Those years when I hung up and upgraded in the hospital

Chapter 139 Disassembly and Reset (Please subscribe)

Shoulder dislocation is divided into anterior dislocation and posterior dislocation according to the position of the humeral head.

Anterior dislocation of the shoulder joint is common and is often caused by indirect violence. For example, when a fall occurs, the upper limb is abducted and externally rotated, the palm or elbow touches the ground, and an external force impacts upward along the longitudinal axis of the humerus. The humeral head passes between the subscapularis and teres major muscles. The weak part avulses the joint capsule and prolapses forward and downward, forming an anterior dislocation.

However, if the humeral head is pushed under the coracoid process of the scapula, a subcoracoid dislocation is formed. If the force is severe, the humeral head moves forward under the clavicle, forming a subclavian dislocation.

This patient did not reach under the clavicle, nor under the coracoid process, but was stuck directly under the shoulder socket. The pressure and pulling force of the muscles on the four sides formed a delicate balance, which is equivalent to being stuck.

Even rarer than posterior dislocation.

Director Gong nodded: "Yes, it is very rare. I thought of it before the reduction, but this patient was lucky. The humeral head did not rebound and move upward after dislocation, so the possibility of rotator cuff injury is not high."

"Otherwise, the reset will be more difficult. Does Dr. Fang have a better way?"

As soon as Fang Yun opened his mouth, Director Gong knew that Fang Yun was very professional.

Relatively professional orthopedic surgeons can classify the type, and more professional orthopedic surgeons can estimate the difficulty of reduction and the difficult problems encountered based on plain films.

"Let's do another fluoroscopy, Director Gong. I haven't thought about it yet." Fang Yun's current operating proficiency is still too low, and he cannot theoretically construct a dislocation after another reduction through the previous plain films.

"Come on, come on, let me know one more time."

"This is the doctor I told you about, Fang Yun, from Xiangzhou People's Hospital. I don't need to explain too much, right?" Director Gong said to the other two people.

One is fat and the other is thin.

As he started to push the C-arm machine, one of the fatter ones was older: "Director Gong, you know, he is the face of our Xiangzhou trauma surgery team."

"Although we are all just green leaves, Dr. Fang, our trauma surgeon, is ranked very high in the attending group. We are all very happy."

"Doctor Fang, my name is Zhong Chi. You can also call me Old Pig."

Another thin doctor said: "Brother Yun, my name is Guo Qihai."

Fang Yun nodded slightly to the two of them, and said no nonsense. He just went to help position them for the review.

As soon as the C-arm fluoroscopy results came out, Fang Yun looked at them carefully for a while, then turned around and asked, "Director Gong, how many times have you reset the position before?"

There are indications and contraindications for manual reduction. If Director Gong has already performed reduction more than five times, then don’t think about it and just go to sleep.

Even if Fang Yun's methods are contrary to nature, he still can't do things against the guidelines and principles, and he will not do such stupid things.

"This is the third time just now." Director Gong replied.

"Doctor Fang, you don't have to worry. I asked you here to help, so it won't be completely shameless. Director Chen and Director Hu Jun both know about this. We don't need to avoid suspicion like this."

"Dr. Fang thinks that such a dislocation can be reduced directly through open reduction, or should he try it one or two more times?"

Five times, if it can be manually reset, it is best, but if it cannot be reset, then it should be open reduction or open reduction.

After all, in the operating room, after the second reduction failed, the circulating nurse was already called to prepare the instrument package for shoulder joint surgery, so that it could be sterilized and draped at any time for surgery.

"If there are only three times, we can try it, but we have to follow the steps. The first step is to move the humeral head out from under the shoulder joint socket, convert it into a simple anterior dislocation of the shoulder joint, and then reposition it anteriorly. The dislocation is manually reduced.”

"This process may require assistance from Dr. Zhong and Dr. Guo."

"But the two brothers just performed a manual reduction. Let's take a 5-minute break to recover our strength." Fang Yun himself has done manual reduction, and he knows that the force required for the reset is very great. And it requires continuous traction, and humans are not animals.

"Okay!" Director Gong didn't hesitate.Not even a single question.

Fang Yun's strength is shown here. Even Dr. Dong Yue, a highly talented person who previously worked at Shashan Central Hospital, can only regret his low position in front of Fang Yun. How could he doubt Fang Yun's ability and vision?
Zhong Chi and Guo Qihai took a few minutes of rest after pushing the C-arm machine away.

At this time, a few people said a few polite words to Fang Yun, but it was okay.

During the chat, Fang Yun also found out that it turned out that Director Gong was from Xiangzhou People's Hospital before, but later he felt that the level of trauma surgery at Ji City People's Hospital was too low, so he came here to do it. construction.

Xiangzhou is divided into three places, one is Jishi, the other is Qianzhou, and the other is the Economic Development Zone, which are relatively far apart.

After resting, Fang Yun took Zhong Chi and Guo Qihai to start the operation without further ado.

Fang Yun stood in the operating position, while Guo Qihai stood in the fixed position. Fang Yun said to Zhong Chi: "Dr. Zhong, after I continue to pull until it is relatively loose, you add an outward force, but at the same time it is still You need to assist me in pulling."

"It's equivalent to the force in the outer and lower direction."

"This patient's muscle strength is not weak, because once the humeral head comes out from under the shoulder socket, the muscle retraction force is very strong. If it is not resisted, I am afraid that it will damage the rotator cuff or cause a fracture."

The strength of the muscles and their own contraction force can cause fractures. This is not an alarmist statement.

"Okay!" Zhong Chi thought for a moment and roughly understood the meaning.

Then, Fang Yun did not use any external rotation method, but used a variant of the chair method to start traction and reset.

The original reduction method of the chair method is for the patient to sit sideways on a chair and the affected limb to go around the back of the chair.The clinician holds the forearm in a supinated position and the patient slowly stands up.

The patients are anesthetized, so of course they can't do it, but mainly they adopt his ideas.

The veins on Fang Yun's arm began to bulge. While slowly increasing the traction force, he felt the relative position of the humeral head and shoulder joint.

Zhong Chi did not completely let Fang Yun fight alone. He used his side force in the same direction to assist Fang Yun in pulling him.

At a certain moment, after Fang Yun felt that the traction force had slightly loosened the compression between the humeral head and the shoulder joint socket, he quickly said: "Now, use external force."

Hearing this, not only did Zhong Chi have quick eyesight and quick hands, but Director Gong also grabbed the proximal end of the patient's upper arm, ready to provide reverse resistance after transposing the irreducible dislocation to a simple anterior dislocation, so as to avoid the patient's shoulder joint. Rebound, causing rotator cuff injury or fracture.

With the combined efforts of several people, the patient's right shoulder joint still shrugged slightly.

Even the force of retraction caused Fang Yun to move half a step forward. Fortunately, in the end, there was no particularly heavy snapping sound, only a relatively slight click, which was the sound of the humeral head sliding out. .

After this, Fang Yun continued to operate and used a very simple external rotation reduction method to reduce the anterior dislocation of the shoulder joint again.

The clicking sound this time is relatively obvious, but the pulling force of the muscles is not that heavy.

After the square shoulder deformity became visible to the naked eye, Fang Yun and others did another fluoroscopy. They found that the shoulder joint was in place, there was no muscle compression, and the passive movement was smooth.

"Director Gong, the reset is done, but to be on the safe side, we still need to do an MRI after the surgery."

"In case there is a rotator cuff injury, you can talk to the patient." After Fang Yun finished the operation, he felt a sense of joy in his heart, but it was fleeting and did not show up.

Director Gong sighed slightly and gave Fang Yun a thumbs up: "Doctor Fang's thinking and operation are very clear! It's amazing."

(End of this chapter)