The JBJS Quiz of the Month is a collection of 10 relevant questions from each orthopaedic subspecialty. The questions are drawn from JBJS Clinical Classroom, which houses over 4,500 questions and 3,100 learning resources. Take the Quiz to see how you score against your peers!

NOTE: This quiz does not earn users CME credits. The questions must be answered within Clinical Classroom to earn CME credits.

A 25-year-old male patient sustains an open tibial shaft fracture after a high-speed motor-vehicle collision. He is treated initially with serial irrigation and debridement, which leaves the tibia with a clean 4-cm midshaft cortical defect with good soft- tissue coverage. Definitive management should include open reduction and internal fixation with:

    • Placement of bone morphogenetic protein (BMP) into the defect
    • The clinical application of bone morphogenetic protein (BMP) in a 4-cm cortical defect is limited


    • Acute shortening
    • Acute shortening should not be performed for defects of >3 cm


    • Platelet-rich plasma (PRP) in the defect
    • Platelet-rich plasma (PRP) has not been shown to have a definitive effect on bone healing


    • Placement of autologous bone graft into the defect
    • Autologous bone graft is a good option for bone loss of 4 cm