A Physician’s Clinical Diary, Episode 45— Between Numbers and People —Surgery and Treatment of a Motorcycle Accident Patient(2)
Surgery and Treatment of a Motorcycle Accident Patient
[Chapter 2: The War Called Classification]
The air in the conference room was always faintly taut. The windows were shut, and the low hum of the projector fan filled the space. On the screen, the same CT scan played on repeat.
The lateral tibial plateau.
A thin split line.
A depression resting on top of it.
Elias Lee stood with his arms crossed. There was a simple reason he didn’t sit. In this room, judgment was required—and judgment demanded physical tension.
“You were suggesting Type II,” someone said.
It was Junho, the orthopedic fellow, who spoke first. His voice was calm, but beneath that calm lay a clear disagreement.
“Yes,” Elias replied shortly.
“If the depression is the dominant lesion, wouldn’t Type III be more appropriate?”
Another resident chimed in. An arrow on the screen pointed directly at the depressed area.
“There’s a split at the margin,” Elias said.
“At this extent, couldn’t it be incidental?”
The word landed heavily in the room. Incidental was a dangerous term in medicine. Elias paused the video and magnified the split line as much as possible.
“Does this look incidental to you?”
He asked the question quietly. No one answered.
“The Schatzker classification doesn’t look only at the size of the depression,” Elias continued.
“It considers the direction of energy transfer, the stability of the articular surface—and reproducibility.”
Minjae opened his laptop.
“Type II is the most common.”
“Which is exactly why it’s more dangerous,” Elias shot back immediately.
“Common means it’s easy to decide too quickly.”
He paused and advanced the slide. An old case appeared on the screen. The same lateral depression. The old note beneath it.
— Conservative reduction.
“This patient came back two years later.”
Elias’s voice grew lower, but the air in the room grew heavier.
“Collapse of the articular surface. Early degenerative changes.”
Someone swallowed.
“Classification is the beginning of war,” Elias said.
“If you lower the number to avoid the fight, the war comes back in another form.”
Junho asked again,
“Surgical approach?”
“Lateral approach.”
“Plate?”
“A locking plate. Not a butterfly.”
That decision immediately translated into cost, time, and the risk of complications. Elias knew all of that. And knowing it, he still chose it.
When the conference ended, footsteps scattered in different directions. Elias remained behind and finally sat down. The legs that had kept him standing now felt heavy.
He opened a photo saved on his phone. An old patient record. The name had been erased, but the date remained. Seven years ago.
Since that day, he had treated classification with far more caution.
Around lunchtime, the patient’s wife arrived at the ward. Her eyes were red. Elias guided her into the consultation room.
“The fracture is more complicated than it appears,” he began.
“It’s not just a broken bone—the surface that forms the joint has collapsed.”
She nodded, but her expression showed more anxiety than understanding.
“Will surgery fix it?”
Elias was silent for a moment. Then he said,
“We can do our best.”
He didn’t use the word cure. Instead, he explained the process and the possibilities—plates, screws, rehabilitation, and the fact that time would be needed.
“The reason classification matters,” he continued carefully,
“is because it determines the extent of surgery. Doing less may seem safer, but it can return later as a much bigger problem.”
She clasped her hands tightly.
“I trust you, doctor.”
Those words were always heavy. Elias lowered his head.
Back in the residents’ office, Minjae approached him.
“Professor.”
“Yes.”
“That past case you mentioned earlier… do you still think about it?”
Elias paused.
“There’s no case that truly disappears.”
He said that and turned on the computer. The same CT scan was still on PACS. The classification chart was pinned beside it.
“Schatzker created numbers,” Elias said quietly,
“but the numbers don’t carry the responsibility.”
Minjae said nothing. Instead, he wrote a single line in his notebook.
— Classification is the beginning of choice.
That evening, Elias went up to the hospital rooftop for a moment. The city lights spread out below him. He didn’t smoke, but the habit of standing in the wind remained.
The surgery was scheduled for tomorrow.
He wondered: Will tomorrow’s me stand by today’s judgment?
Below, an emergency siren wailed. Another case. Another classification.
Elias Lee put his gown back on.
The war was not over yet.
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To be continued
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