Sisi’s father’s examination results came out. The right ankle joint was fractured, with four degrees of supination and external rotation. Four points of the front and back were injured. The medial malleolus was fractured, the lateral malleolus was fractured, the posterior malleolus was fractured, the tibiofibular syndesmotic ligament was ruptured, and the ankle joint was damaged.
Widening, external displacement of the talus, and subluxation of the ankle joint. This kind of fracture requires surgery and manual reduction. Even if it can be reduced satisfactorily, it cannot be fixed well.
Every treatment method has indications. To mythologize any treatment method without indications is against scientific principles.
"Lange-Hanson classification---four degrees of supination and external rotation, AO classification---C!"
Song Zimo opened the electronic reading screen, and Sisi's father's X-ray and CT were displayed on the screen. Several trainees and interns gathered around, and Song Zimo explained to everyone the knowledge of ankle fractures.
The classification of ankle fractures is the most complicated among the classifications of limb fractures, especially the Lange-Hanson classification. Many senior orthopedic surgeons are confused and cannot understand it.
In this classification, what does pronation and supination refer to and what state it is; what does external rotation and internal rotation mean, what state it is and why it is combined in this way. Song Zimo will explain it to you in detail.
He also took out a piece of A4 paper and explained and drew pictures at the same time. In order to make it easier for everyone to understand, Song Zimo drew a picture of a hinge to simulate the mechanism of an ankle joint injury.
Most students are very motivated to learn, especially at the academic meeting, when Yang Ping and Song Zimo demonstrated superb surgical skills and defeated the two Japanese trauma surgeons, making these young people excited and admiring them, and further determined these students to do it.
The belief of a good doctor.
The power of idols cannot be underestimated. It is a spiritual pillar, like a lighthouse, giving you hope, giving you direction, and giving you the confidence to move forward into the distance.
Being able to study in Comprehensive Orthopedics for a period of time is a supreme honor; being able to be strictly required by the teachers here is also a supreme honor, they all think so.
In terms of teaching, Yang Ping advocates learning based on clinical cases. Using a case, one must thoroughly understand all relevant knowledge. Even an intern who comes from comprehensive orthopedics must thoroughly understand and firmly grasp the knowledge that should be mastered.
Keep a firm grasp.
Usually, interns and trainees are all taught by Zhang Lin, and some basic knowledge is taught by Zhang Lin. When it comes to more complex professional knowledge, Song Zimo teaches.
Yang Ping usually gives lectures to Song Zimo, Zhang Lin and Xiao Wu. During teaching rounds, he will also explain cases to trainees and interns, ask some questions, and check the practical effect of the department's clinical teaching.
"Treat the swelling first, and then arrange for surgery." Yang Ping ordered Song Zimo.
This kind of fracture cannot be operated during the swelling period, otherwise it will easily cause incision complications, such as inability to suture, necrosis, infection, etc. You must wait for the swelling to subside before operating.
Song Zimo's cell phone vibrated. It was Duan Xiaoming, the director of Hai Fu Dao's operating room: "Mr. Song, your surgery tomorrow is for liver tumors?" "Yes!"
"The medical office just called and said that you have exceeded your authority. Only the general surgery department, the oncology department and our department have the authority to perform this operation. Your orthopedics department does not have the authority."
"For Sisi's surgery tomorrow, we are going to do liver metastases. This surgery is not within the scope of our orthopedics department, but is within the scope of general surgery and oncology surgery. Brother Ming just called to say that we are being monitored by the medical office and the surgery needs to be cancelled.
"Song Zimo hung up the phone and said.
They have been focusing on treating Sisi's illness, and Yang Ping and Song Zimo didn't care. Indeed, this operation went beyond their authority.
"How about we deal with the primary tumor on the left femur first?" Song Zimo suggested.
Yang Ping shook his head: "The current treatments are all palliative, and priority should be given to solving the most painful part. You also saw Sisi's painful expression lying on the bed during the ward rounds."
"Can you name Brother Ming and do it for you?" Song Zimo thought for a while.
The matter of surgical permission is very serious, just like requiring a driver's license to drive.
Brother Ming, whose real name is Duan Xiaoming, is the director of the Haifu knife department. No matter what kind of tumor is in the body, as long as there are indications for Haifu knife, he can do it.
This is a good idea, but people may not agree to name it because they have to take risks.
"I told him, he will definitely agree." Song Zimo was very confident.
It was Song Zimo who helped resolve Duan Xiaoming's child's academic degree. It should be no problem to ask him to help name this friendship.
Based on Yang Ping's trust in Sanbo, since he dares to perform this operation, he must be very confident, and Duan Xiaoming will not be too worried.
"Don't worry, let me talk to Director Han!" Yang Ping called Director Han and explained the situation.
Not long after, Director Han called: "Xiao Yang, you go ahead and do it. I just communicated with the medical office and gave you a one-time temporary authorization. Dean Xia and I signed and endorsed it. I will call the General Surgery Department and the Oncology Department."
We greeted him and explained that this is a special situation. This patient is the target of charitable funding from our department and is a scientific research case, so they will have no objection."
With just a few words and without asking Yang Ping too many questions, Lao Han settled the matter.
Lao Han's idea is very simple. Since you want to do it, just do it. I will remove the obstacles and bear the risks.
"Director Han has sorted everything out." Yang Ping put down his cell phone so that Song Zimo didn't have to deal with it.
In the hospital, doctors are divided into specialties, each doing their own work in their own field, and they cannot overstep their authority without authorization.
This cross-border thing can be done once, but it certainly cannot be normalized. All surgeries must be performed, which is nonsense.
Cheng Liquan sent a message that his medical tour group had arrived at the hospital and asked when the operation could be arranged. There were eighteen patients in the operation.
Eighteen?
At first it was said to be eleven, but later it was increased to sixteen.
Now the exact number is eighteen, and two patients from Southeast Asia have temporarily joined the group.
Do you need to organize a group for surgery? Will there be a group purchase price for the group? Yang Ping was curious, but it was inconvenient to ask Cheng Liquan.
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If this continues, it will only accumulate more and more, and we must find a time to clear it out. While there are not many patients in our department, we should quickly clear out these eighteen patients, just on Sunday.
If Professor Zhang operates the outpatient clinic at full capacity, the ward can be filled up within two weeks. At that time, it may be difficult to find time.
Mr. Zhang has a good reputation and is very responsible. Many patients from outside the province come to call him.
Some of his patients are still being followed up twenty or thirty years after surgery.
A patient with congenital hip dysplasia had surgery when he was two years old. Now the patient’s children are in middle school, and he is still following up on the patient.
At that time, there was no WeChat, and even telephone calls were not widely available. Follow-up visits relied entirely on letters and visits. I persisted in this, what a sense of responsibility it was.
The serious and rigorous attitude of the older generation puts most doctors to shame, which is why many patients trust him and travel thousands of miles to see him.
The nurse station called the doctor on duty. Professor Zhang admitted the patient, a girl in her twenties. Professor Zhang was considering thoracic spinal tuberculosis.
Tuberculosis is rare now, but it has been on the rise in recent years because the tuberculosis bacteria have mutated.
Zhang Lin was on duty and went to see the patient. Yang Ping had nothing to do, so we went to see him together.
The patient's name is Fang Xiaoyun, female, 24 years old, very thin, with low back pain for 3 years, and numbness and weakness in both lower limbs for 3 days. The physical examination showed that the spine formed a kyphotic deformity at the thoracic 9 position, and the skin below the groin on both sides of the lower limbs felt numb.
Decreased, muscle strength of both lower limbs was grade four.
Professor Zhang considered that patients with medical insurance can be reimbursed for inpatient MRI, but reimbursement for outpatient MRI is too low.
Therefore, Professor Zhang only gave the patient an anteroposterior and lateral view of the thoracolumbar spine in the outpatient clinic, which showed that bone destruction could be seen on the upper and lower edges of the thoracic 9 vertebrae, the upper and lower intervertebral spaces were narrowed, and widened soft tissue shadows could be seen next to the vertebrae. Professor Zhang was experienced and made a diagnosis based on the medical history, physical examination and X-rays. He called Zhang Lin on duty and ordered him to perform a further MRI on the patient.
This is thoracic spinal tuberculosis and paraplegia. Emergency surgery is required to relieve the compression of the spinal cord by the pus, granulation tissue, caseous necrotic tissue and dead bones in the spinal canal, and allow the neurological function to recover.
The current compression period is not long, and if these compressing substances are removed in time, the paraplegia can be fully recovered.
Judging from the X-ray, the compressing material has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. In this way, no matter how perfect the operation is, paralysis will remain in the future.
Zhang Lin arranged an emergency thoracolumbar spine MRI for Fang Xiaoyun. When the results came out, it was as expected based on the X-rays.
The compressing material was at the level of the 9th thoracic vertebral body and had entered the front part of the spinal canal. Yang Ping immediately took Zhang Lin to Fang Xiaoyun to discuss the condition and it was best to undergo emergency surgery.
Fang Xiaoyun's eyes were a little red, as if he was aggrieved and had secretly cried.
"Doctor, do I need surgery for this disease?" Fang Xiaoyun asked.
Yang Ping said firmly: "Surgery is necessary, otherwise the lower body will be paralyzed in the future."
"From the magnetic resonance imaging, the compressed material has entered the front half of the spinal canal. Once the anterior artery of the spinal cord is embolized, it will cause permanent damage to the spinal cord. In this way, no matter how perfect the operation is, paralysis will remain in the future. You still have
You are so young, don't delay, we will arrange emergency surgery for you." Yang Ping was not trying to scare you, but was objectively informing you about your condition.
Fang Xiaoyun's face was obviously hesitant, and it was difficult to make a decision: "Let me think about it, is it okay? I will give you an answer tomorrow morning. Is it okay to wait overnight?"
"If you wait overnight, there will definitely be an impact. This risk cannot be determined. If you can't make a decision now, try not to delay it for too long. Give us a reply as soon as possible. If you have any questions, let us know at any time."
"Okay, thank you Dr. Yang. I will give you an accurate answer at eight o'clock tomorrow morning."
"Tell me when you think about it. Don't delay. If you have any difficulties, you can tell us." Zhang Lin felt that her demeanor was a bit abnormal and her eyes were red, as if she had quarreled or cried with someone.
She came here specially for the surgery, but now that the emergency surgery was performed on her, she was hesitant, wondering if there was any hidden secret behind it.
It was difficult for the doctor to ask further questions, so he could only leave her one sentence.
After leaving the ward, Yang Ping told Zhang Lin: "Follow this patient closely, don't delay for too long."
