Pediatric physeal fractures have traditionally been described by the five-part Salter-Harris classification system. Type I fractures occur through the growth plate. These injuries may present with normal radiographs, and the diagnosis is often made clinically when tenderness is palpated over the growth plate. Type II fractures occur through the growth plate and metaphysis. Type II injuries are the most common physeal fractures. Type III fractures occur through the ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 48-year-old man is evaluated for a 2-day history of right anterior knee pain and swelling. The pain began suddenly and has increased in intensity. He currently rates his pain as an 8 on a 10-point scale. He has no knee instability and reports no fever or ...

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A friend of mine recently underwent a total knee replacement. Although he did well and was pain-free, he did say that he felt he was on an assembly line. I asked him what he meant. As he was talking, I flashed back 30 years, back to a time when by today's standards I would be considered a “good old country orthopedist.” Thirty years ago, I moved to a small community to ...

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American physicians deserve to be paid well for their work. As a physician, myself, I know what it takes to become a doctor in the U.S. Four years of late nights in the college library in hopes of achieving a GPA commensurate with medical school admission; then four years of medical school, which makes the college work load feel light in retrospect; then, in my case, three years of residency ...

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My first year after completing surgical residency was an exhilarating and exhausting experience that most physicians will recall as part of their training.  The American medical culture has imagined that the nation’s doctors -- no matter their workload -- simply don’t reach physical or emotional exhaustion in their work. But they do, and as we debate the future of healthcare in our country, we need to address this problem and quickly get to solutions, ...

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To listen to all those desperate to reform health care, you get the impression that physicians are pretty horrible people. We are all sexist, greedy, money grubbing tyrants who will perform unnecessary tests and procedures just to make money. We don't care about quality or cost. We are killing off 250,000 patients every year with our ignored "errors." We purposely keep our patients in pain, or we addict them to ...

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“You find joy that people are doing better because of what you did for them.” #BornToHeal Courtesy of the American Medical Association (AMA).

A patient of mine recently came to see me in a follow-up appointment after an emergency department visit. He had been working out at the gym, on a hot day, after he had skipped breakfast, and after his usual routine he felt extremely lightheaded. Everyone told him he looked "white as a sheet", and a physician who was at the gym told him he must go to the emergency department. In ...

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Test your medicine knowledge with the MKSAP challenge, in partnership with the American College of Physicians. A 67-year-old woman is evaluated during a routine examination. She has a history of hip and knee pain related to degenerative joint disease. The joint pain is now well controlled with diclofenac, which was started 3 months ago. A previous trial of high-dose acetaminophen was not effective. ...

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During my salad days, I — like a lot of physicians — thought I could take on the world. Despite working in a smaller, community hospital, our ER saw a lot of the same type of orthopedic trauma I saw during residency. And my young partners and I took virtually every case that came in except spinal trauma. We did this whether we were on unassigned ER call or not ...

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