Chapter 79: You Guys Just Did It?
Five to six hundred and five to six thousand, the difference is quite large.
Lu Cheng carefully reviewed the hospital’s fees. The charge for open reduction and internal fixation of radial and ulnar shaft fractures + manual reduction and internal fixation of fractures was 1690 + 145, plus the cost of the steel plate. The cost incurred during the surgery alone was over 2000.
Adding anesthesia fees, the cost for that day approached four thousand.
Zhang Hongchun hesitated, “Doctor Lu, if the manual reduction isn’t successful, do we still have to pay?”
Hearing this, Lu Cheng frowned, “Yes! So you need to think carefully and be sure.”
Zhang Hongchun asked again, “Doctor Lu, if it’s not reduced, we still have to pay? Isn’t that unreasonable?”
Lu Cheng explained, “If you think it’s unreasonable, you can directly choose surgery. Surgery guarantees reduction. And the risk of re-displacement is much lower, and postoperative recovery will be faster!”
When medical services are provided, there should be a charge. The inherent risks of manual reduction are not included in this.
During the surgery, the chief physician will also perform multiple C-arm irradiations, requiring the circulating nurse to be called over, and an assistant, and it takes a long time to manipulate; it’s actually a physically demanding job…
“Then I’ll think about it again and discuss it with my family.” Zhang Hongchun was unsure.
What he was thinking was, if the manual reduction wasn’t successful, it would be great if there were no charges…
Lu Cheng didn’t try to persuade him either and said, “You can think about it again. I also need to do a simple physical examination to prevent compartment syndrome…”
Lu Cheng then proceeded to systematically examine the distal limb’s sensation and blood supply function, and the tension of the fracture site. After initially ruling out compartment syndrome, Lu Cheng asked Zhang Hongchun to discuss it with his family.
After the patient left, Zeng Huanqi looked up with his dark face, “Xiao Lu, are you really going to do fracture manual reduction?”
“Why aren’t the Orthopedics people coming?”
“According to the consultation rules, not directly calling the Medical Affairs Department to find an orthopedic doctor is already being considerate of these elders,” Lu Cheng said.
The Emergency Department calls for a consultation, and they don’t come? If Lu Cheng were to be serious about it, they would have a lot to deal with.
However, thankfully, if it were an open fracture, the Orthopedics department wouldn’t dare to delay, so Lu Cheng didn’t need to completely fall out with them.
“Then what if something goes wrong?” Zeng Huanqi’s tone was conflicted.
“That’s why we must write down the risks of fracture manual reduction as a template in advance, letting the patient consider and choose, and emphasize risks such as re-fracture and fracture re-displacement.”
“Our Emergency Department’s consultation area has recordings and videos from the Security Office! I’m not coercing patients, so it will be fine,” Lu Cheng replied.
If he’s confident he can do it, he does it. If he’s not confident, he admits defeat. This has always been Lu Cheng’s principle.
Of course, if his ability wasn’t sufficient and the success rate of manual reduction was less than half, Lu Cheng wouldn’t take the risk.
But with an 80% or even 90% success rate, and if the patient is willing to try to save money, Lu Cheng is happy to help.
Manual reduction isn’t something Lu Cheng *has* to do, but something he *can* do at his discretion…
Fifteen minutes later, Zhang Hongchun walked in, his eyes sincere:
“Doctor Lu, I’ll go ahead with the manual reduction. Please do a good job for me and try to reduce it successfully in one go.”
“Okay, come with me for the consultation and sign. We need to discuss the specific risks carefully.”
“Mainly, there are a few points. First, manual reduction and plaster external fixation are not as stable as internal fixation with a steel plate; there’s a risk of re-fracture and displacement.”
“Second, the pain experienced after reduction will be more intense than with surgery, and it will last longer…”
An hour later, Zhang Hongchun entered the doctor’s office for another X-ray. His left hand was clearly fixed in a supinated cast, but he was still very nervous and worried:
“Doctor Lu, how is my result? Have you looked?”
“It looks good so far. The fracture line has converged, and the fracture fragments are held in place because your hand is fixed in a supinated position.”
“The soft tissues will also protect the fracture alignment, which is considered a good quality manual reduction. Postoperative recovery is promising,” Lu Cheng assessed very professionally.
He added, “You can come and see. There is basically no anterior-posterior or medial-lateral displacement of your ulnar and radial bone edges postoperatively. This kind of alignment is a reduction to be confident about.”
“Under normal circumstances, as long as you don’t suffer external trauma, re-displacement is rare. And if you do suffer external trauma, a normal person would break a bone…”
Zhang Hongchun finally felt relieved, “Doctor Lu, thank you!”
“You’ve worked hard. I thought manual reduction was just you casually touching it and finishing, I didn’t expect it to require so much strength!” Zhang Hongchun recalled Lu Cheng and Zeng Huanqi sweating profusely in the operating room and felt the money was well spent.
“I’ve remembered what you told me and how to take these medications.”
“It doesn’t hurt as much now. Actually, it didn’t hurt that much during the manual reduction. Thank you so much.” Zhang Hongchun bowed again, a sheepish grin on his face.
A method to save money that is also effective, this is the only good thing amidst today’s misfortune.
If surgery were performed, it would have cost several thousand yuan more, and at least ten days of work would have been in vain!
Lu Cheng said, “Be careful on your way back. Don’t fall. If you experience numbness, swelling, or increased pain, you must come to the hospital for a follow-up appointment promptly!”
“Your fracture is only externally fixed, not internally fixed, so it’s not that stable. Please be extra careful,” Lu Cheng took a few more steps forward and reiterated in a nagging manner.
“There’s nothing else. You’ve also added my WeChat, so if you have any problems postoperatively, you can contact me anytime.”
“Except at night and in the early morning while sleeping,” Lu Cheng added.
“Okay, thank you, Doctor Lu.” Zhang Hongchun smiled and waved goodbye to Lu Cheng, carrying his bag of medicine.
Lu Cheng turned and carefully reflected on the manual reduction he had performed today, with no further concerns.
In fact, manual reduction for radial and ulnar fractures is relatively simple.
A proficient level is sufficient, with at least an 80% success rate. With specialized-level manual reduction technique, the success rate is around 90%.
Whether the reduction effect is good or not can be seen postoperatively: the fracture ends are neatly aligned, the fracture line is smooth, the fracture is fixed in place, and the external fixation is reliable.
Moreover, the fracture itself is not comminuted and doesn’t have a significant displacement tendency, so Lu Cheng was somewhat confident.
After completing these tasks, Lu Cheng returned to the ward and began to write a very detailed operative record for the patient’s ‘manual reduction’.
Just as he was nearing the end, a somewhat sharp voice came from the door of the general ward, “Did you handle our Orthopedics fracture patient directly?”
Lu Cheng looked up and, upon seeing Xiang Kuihua’s sturdy build, stood up. Although he was half a head taller than Xiang Kuihua, Lu Cheng’s voice was low, “Yes, Director Xiang, I performed manual reduction.”
Xiang Kuihua was robust and tall, with a relatively small face, dry skin, and a stern demeanor, “You… Lu Cheng, I’m not saying this to criticize you, but what do you know about manual reduction?”
