Chapter 0005 Fractures that cannot be seen on CT (Part 1)
After the interview, a written test was arranged. As someone who was once in the top ten in the school, the written test was very easy.
At noon, Sanbo provided a free lunch. After the meal, Yang Ping went to Sanbo Hospital for a walk.
The hospital is really good. The main buildings are the Twin Surgery Building and the Internal Medicine Building, which have more than 30 floors.
Others include the administrative building, outpatient building, emergency room building, medical technology building, overseas Chinese building, and comprehensive building. They are all six- to eight-story buildings with reasonable distribution and well-proportioned layout.
The rooftops of the surgical building and internal medicine building are the parking areas for helicopters. A helicopter parked on the roof of the surgical building looks quite impressive and has become the symbol of the hospital.
Yang Ping ran to the Orthopedics Department to have a look. The Orthopedics Department of Sanbo Hospital has more than 100 beds and is divided into four wards: trauma, spine, joints, and sports medicine. Director Han is the director of the Department of Orthopedics and concurrently the director of the Department of Traumatology and Orthopedics.
Orthopedics is a wide range of departments. Many large hospitals are divided into sub-specialties: trauma, spine, joints, sports medicine, and some are branched out to pediatric orthopedics. Some hand surgeries are better and are separated into hand surgeries. Some have a wide radiation range.
The Regional Medical Center also has bone tumors.
More impressive hospitals will continue to divide them into categories. Traumatology and orthopedics can be divided into upper limb orthopedics and lower limb orthopedics. The spine can be divided into cervical spine, thoracic spine, lumbar spine, and the joints are hip joints, knee joints, etc.
That is to say, one group of people specializes in upper limb surgery, and another group specializes in lower limb surgery - this is something ordinary hospitals dare not think of, and is an exclusive method only available to top hospitals in the industry.
There is an expert from a top hospital in the imperial capital who specializes in the upper cervical spine, that is, the base of the skull, the first cervical vertebra, and the second cervical vertebra.
I spent a whole day wandering around Sanbo Hospital, had dinner at a nearby restaurant, and took the subway back to my rental house in the city.
A few days later, he received a call informing him that he had passed the interview and could work in the orthopedics department. This was expected. From Director Han's last words, Yang Ping knew the result.
On the first day of work, Yang Ping came very early.
The stupid bird flies first. Although I don’t think I am a stupid bird, there is nothing wrong with flying first.
Yang Ping must become familiar with the duty room, men's changing room, women's changing room, interview room, dining room, demonstration classroom, treatment room, etc. as soon as possible so that he can carry out his work.
Everyone came together one after another, and the shift was handed over on time at eight o'clock. Everyone lined up in a U shape, with a projection on the opposite side of the U shape, and at the bottom of the U shape was the director with several team leaders, with the doctor on the left and the nurse on the right.
Doctor, neatly dressed, in shirt, dark trousers, dark leather shoes, tie, and white coat.
The nurses have obviously been selected. They are all over 1.6 meters tall. They wear slim-fitting blue nurse uniforms, their hair is tied back and covered by black silk mesh, making them look youthful and beautiful.
After handing over the shift, Director Han briefly introduced the new doctors, including Yang Ping, and everyone applauded to welcome the newcomers.
There was no objection to the shift handover, so the nurse left the office and started a busy day of work.
The doctor started a brief morning meeting, showing the images and pictures of the operations performed the day before and the operations to be performed today, and making a brief report.
Each group takes turns to report on the cases within their group.
One of the patients, He Jianmin, is a seventy-six-year-old male. His X-rays caught Yang Ping's attention - he had a left femoral shaft fracture, and today he is going to undergo interlocking intramedullary nail fixation, which is the first one.
In the X-ray of this patient, Yang Ping found that the femoral neck was also fractured, but the diagnosis was not mentioned at all.
The choice of surgical technique also shows that the surgeon did not notice the femoral neck fracture at all.
This kind of fracture is an occult fracture, which is difficult to see on X-rays and CT and is almost impossible.
Yang Ping has received training in image reading and can clearly detect even hidden fractures.
If it is really an occult fracture of the femoral neck, the surgeon can easily fall into a trap because the surgeon does not know that there is a fracture in the femoral neck. According to the conventional surgical procedure, a hole is made from the proximal end of the femur and the intramedullary nail is screwed or driven into the femur.
In the medullary cavity, these operations will turn the occult fracture of the femoral neck into an obvious fracture, and the surgeon will be completely unaware of this process.
Postoperative review and X-ray: there is still a fracture in the femoral neck!
What should I do? You can’t ignore this femoral neck fracture, right?
In this way, you need to explain to the patient: Sorry, you still have a femoral neck fracture that has not been treated. You need a second operation to treat the femoral neck fracture.
What is the patient's reaction: There was no fracture in the previous X-ray, but now you find a fracture in the X-ray. The fracture was not caused by your doctor's surgery? He also tricked me into doing a second operation. At this time, disputes naturally arise.
After the film ended, Director Han scanned the audience and said briefly and clearly: "If anyone has any questions, if there are no questions, the meeting will be dismissed."
This patient must have a femoral neck fracture. There is no mistaking this. I recently received basic skills training in the system space and have seen more than tens of thousands of images.
Be sure to remind the surgeon to avoid this unnecessary dispute.
Yang Ping immediately raised his hand, and all the doctors focused their attention.
Director Han said: "Xiao Yang, what do you have to say?"
Some people came to the door, ready to open it and go out, but then they came back.
It is offensive to question other people's diagnosis and treatment plans, let alone on your first day at work, in front of the public.
If you don’t say it, will you watch others fall into the trap?
Yang Ping thought for a moment and said, "Can you please check out He Jianmin's film?"
Both X-rays and CT scans were called up and projected on the screen.
"Any questions?" Director Han asked.
Yang Ping said humbly: "Sorry for wasting everyone's time! This patient, I suspect, has an hidden fracture of the left femoral neck."
Anyway, a few words won't waste time. If you have any doubts, just say it. Director Han said: "Xiao Yang, tell me about this case. What are the doubts?" Director Han encouraged Yang Ping.
Yang Ping received the director's approval and continued: "I just saw the X-ray, and there was swelling in the soft tissue in front of the knee. This indicates that the front of the knee has been contusion, which is very similar to the damage mechanism of the dashboard; there is subtle disorder in the trabeculae of the femoral neck. On the CT film,
A picture shows cortical wrinkles, and the combination of the three factors indicates that this patient may have an occult femoral neck fracture. It is recommended that further MRI of the hip joint be examined to confirm the diagnosis."
The group this patient belongs to is headed by Tian Yuan, Director Tian, deputy chief physician, Ph.D., and graduated from West China University of Medical Sciences.
He looked at Yang Ping, stood up, and sat down by the computer connected to the projector. On the computer, he repeatedly looked at the X-rays and CT scans.
It is true that there is some trabecular disorder in the X-ray of the femoral neck, and there seems to be wrinkles in the cortex at one level in the CT, but it seems to be there or not, so it is impossible to determine. If I hadn’t looked at it preconceptionally, I wouldn’t have noticed this at all.
"CT is the gold standard for diagnosing fractures. CT is better at seeing fractures than MRI, right? CT can't see fractures, but MRI can?" said resident physician Zhang Lin.
"Yes!" Tian Yuan's chief physician Fang Yan also agreed.
Yang Ping is a newcomer, and the rejection of newcomers is the same everywhere.
Director Han had a critical tone: "You are right, there is an occult fracture of the femoral neck. MRI is the best diagnostic tool.
Zhang Lin was criticized in public by the director and felt very resentful of Yang Ping.
After Tian Yuan finished flipping through the film, he turned to Director Han and said, "Director Han, Xiao Yang really reminded me that there is indeed something suspicious."
The patient is now under anesthesia in the operating room.
Tian Yuan immediately picked up the phone: "Xiaobo, please check the patient's left knee. Is there any swelling or ecchymosis?"
"Since there are doubts, let's stop the operation and find out first!" Director Han made the final decision.
The other doctors, including several directors who led the team, all craned their necks and looked at the film on the projection screen carefully. Where can you see the fracture?