Xie Jian was still waiting for Lu Cheng's answer, but Lu Cheng remained silent and went to ask Zhou Linli and Peng Shanquan. He knew that his answer was not very satisfactory to Lu Cheng, so he went to them to seek a more suitable answer.

.

It doesn't matter if the answer is wrong, but you didn't tell me what to do next, so we all just froze here, and Xie Jian felt quite embarrassed.

Also, since Lu Cheng himself is so good, he is naturally more strict.

Moreover, Xie Jian was an undergraduate student in the five-year program of Hunan University before. Although Zhou Linli and Peng Shanquan did not belong to the five-year program, he had heard of the reputation of these two academic masters. He was not even qualified to be admitted to the postgraduate program.

Squeeze in and compare with them, the foundation may be slightly worse.

Zhou Linli looked at it and replied: "It should be possible to perform intramedullary nailing. I have seen the classification of this fracture, but I have forgotten it!"

Zhou Linli said very frankly that he was now in the period of choosing a department. He only understood but did not master the extremely professional knowledge of orthopedics. Naturally, he could talk about it openly. There was no need to hide it.

After listening to Zhou Linli's words, Peng Shanquan took over: "This fracture should be classified as C2.1 in the AO fracture classification! But I don't understand what Brother Zhou said about intramedullary nail internal fixation.

"

Everyone's grasp of the basic knowledge of each subject is different.

For example, the common surgical procedures and classifications of orthopedic fractures are the basis of orthopedics, but they are relatively in-depth foundations.

Peng Shanquan and Zhou Linli actually completed this supplement, which surprised Lu Cheng.

Lu Chengcheng nodded and said: "Xie Jian, this operation is scheduled to be closed reduction and intramedullary nail internal fixation of fractures. It is a level four operation. It requires routine blood preparation of 200ml of plasma + 4u of red blood cells, and pre-operative blood matching and other examinations!"

"

"Intravenous antibiotics + tranexamic acid to stop bleeding half an hour before surgery."

Xie Jian felt as if he had been granted amnesty. He looked at the two "unconventional" interns Zhou Linli and Peng Shanquan with some fear, and quickly went to work.

Then I thought to myself, it seems that even now that I have become a graduate student, I can't just relax. I still have to continue reading the professional books that I should read.

Lu Cheng looked at Xie Jian and explained as he wrote the doctor's order: "The AO classification of fractures is very widely used in fractures. In addition to the different codes of each bone, the fracture position of each long bone is different, and it can be

Divided into three groups of positions: proximal, backbone and distal."

"This patient's fracture is located in the middle and lower part of the femur, which is also a diaphyseal fracture."

"The types of fractures are divided into ABC three types based on simple, wedge-shaped bone fragments and complex fractures. Type A is simple, type B has wedge-shaped bone fragments, and type C is complex, comminuted fracture. Then the three types of ABC can be subdivided into 123

There are three subtypes, and each subtype can be divided into three categories: 123 based on specific circumstances."

"In total, fractures at each location can be subdivided into twenty-seven situations."

"Peng Shanquan just mentioned that this fracture belongs to C2.1. How did this come about? Complex fractures locate his C classification. The multi-segment fractures or columnar bone fragments in complex fractures determine that it belongs to

Type C2 fracture. C1 is a comminuted wedge-shaped bone fragment, and C3 is a comminuted irregular bone fragment type.”

"Type C2, in a complex columnar fracture, if there is only one columnar bone fracture, then it is C2.1. If there is a columnar bone fragment plus another wedge-shaped bone fragment, it is type C2.2. If it is a multi-segment columnar bone fragment, then

It’s C2.3!”

"The significance of this classification is to guide surgery. For example, in the C1 and C3 classifications, wedge-shaped bone fragments are absolutely unstable fractures. If intramedullary nails are used to fix them from within the bone marrow, it is definitely not advisable. Steel plates must be used

The fixation method is to add titanium mesh.”

"But for C2 type fractures, because there is a complete medullary cavity in the middle of the fracture fragment, the intramedullary nail can pass through the medullary cavity to achieve anatomical reduction. Therefore, intramedullary nail internal fixation can be used."

"The choice of surgical method is very clear and reasonable."

"Of course, this is just the classification of simple long bone fractures and the choice of internal fixation. If it is close to the joint surface, then the classification and selection of internal fixation are different, and there should be other reasons. But, study

, just like eating, you can’t eat enough in one bite.”

"We can discuss this issue slowly in the future."

"Xie Jian, you have delivered the operation first, done all the talking, and then wait for the operation to start at any time. If the operation is to be performed later, you must be there. There may be an emergency operation here and I won't be able to get there.

.”

Xie Jian quickly nodded and said, "Okay, thank you, Brother Lu."

Xie Jian naturally understood that what Lu Cheng said so much was not only to Zhou Linli and Peng Shanquan, but also to him. The reason why he came here before was because of the deliberate intention of his teacher Chang Weilong

The arrangement was to hope that Xie Jian could come to the emergency department and hang out with Lu Chengduo.

Lu Cheng is now the chief resident and can see a lot of basic orthopedic operations and surgeries. If he performs well, he may be able to get some surgical opportunities. This is an opportunity that Xie Jian cannot get in the sports medicine department.

Unless Xie Jian can, like Lu Cheng, participate in a sports medicine competition or go to a large sports medicine conference, get the appreciation of the boss, and then recommend him, but is this possibility?

Chang Weilong still felt that it would be better not to put more pressure on Xie Jian. Xie Jian would just go for the first-level emergency trauma surgery and feel more at ease.

People who do not have a medical qualification certificate should not dream of performing high-level surgeries.

Sure enough, when the first patient with a comminuted fracture of the shoulder joint came on stage, Lu Cheng's general hospital duty phone rang again.

Emergency rooms are like this. If it's not a large-scale car accident or other accident, emergency rooms are like goat poop. It happens every now and then. It may not be big, but it happens all the time.

There were quite a few people who could go on stage now, so Lu Chengcheng brought Zhou Linli with him, and then called Xie Jian and Peng Shanquan to go to the surgery.

Xie Jian and Peng Shanquan didn't think Lu Cheng was paying attention to Zhou Linli. After all, no matter how famous Lu Cheng was now, in their hearts, Professor Li Dongshan was still a big mountain. If they could get a stone off of him,

Those are all treasures.

Zhou Linli wouldn't be upset that Lu Cheng called him to the emergency room, because when he went to Professor Li Dongshan's place, there was a group of people following him. He was alone with Lu Cheng, and he might be able to practice his skills.

Each has his or her own merits, so that we can subtly allocate the interns and bedside doctors below. Of course, except for those who are deliberately lazy.

After Lu Cheng came to the emergency clinic of the emergency department, he found that the patient was a little girl with a double fracture of the ulna and radius. The X-ray had already been taken and she was crying profusely before the film was taken out.

Her parents were almost dying of panic, and her grandparents also looked worried.

As soon as they saw Lu Cheng coming, Yang Liao, a neurosurgeon who was rotated by the emergency surgery clinic, and Zou Qian, who was dragged to the emergency department by Yang Liao, both came over and said to Lu Cheng: "The patient's family members are not very easy to talk to.

They said that since the child is a girl, it would be difficult to have scars and they did not want to have surgery."

"So I can only call you here."

Zou Qian also worked with Li Dongshan in the past, so he has a certain understanding of fractures and can even perform fracture surgeries. But now that the emergency surgery and trauma center have been separated, Zou Qian still chooses to return to his old profession and does not plan to

I'm an orthopedic surgeon, so it's natural to come and give me some advice and help.

But he still didn't want to take risks when it came to manual reset.

Lu Chengcheng stood in front of the computer and scanned the patient's films.

The girl is very young, one or two years old at most, her epiphyses are far from closed, and her wrist bones only have two biochemical bones!

The fracture is not a common greenstick fracture in children, but it is not comminuted and is displaced. It is a junctional fracture where the classification of oblique fractures and transverse fractures is unclear.

The definition of a transverse fracture is that the angle between the fracture line and the long bone is greater than 60 degrees. An oblique fracture is that the angle is less than 60 degrees.

This little girl's fracture line is classified between fifty-five and sixty degrees. In principle, it is an oblique fracture and requires surgical intervention! However, manual reduction is not impossible. It is just that it is more difficult to reduce.

Because if the slope of the fracture surface is too large, it is very likely that dislocation will occur. If the malformation is healed by then, the interosseous symphysis will have to be scraped open again and internal fixation surgery will be performed again!

Not a good choice.

Lu Cheng raised his head and looked at the family members and asked: "Your child's fracture line is unstable. The best way is to choose surgical treatment. Conservative treatment is very risky, and there is a huge risk that it will be displaced after manual reduction."

, it will be a lot of trouble if I have to undergo surgery at that time."

"What do you think?"

The child's mother's eyes were red at the moment. The child fell down on the sofa without her paying attention. Her hands were swollen at that time. When she picked her up, she found that she had a fracture and needed surgery. She was full of guilt at the moment.

At the same time, I was also very anxious.

She said pleadingly: "Doctor, would you please call the best professor in your hospital to take a look? My child is less than two years old. She is so young, but she has such a big scar! The rest of her life will be like this.

But what should I do?”

"You are here at the Second Xiangya Hospital. There is definitely no risk without surgery, right? Don't you have experts and professors here?"

Lu Cheng is also very experienced in dealing with such situations. After all, he has managed the bed himself. He said: "Nearly all the professors are doing surgeries now. If you are willing to wait, you can wait until they finish the surgeries before you come to see them."

Look, the child’s current situation is not a particularly urgent one.”

"Moreover, you must also be mentally prepared. Professors are not omnipotent, and they cannot do things that violate principles or medical laws."

"If you choose to continue waiting, the child's swelling and pain will continue."

Such family members are also easier to answer. If you are looking for a professor, then wait for the professor to come first. Anyway, you are definitely not a professor, and there is no way to meet the requirements of the professor you are looking for.

Moreover, professors also have operations to perform now. You need to find the professor immediately. You can go to the medical department to apply, or kill all the patients and family members who are currently undergoing operations. Let him serve you exclusively.

"What's not urgent? How can it be urgent if you already have a broken bone? Doctors, don't you want to be responsible?" The child's grandfather immediately became irritable.

"Look at my child crying. You don't have children, right? That's why you're saying this, it's not urgent!"

"Please think about it carefully for us. If this happens to your cub, will you let her wait here?"

His voice was a bit loud, which attracted many people's attention.

Then he said: "Come and see, my granddaughter's bones are all broken, and he still says there's no rush."

People around him were gathered around curiously, each talking about his own words.

Zhou Linli's face felt a little painful at that time. This happened just after he came to the emergency consultation with Lu Cheng.

Lu Cheng didn't speak at that time, just said: "Hello, this is a hospital, I hope your voice is a little lower. There is an observation ward inside, and there is an ICU next to it. The patients living in it need to rest."
To be continued...