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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.

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QUIZ of the Month Title Image with Orthopaedic Icons

September 2022

1 / 10

You are assessing a 37-year-old male patient with an anterior-posterior compression (APC) type 2 pelvic ring injury. The injury has been stabilized with a pelvic external fixator and the patient is hemodynamically stable 3 days post-trauma. Which of the following is the definitive management of the patient's pelvic injury?

Remediation:
A. APC type 1 or lateral compression type 1 injuries can be treated nonoperatively with protected weight-bearing due to the low likelihood of further displacement.
B. Vertical shear injuries are unstable with complete disruption of all ligamentous supporting structures and require operative stabilization of anterior and posterior injuries with a possible posterior plate.
C. APC type 2 injuries are defined by anterior diastasis of >2.5 cm and anterior sacroiliac joint widening, and require anterior stabilization with possible posterior stabilization.
D. Posterior stabilization can be used in addition to anterior pelvic ring stabilization in APC type 2 injuries but should always be performed in APC type 3 and vertically unstable pelvic ring injuries.

2 / 10

A 50-year-old male presents for persistent Achilles tendon pain. You saw him 1 year ago and diagnosed him with noninsertional Achilles tendinitis. He has tried physical therapy, activity modification, rest, immobilization, and shockwave therapy. He continues to have pain, and has been unable to return to his running program. He has 10° of ankle dorsiflexion, both with the knee flexed and extended. Magnetic resonance imaging confirms the diagnosis of noninsertional Achilles tendinosis. Which of the following is the next step in management?

Remediation:
A. His ankle dorsiflexion does not decrease with knee extension. This is not consistent with a gastrocnemius contracture and, therefore, a gastrocnemius recession would not be indicated.
B. This would be appropriate for insertional tendinitis with a Haglund deformity, not for noninsertional tendinitis.
C. After extensive nonoperative treatment, surgery should be considered.
D. After extensive nonoperative treatment, surgery should be considered. A flexor hallucis longus transfer should be considered if >50% of the tendon is involved.

3 / 10

An 81-year-old female patient who is an avid hiker slips and falls on some loose gravel, striking her head and twisting her ankle. She is taken to the nearest trauma center and diagnosed with a closed right ankle fracture, a left distal radial fracture, and a type-II odontoid fracture. Her ankle and wrist fractures are reduced and splinted. Which of the following most accurately describes the prognosis for her odontoid fracture?

Remediation:
A. There is a difference in risk of morbidity and mortality. Specifically, odontoid fractures in octogenarians (>80 years old) are associated with higher morbidity and mortality compared with patients between 65 and 80 years old.
B. Odontoid fractures in octogenarians (>80 years old) are associated with higher morbidity and mortality compared with patients between 65 and 80 years old.
C. Odontoid fractures in octogenarians (>80 years old) are associated with higher morbidity and mortality compared to younger patients, regardless of intervention. This may be due to age-related factors such as higher risk of nonunion due to insufficient blood supply, more medical comorbidities, osteoporosis, or diminished rehabilitation capacity seen in elderly patients.
D. Low-energy trauma (e.g., a fall from standing) is a common cause of odontoid fractures in elderly patients. A low-energy mechanism indicates fragility fracture and underlying diminished bone density and/or frailty, both of which increase the risk of morbidity and mortality.

4 / 10

A 55-year-old male patient dislocates his shoulder while skiing. The shoulder is reduced immediately on the ski slope. Afterwards, he asks you whether he should have magnetic resonance imaging (MRI). An MRI would be clinically helpful to assess for the presence of which of the following?

Remediation:
A. While an acute labral tear is possible, patients who are >50 years old have a higher chance of a rotator cuff tear after dislocation.
B. Patients who are >50 years old have a higher chance of a rotator cuff tear after dislocation when compared with younger patients.
C. While a Hill-Sachs defect is possible, patients who are >50 years old are more likely to have an acute full-thickness rotator cuff tear.
D. Patients who are >50 years old are more likely to have an acute rotator cuff tear than a Bankart lesion.

5 / 10

A 5-year-old boy presents with limited neck range of motion, no pain, and no history of trauma. The neck appears short, and the posterior hairline is low. This triad of findings is most likely due to which of the following?

Remediation:
A. A short neck is not seen in os odontoideum.
B. A patient with cerebral palsy will not have a short neck.
C. Congenital muscular torticollis does not involve short necks with a posterior hairline.
D. These atraumatic findings indicate Klippel-Feil syndrome, a congenital fusion of 2 or more cervical vertebrae.

6 / 10

Induced pluripotent stem cells (iPSCs) can be produced by which of the following methods?

Remediation:
A. iPSCs are produced by transfection of selected genes in somatic cells. Genes that are often used are are Oct4, Sox2, c-Myc, and Klf4.
B. iPSCs are produced artificially from differentiated somatic cells.
C. iPSCs are produced artificially from differentiated somatic cells.
D. iPSCs are produced artificially from differentiated somatic cells.

7 / 10

A 45-year-old male patient who is a chiropractor has been seen for several years with increasingly symptomatic trapeziometacarpal osteoarthritis. He would like to proceed with trapeziometacarpal fusion. Which of the following is a relative contraindication to this procedure?

Remediation:
A. Age is not a contraindication to trapeziometacarpal fusion. Fusion has been classically utilized in younger patients, especially those who work as manual laborers.
B. Severe trapeziometacarpal arthritis is not a contraindication to fusion.
C. Trapeziometacarpal fusion puts further stress on the STT articulation; therefore, STT joint arthritis is a contraindication to trapeziometacarpal fusion.
D. Contralateral trapeziometacarpal arthritis is not a contraindication to fusion.

8 / 10

Symptomatic hallux valgus associated with the radiographic finding of an elevated distal metatarsal articular angle (DMAA) is best addressed by which of the following operative interventions?

Remediation:
A. A lateral distal soft-tissue release is performed along with medial capsulorrhaphy when addressing an incongruent deformity (or normal DMAA).
B. Medial capsulorrhaphy affects the angular correction of hallux valgus with an incongruent joint.
C. Unless it is associated with arthritic disease, hallux valgus with increased DMAA is not treated with a joint-sacrificing procedure.
D. Biplanar chevron osteotomy allows angular correction of the hallux valgus deformity without causing a congruent joint to become incongruent.

9 / 10

A 56-year-old male patient who is a police officer presents with a new onset of medial left knee pain following a slip and fall. The knee is swollen, and the patient reports occasional locking and catching. The knee has 3° of varus alignment. He denies pain prior to the fall. Magnetic resonance imaging of the knee shows a large tear in the posterior horn of the medial meniscus and Kellgren-Lawrence grade 2 arthritic changes. The pain and dysfunction are preventing him from working, and the knee is too swollen and painful for physical therapy. Optimal treatment should consist of which of the following?

Remediation:
A. The patient has a symptomatic medial meniscus tear with minimal arthritis; therefore, an arthroscopic partial medial meniscectomy is indicated.
B. The patient does not meet indications for a total knee arthroplasty.
C. The patient does not currently have advanced medial compartment arthritis to require unloading. Magnetic resonance imaging shows a medial meniscus tear that can be addressed with arthroscopy.
D. The patient has a symptomatic medial meniscus tear that is preventing him from performing his job; therefore, arthroscopy is indicated rather than injection therapy.

10 / 10

Which of the following is the anatomic dissection plane utilized in the anterior approach to the hip?

Remediation:
A.  The gluteus maximus is encountered during the posterior approach to the hip.
B. The tensor fascia lata and sartorius muscles comprise the dissection plane for the anterior approach that is superficial to the rectus femoris and gluteus medius.
C. This is the correct dissection plane for the anterior approach, deep to the tensor fascia lata and sartorius muscles
D. The piriformis is encountered during the posterior approach to the hip, and although the piriformis may be released during extensive femoral exposure during an anterior approach, it is not part of the anatomic dissection plane.

 

 

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