godfather of surgery

Chapter 5 Fractures not visible on CT
After the interview, the written test is arranged. As one of the top ten students in the school, the written test is very easy.

At noon, Sanbo provides a free lunch.After the meal, Yang Ping walked around the Sanbo Hospital.

The hospital is really good. The main buildings are Gemini's surgery building and internal medicine building, with more than 30 floors.

Others include administrative building, outpatient building, emergency building, medical technology building, overseas Chinese building, and comprehensive building.

The rooftops of the surgical building and the internal medicine building are the parking areas for helicopters.A helicopter, parked on the roof of the surgical building, looks quite imposing and has become the symbol of the hospital.

Yang Ping went to the orthopedics department to have a look.The Orthopedics Department of Sanbo Hospital has more than 100 beds, divided into four wards: trauma, spine, joints, and sports medicine.Director Han is the director of the Department of Orthopedics and concurrently the director of the Department of Trauma Orthopedics.

Orthopedics is a wide-ranging department, and many large hospitals are divided into sub-specialties: trauma, spine, joint, sports medicine, and some have pediatric orthopedics.Some hand surgeons have done a good job, and they are divided into hand surgery alone.Some regional medical centers with extensive radiation coverage also have bone tumors.

More arrogant hospitals will continue to be divided. Trauma orthopedics can be divided into upper limb orthopedics and lower limb orthopedics, spine can be divided into cervical, thoracic, lumbar, and joints are hip, knee, and so on.

That is to say, one group of people specializes in upper limb surgery, and the other group specializes in lower limb surgery—this is something that ordinary hospitals can’t imagine, and only the top hospitals in the industry have exclusive gameplay.

There is a Daniel from a top hospital in the capital, who specializes in the upper cervical vertebra, that is, the base of the skull, the first cervical vertebra, and the second cervical vertebra.

Wandering around in Sanbo Hospital all day, went to a nearby restaurant for dinner, and took the subway back to the rental house in the city.

A few days later, I received a call to inform me that I had passed the interview and that I could go to work in the Department of Orthopedics. This was expected. Yang Ping knew the result from Director Han's last sentence.

On the first day of work, Yang Ping came very early.

Stupid birds fly first, although they don't think they are stupid birds, but it's definitely right to fly first.

The duty room, men's locker room, women's locker room, meeting room, dining room, demonstration classroom, treatment room, etc., Yang Ping must be familiar with it as soon as possible, so that he can start his work.

Everyone came together one after another, and the shift was on time at eight o'clock.Everyone is lined up in a U shape, the opposite side of the U is the projection, the bottom of the U is the director with several team leaders, the left is the doctor, and the right is the nurse.

Doctor, neat, shirt, dark trousers, dark leather shoes, tie, white coat.

The nurses had obviously been selected. They were all more than 1.6 meters tall. They wore slim blue nurse uniforms. Their hair was coiled behind their heads and wrapped in black silk netting, making them look youthful and beautiful.

After the shift, Director Han briefly introduced the new doctors, including Yang Ping. Everyone applauded and welcomed the new doctors.

If there is no objection to the shift, the nurse leaves the office and starts a busy day.

The doctor started a brief morning meeting here. The operation performed the day before and the operation to be performed today will be played through the images and pictures, and a brief report will be made.

Each group takes turns and reports the cases in their own group.

One of the patients, He Jianmin, male, 76 years old, caught Yang Ping's attention on his X-ray—the fracture of the left femoral shaft was going to be fixed with an interlocking intramedullary nail today, and it was the first one.

In this patient's film, Yang Ping found that the femoral neck was also fractured, but the diagnosis of the shift did not mention it at all.

The choice of surgical procedure also shows that the surgeon did not notice the fracture of the femoral neck at all.

This fracture is an occult fracture, which is difficult to see on X-ray and CT, and is almost impossible.

Yang Ping has received training in the interpretation of images, and even if there is an occult fracture, he can clearly detect the fallout.

If it is a hidden femoral neck fracture, it is easy for the operator to fall into the trap, because the operator does not know that the femoral neck is fractured. According to the conventional surgical procedure, a hole is made from the proximal femur, and the intramedullary nail is screwed or driven into the femur. In the medullary cavity, these manipulations can turn occult fractures of the femoral neck into overt fractures, completely unaware of the operator.

Postoperative re-examination: There is still a fracture of the femoral neck!

How to do?You can't ignore this femoral neck fracture, can you?

In this way, I have to explain to the patient: I'm sorry, you still have a femoral neck fracture that has not been treated, and you need a second operation to treat the femoral neck fracture.

What is the patient's reaction: There was no fracture in the previous X-rays, but now you find the fractures in the X-rays. Wasn't the fracture caused by your doctor's operation?He also fooled me into having a second operation, and disputes naturally arose at this time.

After the film was over, Director Han glanced at the audience and said briefly and clearly, "Do you have any questions? If there are no questions, the meeting will be dismissed."

This patient must have a fracture of the femoral neck, and I can't see it wrong. I recently received basic skills training in the system space, and I have seen more than tens of thousands of images and pictures.

Be sure to remind the chief surgeon to avoid this unnecessary dispute.

Yang Ping immediately raised his hand, and all the doctors focused their attention.

Director Han said, "Xiao Yang, what do you want to say?"

Everyone went to the door, ready to open the door to go out, but backed away.

It's offensive to question someone's diagnosis and treatment plan, especially on the first day of work, in the public eye.

If you don't say it, watch others fall into the trap?
Yang Ping thought for a moment and said, "Can I trouble you to tune He Jianmin's film to see it?"

Both X-rays and CTs are called out and projected on the screen.

"Is there a problem?" Director Han asked.

Yang Ping said humbly: "Sorry for delaying everyone's time! I suspect that this patient has a hidden fracture of the left femoral neck."

Anyway, saying a few words will not delay the time. Since there are doubts, say them. Director Han said: "Xiao Yang, tell me about this case, what are the doubts?" Director Han encouraged Yang Ping.

Yang Ping got the director's approval and continued: "I just saw the X-ray, and there was swelling in the soft tissue in front of the knee, which suggests that the front of the knee suffered a contusion, very similar to the damage mechanism of the instrument panel; the trabecular bone of the femoral neck is slightly disordered. A picture shows cortical folds, and the combination of the three suggests that this patient is likely to have an occult femoral neck fracture, and further MRI of the hip is recommended to confirm the diagnosis."

This patient belongs to the group, the team leader Tian Yuan, Director Tian, ​​deputy chief physician, doctorate, graduated from West China Medical University.

He looked at Yang Ping, stood up, and personally sat beside the computer connected to the projector. On the computer, he repeatedly flipped through X-rays and CT scans.

It is true that the X-ray of the femoral neck has a little trabecular bone disorder, and there is a layer of cortical folds on the CT, but it seems to be absent, and it cannot be determined.If it weren't for preconceived views, I wouldn't have paid attention to this at all.

"CT is the gold standard for diagnosing fractures. CT is better at seeing fractures than MRI, right? CT can't see fractures, but MRI can see them?" said Zhang Lin, a resident physician.

"Yes!" Fang Yan, the chief physician under Tian Yuan, also agreed.

Yang Ping is a newcomer, and the rejection of newcomers is the same there.

Director Han said in a critical tone: "You are right, MRI is the best diagnostic tool for hidden femoral neck fractures. X-rays and CTs can't reflect it. Xiao Zhang, please read the book and make up for the get out of class."

Zhang Lin was criticized in public and was a little unhappy.

After reading the film, Tian Yuan turned around and said to Director Han, "Director Han, Xiao Yang really reminded me, there are indeed doubts."

The patient is now under anesthesia in the operating room.

Tian Yuan immediately picked up the phone: "Xiaobo, check the patient's left knee for swelling or ecchymosis?"

"Since there are doubts, stop the operation and find out first?" Director Han made a final decision.

The other doctors, including several directors of the team, all stretched their necks and carefully looked at the film on the projection screen. Where did they see the fracture?
My eyes are sore, but I can't see it!
(End of this chapter)