Radial head subluxation is a very common "minor problem" in children. In fact, this minor problem does not cause any serious consequences. And its main cause is somewhat speechless. In most cases
, radial head subluxation is caused by parents pulling their children's hands hard.
There are two main reasons why this kind of dislocation is easy to occur in children aged 2 to 4 years old. The first is because the radial head of the elbow has not been fully developed before the child is 5 years old, so the annular ligament is relatively loose. This looseness
, creating congenital conditions for radial head subluxation.
The second reason is that parents are used to "holding their children". Many parents feel that holding their children with one hand is a form of protection when they are walking or going up and down stairs. This makes it easier for parents to hold their children while they are walking or going up and down stairs.
When a child loses his footing and falls, use force quickly to pull the child who is about to fall back to prevent injuries.
But what parents don't know is that this rapid upward and backward pulling is the main cause of subluxation of the radial head. What's even more unfortunate is that children of this age have extremely low pain tolerance, and subluxation causes
The pain will greatly cause children to be irritable, resist and cry. And when they cry in pain, they cannot clearly express in words which part of themselves was injured.
So parents are in a dilemma. Unless they have relevant knowledge, it is really difficult for parents to realize that their children have dislocated at the first time. Sometimes some children are not sent to the doctor for treatment until more than two days after the dislocation.
The long-term dislocation caused ligament damage and surrounding joint edema. Finally, the doctor had no choice but to perform reduction and fixation through surgery and Kirschner wire. In the end, the child was left with scars, and the parents slapped themselves in distress.
Fortunately, the father of Zhuang Zihao's child seemed to understand the matter quite well. He rushed to the Fourth Central Hospital with his child in his arms. The nurse who received the treatment was shocked by this look. Both the pediatric outpatient clinic and the emergency department were in the ninth hospital.
Building, Zhuang's father was directly directed into the emergency room and met Sun Lien.
"What happened?" Sun Lien has a complete understanding of the child's condition. The situation is not critical or dangerous. Although it should be sent to the pediatric department on the ninth floor for treatment, Sun Lien's charge today is really too high.
Full, so he decided to deal with it directly. Anyway, it only took a few tens of seconds to perform a manual reset.
"I took my child to play in the children's playground in Sun City." Dad Zhuang wiped the sweat from his head. "He slipped when he climbed up the slide. I happened to hold his hand and subconsciously
La..." Zhuang's father looked very apologetic, "Then I felt something wasn't right about the movement in my hand, as if his arm suddenly stretched a little."
Sun Lien found a chair and motioned to Zhuang's father to put the child Zhuang Zihao on the stool. He asked Zhuang Zihao, who was holding his left arm, "Child, come, let's play a little game with my brother, okay?"
After Zhuang Zihao came out of his father's arms, he seemed to be calmer because there was no longer continuous pain in the affected limb. He nodded timidly, then looked at Sun Lien, waiting for the little game to begin.
"Learn from your brother." Sun Lien faced Zhuang Zihao and gently raised his right hand. Children have no concept of left and right, and it is difficult for them to understand the inverted left-right relationship of mirror images. So when doing this small examination,
Sun Lien chose to switch left and right. "Lift this arm..." He looked at Zhuang Zihao's movements and nodded with satisfaction, "Can you touch your head?"
The child tried it, but his arm was only slightly raised and straightened, then stopped, and then he shook his head vigorously at Sun Lien.
"What about this?" Sun Lien stretched out his arms and asked, "Can you move?"
This time, the kid Zhuang Zihao didn’t even have the interest to try, and he started crying again.
"Doctor, what's going on?" Zhuang's father was anxious. He looked at the young Sun Lien and felt that the doctor in front of him, who might be a few years younger than him, was very unreliable.
"It should be subluxation of the radial head. Don't worry, it's not serious." Sun Li'en nodded towards Father Zhuang, "I'll make an order for you. You go and take the child for an X-ray first. As long as there are no other problems,
Make a quick reset."
Father Zhuang nodded. The child had signs of bone injuries, and it was definitely right to have an
The nurse did it for me. Zhuang Zihao's situation was really not good, so Zhuang's father took the children to queue up.
"Isn't this just a manual reset?" Xu Yourong looked at the leaving Zhuang Zihao and his father's back and asked in a low voice, "It's just a matter of twisting it, isn't it easy?"
"Then we have to rule out other possible bone injuries first." Sun Lien spread his hands. Xu Yourong was indeed different from him. After working in the gods for a long time, she was not as good at this common injury as Sun Lien. "We need to rule out the humerus.
Only condylar fractures, radial capitellum fractures and other fractures at the same site can be reduced. Otherwise, what if you make a mistake and just try this with your hands, and the reduction is not successful, but the fracture is pressed into a fracture?"
Sun Lien himself knew that Zhuang Zihao must have subluxation of the radial head. After all, the status column had already stated it clearly. However, Feng Chujie's lesson made him firmly understand that treatment must rely on evidence. The status column was just
It's a reminder. Although for him, the prompt on the status bar is basically conclusive evidence. But other doctors don't think so, and neither do patients. Only after examination and providing solid evidence
, he can make a diagnosis.
"Anyway, it's quick to take an X-ray." Sun Lien smiled at Xu Yourong, "Has Lin Lan's examination been arranged?"
"It's arranged." Xu Yourong nodded, "But the people in the laboratory department said that this kind of genetic testing takes a long time. It will take about a day to reach a conclusion."
"It doesn't matter." Sun Lien didn't have any objections to this. "Anyway, in her current condition, even if she is diagnosed immediately, she cannot undergo surgery. It doesn't matter if the test results are delayed by one or two days."
Xu Yourong continued to whisper, "The police have arrived."
"Police?" Sun Lien was stunned. He didn't know why the police came.
"Gao Yan's treatment has been stopped." Xu Yourong explained, "The police came and were waiting to get the death notice."
Gao Yan's treatment stopped here, and Sun Lien was actually somewhat depressed. After all, including Zhou Xiufang and Gao Yan, these were two consecutive patients who died. Especially after Zhou Xiufang's death, Sun Lien still wanted to leave emotionally.
Gao Yan was rescued. After all, Gao Yan was almost the last patient for whom Zhou Xiufang gave diagnostic advice in his life, and the family members of such patients finally chose to give up treatment, which indeed made Sun Lien feel uncomfortable.
Xu Yourong had just finished explaining the matter to Sun Lien, and the nurse Xiao Guo on the other side also walked over slowly. After watching Xu Yourong walk away, he whispered to Sun Lien, "Brother Sun... I may have caused trouble.
."
"Causing trouble?" Sun Lien asked, "What did you do? Which patient's ribs were broken?"
"No, no..." Xiao Guo whispered, "Old Mrs. Zhou left before... I posted it on Moments first."
"Huh?" Sun Lien still didn't understand what Xiao Guo was talking about.
Guo Yulai was anxious, and he explained in a hushed tone, "That's it... I told people outside first that Mrs. Zhou left. As a result, many people gathered in the hospital." Guo Yulai raised his eyelids, worried.
Glancing at Sun Lien, he asked, "Brother Sun, have I gotten into trouble?"
"It turns out it's your kid!" Sun Lien was still wondering before. After all, it was understandable that reporters came to the hospital, but how did those ordinary people, those Zhou Xiufang's students, friends, colleagues, patients and even the patients' families know about it?
Zhou Jun was busy moving Zhou Xiufang's case records from home at that time. He had no time to notify outsiders, let alone publish any obituary.
Nurse Xiao Guo sighed, "Brother, what should we do?"
"What else can we do? What else do you want to do?" Sun Lien was a little angry. Medical staff must keep the patient's condition strictly confidential. Xiao Guo posted a private WeChat Moment, which was tantamount to directly leaking the patient's condition and privacy. Although he was sure
Zhou Jun will not blame Xiao Guo for this, but after all, this is a very serious disciplinary issue. "Delete it quickly! Then go to Director Liu to admit your mistake!" Liu Tangchun has always been protective, as long as Xiao Guo's attitude is correct, he will be pointed at by Old Liu at most.
A scolding on the nose.
Xiao Guo went out to find Liu Tangchun to admit his mistake. Sun Lien waited in the emergency room and received the X-ray picture of Zhuang Zihao's child. There was no obvious abnormality on it. There was no fracture of the lateral condyle of the humerus or the radial head. The evidence was conclusive. This was a simple child.
Subluxation of the radial head.
Looking at the child Zhuang Zihao who was still crying while holding his own cartoon hat, Sun Lien sighed. "I'll reset the child first. Once the reset is done, it won't hurt anymore."
Zhuang's father nodded quickly. In order to make it easier for Sun Lien to operate, he specially pulled out the cartoon hat Zhuang Zihao was holding in his arms and placed it on the table in the duty room.
"Please put the child on the seat, just hold the shoulders, don't use too much force." Sun Lien ordered. In fact, he just wanted to give Zhuang's father something to do, so as to distract him, and at the same time, he used his father's
Just contact to ease Zhuang Zihao's children's vigilance.
Sun Lien straightened Zhuang Zihao's elbow at 90°, held Zhuang Zihao's elbow with his left hand, pressed his thumb on the small head of the radius bone in front of Zhuang Zihao's elbow, and pinched Zhuang Zihao's left wrist with his right hand. His left hand
The thumb squeezed upward, while the right hand pressed downward. At the same time, the right hand pinched Zhuang Zihao's wrist and rotated it back and forth.
"Click" Sun Lien's left thumb felt an obvious bouncing sensation, which was a sign of successful reset.
The pain at the moment of joint reduction made Zhuang Zihao cry again. Sun Lien quickly let go of his hand. In the last step, he glanced at the status bar on Zhuang Zihao's head. The "radial head subluxation" status had disappeared.
The child cried a few times and seemed to feel that crying alone was not enough to express his dissatisfaction. So while crying, he jumped off the stool and stretched out his hands towards his father for a hug. The movement of reaching out was smooth and natural. Look at it.
The reset was indeed successful.
"Okay, I'll make an order for you, just go out and pay." Sun Li'en nodded towards Father Zhuang who was grateful, "Remember, children should avoid strenuous exercise on this arm in the next week.
Otherwise, the reset arm may be dislocated again. Also, please don’t pull the child’s arm like this again.”
Father Zhuang held the child in his arms, bowed and thanked him, and walked out of the emergency room with the payment slip.
Sun Lien was packing his things. When he turned around, he found that Zhuang Zihao's hat was still on the duty desk and had not been taken away. He picked up the hat and went out to return the things to others. Only to find that the hat in the rescue hall was
Among the crowd at the payment window, Zhuang Zihao and Dad Zhuang were not seen.
"Where did he go?" Sun Lien scratched his head, and the nurse next to him who first let people into the emergency room pointed to the door, "He just went out with the child in his arms."
"Going out?" Sun Li'en was a little confused. If this person didn't register and change his scarf, why would he go out with his child?
The young nurse looked at Sun Lien who was in a daze and asked in a low voice, "Dr. Sun, is it... that the patient has evaded the fee?"