Proximal tibial physis fractures and the use of noninvasive studies in detecting vascular injury: a case report and literature review.

A fracture to the proximal tibia physis is a relatively rare injury, possibly because of the relatively protected position of the physis in the knee. Rarer yet is a displaced, apex-anterior, growth plate fracture. This injury should be regarded as a knee dislocation and evaluated for the potentially catastrophic outcome of a thrombosed popliteal artery. The risk of vasospasm in children from an invasive procedure (e.g., angiogram), however, must be taken into account. This article presents an unusual case of an anteriorly displaced proximal tibia physis fracture in a 14-year-old boy. A noninvasive solution for evaluation of the potential vascular injury is proposed.

Sports injuries of the knee.

In spite of considerable research efforts, knee injuries continue to plague athletes. The rate of occurrence may actually be increasing. Particularly vulnerable to injury because of its anatomic location, the knee sustains a tremendous amount of force during sports. Physicians caring for these patients must be familiar with the mechanism of these injuries. This report aims to familiarize rheumatology physicians with an overview of the anatomy, function, physical examination, and treatment of the various anatomic structures that are commonly injured.

Occupational exposure among medical students and house staff at a New York City Medical Center.

BACKGROUND: The purpose of the study was to ascertain the prevalence of and reasons for underreporting of occupational exposures to patients' blood and body fluids among students and house staff. METHODS: A questionnaire surveyed 110 medical students and 275 house staff members regarding the number of reported and unreported exposures to patients' body fluids, and the reasons why the respondents did or did not report their exposures during the previous 6 months. RESULTS: Of 385 surveys returned, representing a response rate of 60%, 122 respondents (32%) experienced 330 occupational exposures during the previous 6 months. Fifty-two percent of surgical house staff, 27% of students, and 20% of medical house staff were exposed. Whereas the exposure risk to surgical house staff increased with training, the risk to medical house staff decreased with training. Only 29% of exposed respondents reported an exposure. Exposures from sources known to be positive or at high risk for human immunodeficiency virus had the highest reporting rates. The most frequent reason for not reporting an exposure was that the patient was thought not to be infectious. Forty-six percent of respondents exposed to sources of unknown human immunodeficiency virus status who did not report chose "patient thought not to be infectious" as the reason. The most common reason for reporting an exposure was "hospital policy." CONCLUSIONS: Although limited by recall bias, this study showed that a high proportion of students and house staff experience occupational exposures. The results suggest that populations at high risk for exposures are the more experienced surgical house staff and the junior medical house staff. Exposures from sources known to be positive or at high risk for human immunodeficiency virus were reported more frequently than those from unknown risk sources.