System Came When the Doctor was Thirty

[Surgical Basic Techniques: Open Fracture External Fixation Surgery (Skilled 1/10), Fracture Manipulation and Reduction Skill (Skilled 2/10), Fracture Open Reduction Internal Fixation Surgery (Skilled 0/10), Joint Dislocation Manipulation Reduction Technique (Specialization 4/20)...]

It’s been more than a dozen days since Valentine’s Day, and later when Lu Cheng was on duty, he strictly followed the rules and did not interfere with orthopedic surgical consultations...

For the patients of this surgery’s fractures, Lu Cheng still suggested those he couldn’t handle manually to go to the orthopedics department.

After all, Lu Cheng’s Basic Theory of Trauma Surgery was at the specialization level, but the skill level of Fracture Manipulation and Reduction Skill was still at the skilled level.

With improved cognition, Lu Cheng increasingly felt the depth and complexity of fracture manipulation techniques.

Moreover, the modern medical fracture manipulation techniques are quite different from traditional Chinese medicine’s bone-setting techniques.

Lu Cheng did not dare to lightly venture into this field. Yet, it seemed that the orthopedics’ Deputy Director Xiang Kuihua was intent on teaching Lu Cheng a ”lesson,” repeatedly engaging in such actions.

Even a clay Buddha has some temper, and Lu Cheng felt extremely speechless.

Actually, the situation on that day was quite simple; our emergency department invited you for a consultation, you should have just made a trip, and issued a hospitalization certificate for the patient.

Orthopedics provided professional opinions, even though Lu Cheng knew that Mason Type II fracture of the radial head could achieve excellent results without surgery, he would not say anything more.

But orthopedics insisted the emergency department issue hospitalization certificates instead of directly dealing with it themselves, probably because the emergency night shift on Valentine’s Day didn’t want to run around but rather have the ward’s duty doctor assist in ’admitting and diagnosing’!

Lu Cheng encountered this, and being a specialist in trauma surgery, aware of Mason Type II fractures where surgical efficacy is not superior to conservative treatment, how could Lu Cheng issue a hospitalization certificate?

Doubting his professional knowledge for superficial courteous exchanges to the detriment of his skills? Lu Cheng could not do that.

”Fortunately, there are 18 skill points, let’s reset them...”

The panel changes —

[Fracture Manipulation and Reduction Skill (Specialization 0/20)].

Indiscernible clarity surged into his mind, refreshing Lu Cheng, filling his hands with a warm current, making tendons and bones comfortable...

After carefully recalling relevant basic theories of fracture treatment, Lu Cheng retrieved a new surgical mask from the nurse station and wore it as he sought out the patient.

Du Daihua was still attending to other emergencies, so the fracture patients were temporarily placed in the corridor between the observation ward and the nurse station.

After checking the patient’s basic information, Lu Cheng said, ”Who’s the fracture patient Zhang Hongchun?”

Although he immediately saw the person clutching their hand on the far left, Lu Cheng no longer acted based on experience.

”Doctor, it’s me!~” The patient’s right hand supported his left hand, raising his chin as an indication.

He was attending the consultation alone, with no companion.

”Have the X-rays been taken? Come with me to the ward’s doctor’s office, there’s a lot of patients in the emergency room; I’m afraid someone might accidentally bump into you.” Lu Cheng approached and supported the patient’s elbow, helping him up while speaking.

”The X-rays have been taken, but it will take an hour to retrieve them. Doctor, should I wait?” Zhang Hongchun, a man in his forties, thin build, dark skin, with a few strands of gray hair at the temples, asked.

His lips were thick, marking him as an outdoor worker.

”It’s okay, I can view the X-rays on the computer. You haven’t broken the skin, right? No bleeding?” Lu Cheng scrutinized for signs of blood, but still patiently asked.

The treatment principles for open fractures and closed fractures are entirely different.

”No broken skin; I fell from upstairs while sticking exterior tiles for someone. I should’ve secured a safety rope.” Zhang Hongchun expressed regret.

”Be more cautious in the future; thinking ahead is too late once injured. We often receive patients with accidental fractures like yours, indicating how essential safety ropes are even though they may be cumbersome and influence your movement.” Lu Cheng guided the patient into the office.

The on-duty ward doctor, Zeng Huanqi, immediately looked over, thinking Lu Cheng brought a surgical patient, then quickly stood up!

But upon seeing the patient’s deformed left hand, Zeng Huanqi cordially and warmly said, ”Come sit down, you accidentally fractured it, didn’t you?”

”I fell during renovations,” Zhang Hongchun replied kindly, noting Zeng Huanqi’s age.

Lu Cheng said, ”Don’t rush; from the deformation of your left forearm, fracture is definite, but what kind of fracture it is, I need to assess carefully.”

While speaking, Lu Cheng typed Zhang Hongchun’s name in pinyin and accessed the first page of X-ray images of his left forearm.

Deciding if a fracture requires surgery requires evaluating its type; different classifications necessitate tailored judgment for surgical indications based on personal capability.

Upon viewing, the diagnosis was clear, and the fracture line was very distinct.

”This fracture is Type A3.2, an extra-articular fracture of the radius, forming a wedge-shaped bone fragment.”

”Fracture of the proximal third, with an angular deformity of about 5°...”

Lu Cheng finished his assessment while carefully considering the criteria for implementing manipulation reduction for radius and ulna fractures.

The reason fractures are a major category in trauma surgery and are foundational is due to the extensive classification of fractures.

1. Suitable fracture type: Closed fracture, stable fracture, controllable displacement.

2. Adequate reduction conditions: Fracture duration ≤ 2 weeks, no soft tissue entrapment, high patient cooperation!

Lu Cheng determined it was within the manipulation reduction criteria, and given his specialized manipulation skills had a chance for successful reduction, he cautiously said:

”You have a radial and ulnar double fracture; the situation isn’t simple. Manipulation reduction can be attempted but has a certain chance of failure, necessitating surgical treatment.”

”Of course, if you wish, you can directly choose surgical treatment in orthopedics; after fixation, surgical recovery will be faster than manipulation reduction.”

张红春 nodded blankly, licking his dry lips, and asked, ”Dr. Lu, what’s the specific success rate for manipulation reduction of my fracture?”

Lu Cheng shook his head, ”It’s hard to say specifically. Generally, we recommend trying manipulation reduction if the success rate is above sixty percent.”

”If reduction fails, surgery would follow; a successful reduction means casting and leaving, though specific statistics I haven’t calculated.”

Lu Cheng hadn’t made such calculations; success rates for manipulation reduction are variable depending on individual skill, with proficient practitioners achieving nearly ninety-nine percent success...

”It depends on your personal choice, whether you’d like to endure some pain for us to try the reduction and maybe save you some money.”

”But if reduction doesn’t go well, then the money saved would be lost, and you’d suffer pain for nothing.” Lu Cheng spoke frankly, informing the patient of the associated risks.

If the patient strongly requests surgical treatment, that makes it a surgical indication rather than manipulation reduction indication.

The patient hesitated, then asked, ”If I opt for surgery, how much would it cost?”

Lu Cheng, previously an orthopedic doctor, recalled the approximate costs: ”Here at our hospital, the total is about eight to nine thousand dollars.”

”Because this is a double fracture, costs are significantly higher than simple fractures; post-insurance, it should cost around four to five thousand.”

Zhang Hongchun asked again, ”What about manipulation reduction?”

”Manipulation reduction, in total, should be around one thousand; with medication, maybe around eleven to twelve hundred. After reimbursement, about five to six hundred.”

Lu Cheng certainly didn’t belittle his technical worth...