Chapter 68: Meticulous Thoughts And Theoretical Systems
After Lu Cheng replied, Tong Yuan’an took out chopsticks and tapped Lu Cheng’s right finger bone, lowering his voice, his chubby face serious:
“Sentimental value is sentimental value, but sentimental value without ability, and being a saint, is just messing around! Do you understand this logic?”
“Fractures, joint dislocations, and tendon suturing are completely independent disease types!!” Tong Yuan’an was a professional orthopedic doctor, so he immediately advised Lu Cheng afterwards.
Lu Cheng was hit but still smiled, and said honestly: “Thank you, Teacher Tong, for your guidance, but I wasn’t fooling around.”
Chen Song put down his water cup and poured Tong Yuan’an a cup of tea. Feeling it wasn’t strong enough, he called the waiter to specifically change to a pot of self-funded green tea.
“Speak,” Tong Yuan’an said, hands behind his back, staring seriously at Lu Cheng’s expression.
“Teacher Tong, I won’t discuss the overall picture, let’s just talk about the shoulder joint dislocation I treated.”
“First, through physical examination, I suspected her diagnosis was an anterior shoulder joint dislocation. Then, through physical examination, I could determine the position and distance of the humerus head displacement to determine the type.”
“Afterward, I read the medical images and saw the position of the humerus head clearly. After ruling out a fracture, I graded it. I could see the joint capsule was not dislocated, and the acromioclavicular joint space was narrowed, indicating it was not a grade II injury, but still within the scope of grade I injury.”
“Non-grade II injuries are generally not accompanied by rotator cuff or ligament injuries in sports medicine, because the grading can infer the force encountered during the injury.”
“The diagnosis type was clear, shoulder joint dislocation, and the classification was clear, it was the simplest anterior-inferior dislocation.”
“The grading was clear, it was a grade II dislocation.”
“The treatment method was also quite standard. We could choose the hand-pull-foot-push method or the suspension method, and the Kocher reduction method. Among these, the Kocher reduction method has a higher success rate and, if mastered proficiently, can be expected to yield good treatment results.”
“So I proceeded with the operation,” Lu Cheng said, organizing and analyzing the entire treatment process theoretically with sound reasoning.
Chen Song and Tong Yuan’an might not understand the specific classification and grading of joint dislocations, but they were certainly familiar with this kind of analytical approach.
Of course, Tong Yuan’an, who had ample theoretical knowledge, pressed further: “Then why did you choose the Kocher reduction method instead of the ‘external rotation-adduction method, Milch reduction method’?”
After hearing this, Lu Cheng carefully considered before organizing his thoughts: “Teacher Tong, the Milch reduction method is indeed very good!”
“It can be completed with zero traction and only gravity assistance, and the risk of fracture is lower than the Kocher method, only one percent.”
“Most importantly, the risk of nerve injury with this reduction method is lower than with the Kocher external rotation reduction method.”
“It is both labor-saving and low-risk, but it is more suitable for patients with well-developed muscles. The only drawback is that it takes longer than the Kocher method.”
Lu Cheng recalled the precise reduction times: the average reduction time for the Kocher method was about five minutes, while the reduction time for the Milch method was about 7-12 minutes.
“This patient is a girl, and she was constantly frowning while dislocated, so it can be inferred with high probability that her pain threshold is relatively low, and she is very afraid of pain.”
“Even though it’s only a difference of 2-7 minutes, it would be enough to give her a more painful experience.”
“Therefore, I chose the Kocher external rotation reduction method, not the Milch reduction method,” Lu Cheng replied.
Tong Yuan’an’s expression softened, his eyes calm, as if deep in thought.
Hearing this, Chen Song looked at Tong Yuan’an and said: “So, Xiao Lu is truly a professional doctor in your orthopedics. Based on the theoretical level he’s expressed, he’s no worse than a typical postdoctoral student.”
Tong Yuan’an did not refute, patting the front of his thighs with his large, plump hands: “Alright, he has ability, ideas, theoretical backup, theoretical foundation, confidence, an orthopedic resume, and a professional title.”
“Indeed, he has minimized all risks. He has a plan, he’s not blindly rushing forward.”
Tong Yuan’an tapped the table again, praising: “It’s just that he has learned too broadly, not purely enough.”
“Otherwise, with your current technical level, you should be able to perform many surgeries unique to your specialty.”
Tong Yuan’an had thought Lu Cheng was a greenhorn who was unafraid of danger and intentionally challenging orthopedics, but in reality, Lu Cheng had made extensive preparations and was just waiting for an opportunity.
Now, it seemed, the orthopedics department had opened a door for Lu Cheng, and it would not be easy to close it again.
In the current medical landscape, disease categories are not so rigidly defined!
The primary attending physician is responsible, as long as you don’t perform surgery above your level.
The main reason was that Tong Yuan’an hadn’t expected Lu Cheng’s theoretical level to have reached such a systematic stage. Otherwise, he wouldn’t have struck Lu Cheng’s hand.
With this thought, Tong Yuan’an scratched his scalp with his plump hand, his expression troubled: “Xiao Lu, my research project is probably dead in the water.”
“Through your validation, one point has been confirmed: it is useful and can surpass Professor Tajima’s suturing technique, but it’s only equivalent. However, Professor Tajima developed it first, giving him the first-mover advantage.”
“I consulted my teachers after returning, and indeed it’s difficult to proceed, and I have to admit defeat. There’s no way to improve it.”
“Sigh…” Tong Yuan’an sighed.
Then, Tong Yuan’an further explained: “Other conditions in hand surgery are too irregular and inappropriate to be performed in your Emergency Department. As for limb replantation, it’s still too far away for you right now.”
“Flap suturing is possible, but Peng Kun’s current technical accumulation is barely sufficient for treating skin defects. He is a specialist in orthopedics, do you understand what I mean?”
Lu Cheng nodded, conceding: “Teacher Tong, the two techniques you taught me are very useful and have benefited me greatly!”
“It’s just that my accumulation is insufficient, and I can’t get into limb replantation…”
Tong Yuan’an said: “But you could perform ligament release and reconstruction for finger and hand deformities. However, this is an elective condition, and you wouldn’t encounter it in your Emergency Department.”
“In my opinion, you could consider transferring back to orthopedics…”
Chen Song tapped the table: “Tong Yuan’an, you’re still saying this now, do you really not take the emergency patients of Long County seriously?”
“As you said, deformities are elective conditions, while spleen rupture, cholecystitis, and gallstones are life-threatening emergency conditions.”
“Lu Cheng’s spleen preservation surgery and gallbladder preservation surgery are already quite skillful. Are you asking him to come back to orthopedics to deal with deformities with you now?”
“To save those patients a bit of money, you disregard the spleen and gallbladder organs?”
“Saving money is more important, so cut the spleen if it needs to be cut, and cut the gallbladder if it needs to be cut? They aren’t your orthopedic patients anyway, right? Out of sight, out of mind.” Chen Song said with particular sarcastic formality.
Tong Yuan’an said helplessly: “I didn’t mean that…”
Chen Song said indignantly: “Then what’s the point? If you genuinely had intentions, you should teach him the path to accumulating basic suturing skills, so that Xiao Lu can look forward to performing limb replantation, something orthopedics won’t be able to do for the next ten years, which is the right way.”
“What are you thinking about elective deformities for?”
Chen Song was still paving the way for Lu Cheng, hoping that Lu Cheng could participate in the provincial skills competition through Tong Yuan’an.
The National Microsurgery Skills Competition is in December, and the province will select participants. Usually, preparations start in October, which is only two months away from now.
