Chapter 7: Chapter 0006: Fractures Not Seen in CT (Part 2)

A few minutes later, Chen Xiaobo, a resident doctor under Director Tian, called from the operating room: “Director Tian, there are bruises and swelling on the left knee.”

“Xiaobo, pause the surgery and send the patient to radiology for a bilateral hip joint MRI. Yes, I’ll explain to the family right now, immediately, right away.”

It’s really a dashboard injury!

Director Tian hung up the phone and looked at Yang Ping with admiration: “It really is a dashboard injury! You were right, I’m putting the surgery on hold immediately. I am now sending the patient to get an emergency hip joint MRI. Thank you for the reminder!”

Director Han said, “Hmm, if there really is a hidden femoral neck fracture, we’ll have to change our surgical approach. Any other thoughts?”

No one spoke. Director Han said, “Then let’s get ready. Tian Yuan, go to radiology immediately. I will also go down shortly to look at the MRI.”

Director Han dismissed everyone, then found a computer and carefully reviewed the patient’s X-rays and CT scans.

Song Zimo came over and quietly asked Yang Ping: “Does this patient really have a hidden femoral neck fracture? Hidden fractures don’t show up on X-rays and CT scans, do they? How did you see it?”

“I saw it with my eyes.” Yang Ping replied with a smile.

Song Zimo glared at him, then said, “I’m going down to radiology to take a look. Do you want to come?”

Yang Ping didn’t have anything else to do. It was his first day on the job, and he hadn’t been given any tasks. Besides, the doubt was raised by him. Naturally, he needed to go check it out.

Director Han came over at that moment: “Let’s go. Let’s go check it out together. I checked again just now. There indeed is a doubt.”

The three of them headed straight for radiology. Many others have already followed Director Tian there.

The patient was also sent to the MRI room to start preparing for the examination.

Director Han had called Director Meng, the head of radiology, in advance. Director Meng was waiting in the reading room. Director Han, Director Tian, Song Zimo, Yang Ping, along with some curious graduate students and standardized training students, gathered in a large circle.

When everyone saw Yang Ping arriving, they made space for him to stand inside the circle. Everyone was curious to see if there was indeed a fracture, as none of them had noticed it.

“Old Han, what’s going on? Hurrying to have an MRI for this patient, I’ve just looked at his CT and X-rays again, and there’s no femoral neck fracture.” Director Meng said.

Doctor Yang from our department just raised a doubt. He detected a hidden fracture from the X-rays and CT scans. To clarify, we’re doing an MRI. I’ve scrutinized the films myself as well, and there indeed is a doubt about this patient,” replied Director Han.

“I see!” Director Meng, consequently, stopped talking and quietly awaited the MRI images to appear on the screen.

The MRI room nurse was checking whether the patient had any magnetic metals on him, asking about potential contraindications like claustrophobia, and then had a form signed for confirmation.

MRIs use magnetism for examination. Magnetic metals are not allowed in, and if there are magnetic metals implanted in the body, some are also not allowed to be done, as strong magnets can move these metals.

Non-magnetic metals are fine, and most medical implants nowadays are non-magnetic.

Unlike X-rays and CT scans, MRIs don’t emit ionizing radiation. Ionizing radiation is the dreaded nuclear radiation everyone talks about.

Chen Xiaobo, the resident doctor under Tian Yuan, was currently assisting in moving the patient. Attending physician Fang Yan was also there.

“Brother Fang, why did Director Tian suddenly stop the surgery and have the patient taken down for an MRI?” Chen Xiaobo was confused.

“The new doctor Yang said that our patient has a femoral neck fracture. Director Tian didn’t see it, but he did.” Fang Yan didn’t sound too happy either.

The patient was on the operating table and the anesthesiologist’s needle was already in the spine. They were about to administer the drug when the surgery was abruptly halted. Now, they had to take the patient here for an MRI. Naturally, it was somewhat unsettling.

“The new guy, who is he? He’s so amazing!” Chen Xiaobo asked.

“Whether he’s amazing or not, let’s wait until the MRI result comes out.” said Fang Yan.

“You guys, why would you listen to the new doctor? Just because he says so, you bring the patient down here for an MRI. Let’s go, doctors, we can start the examination.” The technician complained as well.

“Upon hearing him say this, Director Tian had to take it seriously, dropping all the hard work on us,” Fang Yan said.

Once everything was ready, the technician pressed the switch on the external control panel, and the moving flatbed, with the patient on it, slowly passed through the ring-shaped machine opening.

On this side, the two directors stopped talking, and so did everyone else. Everyone silently waited for the examination to finish and the technician to upload the images.

The MRI procedure is slightly longer than ordinary inspections, but the MRI machine introduced by Sanbo Hospital is the most advanced 3.0T high-speed MRI in the world, which is dozens of times faster than ordinary MRI scans.

A few minutes later, images began to appear on the screen, filling the entire screen. Director Meng immediately grabbed the mouse and began reviewing the images, curious as to whether this patient had any fractures.

Director Han leaned in. Under the premise of maintaining a certain distance from the two directors, everyone else also gathered around as much as possible. Images were flipped, enlarged, and reviewed one by one.

Then one image was locked, enlarged, and Director Meng leaned forward, his mouse pointing to one area. He looked closely for a good five minutes.

“There is indeed a fracture in the neck of the femur. Look, Old Han, here, T1 and T2—.” Director Meng confirmed.

Director Han turned around and looked at Yang Ping, then leaned in: Indeed! It’s fractured!

This young man is impressive; he identified a concealed fracture in the neck of the femur during the morning shift review. This type of concealed fracture is extremely difficult to detect in x-rays and CT scans, like looking for stripes on a mosquito’s wing.

The first time they met, Han was impressed by Yang Ping’s sublime basic surgical skills, and today, his film reading skills surprised Director Han once again.

“Fractured, it’s fractured!”

With the answer out, everyone looked at Yang Ping in unison.

Fang Yan and Chen Xiaobo rushed from the MRI room to the viewing room. Did they hear correctly? Was there really a fracture? Had he really guessed correctly?

Director Han immediately instructed Director Tian, “We need to speak with the patient’s family again, a new consent form for the surgery needs to be signed, and the surgical procedure needs to be reconfirmed. It’s best to use an elongated PFNA to fix the femur and femoral neck at one time. In this case, the surgery will be postponed until tomorrow. We’ll discuss it this afternoon. Fortunately, we prioritized the MRI, otherwise, we would have fallen into a trap.”

“Thank you, thank you very much!” Director Tian patted Yang Ping’s shoulder.

“Come to my office later,” Director Han also patted Yang Ping’s shoulder.

Song Zimo found it a bit magical, how did he detect the fracture, how did he do it?

“How did you manage it?” Song Zimo asked.

Yang Ping shrugged, “Nothing special, just made a mistake once, and naturally became proficient.”

“The task of recommending a colleague to terminate the surgery and reconfirm the diagnosis has been successfully completed, bringing in the last beginner’s gift package,” the system’s female voice reminded.

Now, Yang Ping had gotten used to the system and wasn’t startled by its sudden voice and captions.

In the director’s office.

Director Han and Yang Ping sat across the desk from each other. “We should thank you for today. You’ve saved the department from a dispute. Have you ever completed any specialist training in radiology?”

Yang Ping shook his head.

But immediately said, “In the past, when I was at the People’s Hospital, I’d thoroughly studied almost all the orthopedic imaging materials in the computer system.”

After thinking for a moment, Director Han understood.

Yang Ping wasn’t lying. He had indeed worked hard in medical school and had studied almost all the image information in the department at the People’s Hospital. He also often went to the Radiology Department for consultations.

With such a solid foundation, coupled with the system suddenly going haywire, providing more than ten thousand image studies, Yang Ping had thoroughly developed a keen eye for imaging studies.

No matter how minute or difficult to detect the abnormalities on the X-ray images were, he could spot them at a glance.