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Chapter 152 Bone Palpation Techniques and Their Teaching (Please Subscribe)

When Fang Ziye and Xue Tao passed by the doctor's office, it was bustling with activity.

Director Zhang Mingcan and former Director Xue Tao were both generous, arranging a mix of various dishes. There was KFC, McDonald's, and one group seemed to be eating pizza, with people feeding each other and exchanging food in a harmonious atmosphere.

Xue Tao glanced at Fang Ziye, then went into the doctors' lounge to wash her hands alongside him, explaining, "Ziye, you wouldn't prefer fast food like KFC, would you? Then I've misunderstood?"

"No, Brother Tao, I'm easygoing. I'll eat anything, as long as it fills me up." Fang Ziye wasn't joking.

It would be better to have delicious food, but KFC definitely doesn't qualify as delicious food.

Disinfecting and washing hands before meals doesn't need to be as meticulous as before surgery. Just rub your hands a couple of times using the six-step handwashing method, rinse them off, and then wipe your hands with the tissues in the duty room.

Fang Ziye and Xue Tao carried six or seven bottles of mineral water out together: "Brother Tao, the benefits here are really amazing!"

Speaking of which, the supplies stored in the duty room of Enshi Central Hospital are really plentiful. Unlike Zhongnan Hospital, tissues here are provided free of charge and in unlimited quantities to a certain extent.

There are also small bottles of mineral water for one yuan each, which you can drink directly. There might also be some other items that you haven't unlocked yet.

Xue Tao smiled and raised his thick eyebrows: "Right? When I went to Zhongnan Hospital for further training, I also found it extremely inconvenient. I had to bring my own water bottle, otherwise there was nowhere to get a drink of water."

"But I later found out that the benefits at Zhongnan Hospital aren't actually in the doctors' lounge, but in the inpatient lounge. Guess why?"

Xue Tao didn't mention it, and Fang Ziye just felt it was a habit, a natural thing.

Upon hearing this, Fang Ziye seemed to realize that Jin Hongzhou's resident chief's "doghouse" duty room was indeed well-stocked with supplies, but under normal circumstances, no one dared to take them.

Xue Tao asked and answered himself, pushing open the door to the director's office as he spoke: "There are two reasons. First, the staff of Zhongnan Hospital are all chief inpatients and above. Second, there are too many students, which consumes too much energy."

"What do you mean by 'our own students' and 'students'?" came a voice from inside as Xue Tao said this.

He was coming from Wu Guonan. He was smiling and talking to people, but his face suddenly stiffened and his brows furrowed.

His gaze was fixed on Xue Tao, and his slightly swollen eyes seemed to release countless pressures, as if to warn him, "Are you setting some kind of rule for Fang Ziye?"
You're from this college, and Fang Ziye is just a student. Are you already trying to cause trouble?

Xue Tao quickly explained that the director had misunderstood.

After a brief explanation, Wu Guonan smiled and said, "Oh, is that so? That's alright, Dr. Fang. Now that you're here, you're practically family. We don't have that many rules here."

Wu Guonan then explained and introduced to a middle-aged man next to him: "Director Huang, this is Dr. Fang Ziye from Zhongnan Hospital."

When I entered the director's office, there were a few people gathered inside.

Wu Guonan sat at a table with a middle-aged stranger, and there was also Wang Zhongxing, who hadn't had time to shave. His beard was like short hair, spanning his two earlobes, and even the hair in front of his ears, which was hard to tell if it was a beard or an eyebrow, was connected to his head, making him look like a miniature version of Sha Wujing.

He and Huang Yunxiao hid on the other side and worked hard to cook.

"Hello, Dr. Fang." Dr. Huang looked up, glanced at Fang Ziye, gave him a polite smile but didn't take it seriously, and then continued eating.

It seems that to him, the doctor is just a person, and he has a somewhat Buddhist attitude.

"Hello, Teacher Huang." Fang Ziye and Xue Tao stepped forward to distribute the bottled water they had brought to everyone. Fang Ziye was handing it out to Director Huang and Director Wu Guonan.

I took a closer look at Director Huang. He's slightly overweight, with an average face shape but a rather thick neck and a typical double chin. However, he doesn't look greasy at all; he's probably one of those special types who has a thick neck but isn't overweight anywhere else.

Fang Ziye subconsciously considered hyperthyroidism, but he did not see any signs of bulging eyes. On the contrary, his temperament was quite restrained, resembling the refined demeanor of Professor Deng Yong, and he did not seem to have the impatient nature that hyperthyroidism should have.

"What did Dr. Fang study?" Huang Haitao couldn't help but ask casually after Fang Ziye replied.

“Professor Huang, my specialty is trauma surgery.” Fang Ziye explained as he turned to walk to another ‘seat’, looking at the menu.

Even when the director is questioning you, eating is the most important thing; if you're hungry, you have to eat.

Naturally, Fang Ziye took a picture first and sent it to Luo Tingzhu. This action was to share it and show it to others.

After reading it, Huang Haitao understood and said, "It's good to be young, isn't it, Director Wu?"

Wu Guonan nodded, knowing that Fang Ziye was probably having an affair with someone. However, he hadn't considered any other possibilities.

The next important thing was dinner. During dinner, most of the conversation focused on Fang Ziye, but mostly on questions like how old he was, what his girlfriend did, and whether it was her profession.

Fang Ziye handled each situation with ease, showing neither shyness nor feigned aloofness.

After almost everyone had finished lighting their Little Happiness cigarettes, Wu Guonan and Huang Haitao were almost done with theirs when Wang Zhongxing and Xue Tao lit their own Little Happiness cigarettes.

They even gave Wu Guonan and Huang Haitao another cigarette.

The room instantly filled with smoke. Although Fang Ziye was displeased, he didn't show it. He simply packed up his lunchbox while asking, "Director Huang, I just heard Director Xue say that your manual reduction technique is excellent. I've never seen anything like it at Zhongnan Hospital. Do you think there are any techniques or patterns to it?"

There's nothing shameful about asking questions if you don't understand.

The questions that Luo Tingzhu can ask openly and frankly are also the questions that Fang Ziye can ask. First of all, acknowledging one's own shortcomings will bring greater benefits than merely great benefits.

Huang Haitao didn't hold back: "This contains the content of traditional Chinese medicine bone-touching and bone-setting techniques. Dr. Fang, do you want to learn it? Then I'll give you a few sets of books."

Fang Ziye paused slightly as he packed up the lunchbox.

In response, I asked, "Teacher Huang, do these books require a foundation in the subject?"

Fang Ziye knew that one of the most crucial steps in osteotomy and reshaping surgery was manual repositioning. Reshaping, in essence, involves rotating and repositioning the abnormal shape after osteotomy to restore it to a normal form and achieve functional replacement.

Manual reduction technique is one of the most crucial components. If he is eager to learn, Fang Ziye would not mind learning it. However, if it takes ten or eight years to master, Fang Ziye feels that it might be a bit difficult.

"It will require a little, but not much. If you can, you can actually read it in the way you understand modern medicine, just to get a general understanding."

"However, it will take a lot of time and you'll need to work on it slowly. If you need it, you can come to Minzu University Hospital to find me. I have a few bound photocopies there."

“I really like people who love reading.” Although Fang Ziye doesn’t have that kind of refined, scholarly air about him, you can’t tell whether someone loves reading at first glance, but you can tell after spending some time with them.

Huang Haitao saw in Fang Ziye a strong thirst for knowledge and a down-to-earth demeanor, qualities cultivated through reading that most people couldn't fake.

"Thank you, Director Huang. I'll definitely come when I have time. Just these last couple of days. I'm a pretty shameless person." Fang Ziye wiped the table with a tissue.

Wang Zhongxing and Huang Yunxiao, who were standing next to him, were doing similar work.

Those with several senior professional titles would naturally not engage in such activities.

When Fang Ziye asked Yuan Weihong for books, he wasn't particularly polite. Even if he had to borrow them and return them, he would just borrow them first and then ask for them back. Moreover, ever since Professor Deng Yong said last year that Fang Ziye could borrow books from him, Fang Ziye had actually borrowed them. Although he hadn't finished reading them or returned them yet, Professor Deng Yong didn't seem to be urging Fang Ziye to return them. Currently, Fang Ziye has even brought them to Enshi.

It's the complete Campbell series, very substantial, covering a wide range of knowledge, and well worth reading carefully and thoroughly. However, it's entirely in English, making it quite challenging to tackle.

Director Huang didn't reply, but he found Fang Ziye rather interesting.

After sitting for a while, Wu Guonan and Huang Haitao began to sort through the X-ray images of the patients in the hospital, comparing them one by one in detail, and discussing which ones were suitable for manual reduction and which ones could not be done.

Huang Haitao was still muttering to himself—

"This won't work. If my master were here, he could try it. I think I've seen it before, but I can't do it. Don't try it."

"This one, we can give it a try..." Huang Haitao's tone was heavy, and he shook the cigarette box as he spoke. Wu Guonan, who was next to him, opened his drawer, looked past the 1541 packs of Yellow Crane Tower cigarettes, and found a six-yuan pack of Double Happiness cigarettes at the bottom. Huang Haitao looked at it as if it were a treasure: "You still have this stuff?"

Fang Ziye was surprised; what could Double Happiness possibly lack...?

Of course, Fang Ziye did not pursue the answer to this question.

Fang Ziye returned to the deputy senior office. After Xue Tao 'rewarded' him with a workstation, he cleverly said, "Brother Tao, you can smoke in here. I'm not that sensitive to the smell of smoke."

Although secondhand smoke is very harmful, smoking is a way for many people to relax, and Fang Ziye couldn't force Xue Tao to break her habit just because of himself.

Fang Ziye had seen Xue Tao fidgeting in her pocket several times before, but he didn't know what she was doing. Now he did.

Xue Tao turned around, chuckled, and then lit a cigarette.

After Fang Ziye finished writing and revising all the admission interview and signing forms, he printed them out and planned to go and have them signed one by one.

These things have formats and forms, but Fang Ziye prefers that everyone conduct the conversation and sign according to their own understanding, which is a kind of refinement of theory and overall understanding of the disease.

After rigorous training, Fang Ziye's orthopedics skills are now close to level 3, and his trauma surgery skills have reached level 3 or higher proficiency, demonstrating that no knowledge points have been wasted.

However, it was already 1:40 PM when I went out.

Fang Ziye's typing speed was relatively faster than Xue Tao and the others, so at this moment, he was the only one who started talking and signing.

Whether by coincidence or not, Fang Ziye happened to run into Wu Guonan and Huang Haitao examining a patient at the bedside. Huang Haitao was even feeling each bone one by one, using the X-ray to determine the type of diagnosis.

Fang Ziye felt this was a rare opportunity, so he postponed the conversation and signing, and stood aside, silently taking notes of what Huang Haitao said. Although he might not understand some of it, he could look it up later.

Huang Haitao's ability to be valued by Wu Guonan and respected by Xue Tao and others must mean he possesses martial arts skills.

Many people in the department say that Xue Tao is a pure clinician. No matter how good you are academically, if he doesn't care about you or need you, you're just trash. But if your clinical skills are good enough, then Xue Tao is very willing to get close to you.

Wu Guonan and Huang Haitao both noticed Fang Ziye, but they only thought that Fang Ziye was genuinely eager to learn and did not consider other aspects.

It took about half an hour to walk the whole loop, which wasn't very long.

However, Huang Haitao said, "Director Wu, there aren't many. I think I can handle about eight repositionings. I have a pretty good idea of ​​how many I can do."

"We'll organize this in a bit. You can have your people go and talk to them and get the signatures."

"We still can't afford to lose the concept of informed consent..." Huang Haitao was quite cautious.

Finally, upon closer examination, Fang Ziye discovered that three patients in his assigned beds had fractures that could be resolved through manual reduction.

These are a double fracture of the tibia and fibula, a type B2.1 fracture of the radius, and another double fracture of the radius and ulna.

Fang Ziye had carefully examined all three types of fractures. From the perspective of modern medicine, at least according to current guidelines for trauma surgery and the corresponding principles of instability, all of them require surgical reduction to achieve a better treatment outcome.

Trying to treat this by manual reduction carries extremely high risks. Moreover, plaster cast immobilization is insufficient to achieve the required fixation. After reduction, unstable misalignment is very likely to occur, leading to reoperation and increasing the patient's suffering.

Of course, since Huang Haitao had already said so, and Director Wu had given the instructions, Fang Ziye wouldn't say anything more.

After obtaining the informed consent form, the patient was informed that this was just an attempt. If the reduction was unsuccessful or the post-reduction assessment still failed to achieve the desired fixation effect, then surgical intervention would still be necessary. However, after reviewing the case, the attending physician suggested that manual reduction could be considered.

Fang Ziye has extensive experience in this regard. When he was at Zhongnan Hospital, he handled the most difficult surgical consultations and signings, which involved more, more complicated, and more disorganized risk clauses. He was able to clarify and inform them of all of them.

In this respect, he is considered a minor Kalami.

Furthermore, everyone was told that they could refuse such an attempt and opt for surgical repositioning instead.

However, all three felt that if surgery wasn't necessary, then it wasn't; if surgery was required, then it would be done. They lacked initiative and participation, and were relatively passive.

After the conversation and signing, when Fang Ziye rushed back to the operating room, Huang Haitao had already completed a reduction. After the reduction was completed, he confirmed the effect of the reduction by palpating the bone and said, "Quickly apply a functional plaster cast. After the fixation is completed, go and check the X-ray again."

"Keep in that position," Huang Haitao instructed.

On the other side, Xue Tao, who had handed over the signature of the ward under his supervision to Huang Yunxiao, immediately prepared the pre-molding polymer plaster material soaked in water. After Huang Haitao finished speaking, he quickly applied the plaster to the appropriate position and began to wrap it.

Clearly, this isn't the first or second time they've cooperated.

Fang Ziye wasn't bothered that he hadn't seen Huang Haitao's operation process; there were still seven or eight more to watch.

However, it is indeed surprising to see the effect of fracture reduction with the naked eye; it is actually possible to treat fractures that should be surgically treated by manual reduction...

The evaluation criteria for whether manual reduction of a fracture is successful are actually quite similar to those for manual reduction of a joint dislocation.

The diagnosis of a fracture is based on: deformity, pain, limited mobility, bone crepitus, and a feeling of friction.

This is a clinical manifestation that is visible to the naked eye.

The clinical manifestations that can be seen after fracture reduction are the disappearance of deformity, relief of pain, and disappearance of bone crepitus.

There's no full range of motion. This is the result of a physical examination after the fracture has fully healed. Right after the reduction was done, if you assess the patient's range of motion and bone crepitus, you'll see if they hit you. This is equivalent to the patient constantly being rubbed between the fracture and the reduction, which is the root cause of the pain.

At least from the naked eye, Huang Haitao's operation was successful.

……

Huang Haitao then played two more games, while Fang Ziye watched silently from the side, his eyes and expression filled with surprise and disbelief.

If he wasn't mistaken, Huang Haitao's manual repositioning technique might not be as skillful as his, because Huang Haitao's control over direction and force might only be at most a level 3, the maximum level of skill.

The reason he could be so certain was because Fang Ziye was looking down from a superior position.

However, Huang Haitao was able to achieve a repositioning effect that even he couldn't. How is that possible?
Fang Ziye dared not attempt to reposition these patients, as it was something that theoretically could not be repositioned.

After performing three manual reductions, Huang Haitao was probably somewhat satisfied with the results, so he deliberately twisted his waist and looked at Wu Guonan: "Director Wu, would you like to try it?"

Wu Guonan and Huang Haitao had known each other for too long, so he shook his head and said, "No, I've tried and failed countless times. Let's give the opportunity to the younger generation first. I need to work on it some more."

Huang Haitao looked at Xue Tao, who was also an old acquaintance of his.

Even Wang Zhongxing and Huang Yunxiao were somewhat familiar to him. Although he couldn't recall Huang Yunxiao's name, he at least knew that he was Xiao Huang.

So Huang Haitao looked at Fang Ziye and asked, "Dr. Fang, would you like to give it a try? Actually, the manual reduction of the next fracture is quite simple. The most important thing is to achieve complete traction, full release, and then compress and match the fragments of the tibial fracture."

"Then, by using a point of compression that is greater than the length of the fracture itself, the tensile force of the muscles is passively stretched to provide support."

"Take a tree branch for example. If you break it in half, but you use a hair tie to wrap around both ends, the branch can still be very stable," Huang Haitao explained the principle to Fang Ziye.

Fang Ziye seemed to think for a moment, then nodded: "Teacher Huang, I'll give it a try."

Upon hearing this, Xue Tao immediately said, "Director Huang, Xiao Fang's manual reduction technique is truly skilled. He does manual reduction of joint dislocations exceptionally well."

"Oh?" Huang Haitao was surprised, and his eyes became even more concerned.

(End of this chapter)