: "Does Dr. Fang really enjoy clinical work?"

"If you can avoid scientific research and just focus on clinical practice, I believe that 90% of PhDs would never even go to the lab." Fang Ziye didn't hide his true thoughts.

Of course, this is not Fang Ziye's truest thought. Although clinical practice has a lot of knowledge and is interesting, who doesn't dream of becoming a research tycoon?
There's a saying that goes something like this: all clinical practice is just a tool for the theories developed through scientific research. All the surgeries, procedures, and medications you perform now are the results pioneered by your predecessors; you're just applying those results.

No matter how amazing you are, you're just a high-level tool unless you can possess something unique and original.

"That's quite honest."

"Dr. Fang, I see that your skills are quite strong. Why don't you try this dislocation?" Xue Tao didn't like the title of "doctor" because their department used to have a doctor, but it was too intimidating.

Zhang Mingcan, who liked the PhD so much, gave him to the head of another department, which shows how much psychological trauma this PhD had caused to the people in that department.

But Xue Tao really enjoys clinical practice and likes to discuss and learn with his clinical colleagues and young people.

"Director Xue, I think we can give it a try." Fang Ziye didn't thank him, but answered relatively calmly.

On Zhang Jinchuan's side, after seeing Wang Zhongxing finish writing the medical record, he said, "Brother Tao, let Wang Zhongxing take this patient to Yuan Hong to get a follow-up appointment order."

"Wang Zhongxing had nearly twenty casts put on his body, which must have been quite tiring."

In the manual reduction operation room, two people are enough. If it weren't for the previous patient with anterior hip dislocation being too difficult to deal with, it would have been impossible to gather four or five doctors at once.

Where are all these people in the department?

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

Xue Tao nodded: "Go ahead, get some rest, and order some food for us all."

“Okay, the best package.” Wang Zhongxing nodded immediately, then led the patient out of the operating room without hesitation.

A mature doctor will not hesitate in the face of such an overcrowded situation; they will act decisively and efficiently.

Rest when you need to rest, and you'll be able to get things done without hesitation, instead of being moved to tears.

(End of this chapter)