Chapter 78: Skill Points That Can’t Be Saved!
【Surgery Basic Procedures: Open Reduction and External Fixation for Fractures （Proficient 1/10）, Fracture Manual Reduction （Proficient 2/10）, Open Reduction and Internal Fixation for Fractures （Proficient 0/10）, Closed Reduction of Joint Dislocations （Mastery 4/20）……】
It had been more than ten days since the Qixi Festival, and afterward, when Lu Cheng was on duty, he behaved himself and did not interfere with the orthopedic surgeries and treatments anymore…
For fracture patients requiring surgery, if Lu Cheng couldn’t handle the fracture manual reduction, he would still suggest they go to Orthopedics for treatment.
After all, Lu Cheng’s Trauma Surgery Basic Theory had reached Mastery, but his proficiency in fracture manual reduction was still at the Proficient level.
After his cognition improved, Lu Cheng increasingly felt the profoundness and intricacy of manual reduction techniques.
Moreover, modern medicine’s manual reduction techniques are quite different from Traditional Chinese Medicine’s bone-setting and reduction techniques.
Lu Cheng dared not easily venture into this area. However, it seemed that Xiang Kuihua, the Deputy Director of Orthopedics, wanted to teach Lu Cheng a lesson, repeatedly doing this.
Even a mud bodhisattva has a temper, and Lu Cheng felt utterly speechless.
In fact, the situation that day was very simple: our Emergency Department invited you for a consultation, and you just needed to come once and issue a hospitalization certificate for the patient.
If Orthopedics provided a professional opinion, even if Lu Cheng knew that a Mason type II fracture of the radial head could achieve good results without surgery, he wouldn’t have said anything.
But Orthopedics insisted that the Emergency Department issue a hospitalization certificate, which was simply because the on-duty doctor in the Emergency Department on Qixi Festival didn’t want to come, and wanted the on-duty doctor in the ward to ‘admit and see the patient’!
Lu Cheng encountered this, and he was a professional doctor in Trauma Surgery, and he knew that the surgical outcome of a Mason type II fracture was not superior to conservative treatment. How could Lu Cheng still issue a hospitalization certificate for the patient?
Doubting his own professional knowledge and disregarding his own abilities for the sake of social graces? Lu Cheng couldn’t do that.
“Fortunately, there are 18 Skill Points, let’s just clear them…”
The panel changed—
【Fracture Manual Reduction （Mastery 0/20）】.
A subtle clear stream ascended into his brain, making Lu Cheng feel refreshed, and a warm current filled Lu Cheng’s hands, unblocking his bones and muscles…
Lu Cheng carefully recalled the relevant basic theory for fracture treatment and then took another surgical mask from the nurse station, put it on, and went to find the patient.
Du Daihua was still attending to other emergency patients, and the fracture patient was temporarily placed in the corridor between the observation ward and the nurse station.
After Lu Cheng reviewed the patient’s basic information, he said, “Which one is the fracture patient Zhang Hongchun?”
Although he saw the person on the far left holding his hand at a glance, Lu Cheng did not act on his experience.
“Doctor, it’s me!~” The patient’s right hand supported his left hand, and he tilted his chin to indicate.
He came for the consultation alone; there was no one accompanying him.
“Have you had an X-ray? Come with me to the ward’s doctor’s office. There are many patients in the emergency clinic, so I’m afraid of bumping into you,” Lu Cheng stepped forward to support the patient’s elbow to help him up, saying as he did.
“I had an X-ray, but it will take an hour to get the results. Doctor, should I wait?” Zhang Hongchun was a middle-aged man in his forties, thin, with dark skin, and a few strands of white hair at his temples.
His lips were thick, clearly indicating he worked outdoors.
“It’s okay, I’ll pull up the X-ray on the computer to look. Have you broken your skin? Is there any bleeding?” Lu Cheng looked carefully, and although he didn’t see any bloodstains, he still asked patiently.
The handling principles for open fractures and closed fractures are completely different.
“I haven’t broken my skin. I fell from upstairs while tiling an exterior wall. I wish I had worn a safety rope,” Zhang Hongchun said with a look of regret.
“Pay more attention in the future. It’s a bit late to think about these things after getting injured. We often treat accidental fracture injuries like yours here. Safety ropes are very necessary, even if they are a bit troublesome and affect your movement.” Lu Cheng helped the patient into the office.
Zeng Huanqi, who was on duty in the regular ward, immediately looked over, thinking Lu Cheng had brought in a surgical patient, and stood up!
But upon seeing the deformity of the patient’s left hand, Zeng Huanqi, understanding and enthusiastically, said, “Come here quickly and sit. You must have broken your bone accidentally, right?”
“I fell while renovating.” Zhang Hongchun saw that Zeng Huanqi was not young and replied kindly.
Lu Cheng said, “Don’t rush. Judging by the deformity of your left forearm, there’s definitely a fracture, but I need to carefully assess how bad the fracture is.”
While Lu Cheng was speaking, he typed in Zhang Hongchun’s name in Pinyin and accessed the first page of the left forearm anterior-posterior and lateral X-rays.
Whether a fracture requires surgery or not depends on classifying the fracture, and depending on individual ability, the surgical indications are considered accordingly.
As soon as Lu Cheng looked, the diagnosis was very clear; the fracture line was very distinct.
“Your fracture is type A3.2, an extra-articular fracture of the radius, with a wedge-shaped fragment.”
“The fracture is in the proximal third, with an angular deformity of about 5°…”
While reviewing, Lu Cheng carefully searched for the indications for manual reduction of a radius and ulna double fracture.
Fractures are a major category and the cornerstone of trauma surgery precisely because fractures in any location have numerous classifications.
1. Fracture type suitability: Closed fractures, stable fractures, controllable displacement.
2. Sufficient reduction conditions: Fracture time ≤ 2 weeks. No soft tissue entrapment, high patient cooperation!
Lu Cheng determined that this was within the indications for manual reduction, and that his Mastery manual reduction technique had a chance of success, so he cautiously said:
“You have a radius and ulna double fracture, and the current situation is not simple. Manual reduction can be performed, but there is a certain probability that it will not be reduced, and then surgery will be necessary.”
“Of course, if you are willing, you can directly choose to have surgery in Orthopedics. After surgical fixation, healing will be faster than with manual reduction treatment…”
Zhang Hongchun nodded blankly, licked his dry lips with his tongue, and asked, “Doctor Lu, what is the specific probability of successful manual reduction for my fracture?”
Lu Cheng shook his head, “It’s hard to say specifically. Generally, we only recommend it if the success rate is above sixty percent.”
“If it can’t be reduced, then it will be surgical treatment. If it’s reduced satisfactorily, you’ll get a plaster cast and go home. I haven’t statistically counted the specific numbers.”
Lu Cheng indeed hadn’t counted. The technique for successful manual reduction is unique to each person. If one is proficient in performing manual reduction, the success rate can be over ninety-nine percent…
“It’s up to your personal choice. Are you willing to endure some pain to let us try to perform a reduction for you? This way, you can save some money.”
“However, if it’s not reduced properly, then this money won’t be saved, and you will have endured the pain for nothing.” Lu Cheng spoke plainly, informing the patient of the corresponding risks.
If the patient strongly requests surgical treatment, then it is a surgical indication, not a manual reduction indication.
The patient hesitated, then thought for a moment and asked, “How much will surgery cost for me?”
Lu Cheng used to be an orthopedic doctor, so he still remembered the approximate cost. “At our hospital, it should be around eight or nine thousand yuan.”
“Because this is a double fracture, the cost will be significantly higher than a simple fracture. After insurance reimbursement, it should be around four to five thousand…”
Zhang Hongchun asked again, “What about manual reduction?”
“For manual reduction, the total cost should be one thousand, maybe one thousand one or two hundred with some medication. After reimbursement, it’s around five to six hundred.”
Lu Cheng would not devalue the worth of his skills…
