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

November 2025

1 / 10

Trauma

A 35-year-old male patient who is a machinist sustained a laceration to the proximal aspect of the forearm and is unable to extend his wrist and metacarpophalangeal joints. He has decreased sensation over the dorsal aspect of his hand and a normal tenodesis effect in the injured hand. Which of the following structures is injured?

Remediation:
A. The posterior interosseous nerve courses distal to the radial neck and innervates most of the wrist and finger extensors but has no cutaneous innervation.
B. The anterior interosseous nerve crosses the anterior portion of the elbow and emerges in-between the pronator heads to run along the volar surface of the flexor digitorum profundus to innervate the radial half of the flexor digitorum profundus, the flexor pollicis longus, and the pronator quadratus.
C. The median nerve runs with the brachial artery and crosses the elbow medial to the biceps tendon. It then branches into the anterior interosseous nerve, the recurrent branch to the thenar compartment, the palmar cutaneous branch, and the digital cutaneous branches.
D. The radial nerve comes off of the posterior cord of the brachial plexus and branches into the posterior interosseous nerve (PIN) and the superficial radial sensory branch. A normal tenodesis effect indicates that there is no extensor tendon rupture.
E. The ulnar nerve runs on the medial aspect of the elbow in the cubital tunnel and is at less risk. The resultant decreased sensation from an ulnar nerve injury would be over the ulnar aspect of the hand.

2 / 10

Sports

A 38-year-old female patient has several years of left knee swelling, stiffness, and pain. She denies any systemic symptoms. Examination demonstrates an antalgic gait, a large effusion, and reduced motion of the knee. A radiograph and magnetic resonance image are shown. Which of the following is the most likely diagnosis?

Remediation:
A. The magnetic resonance imaging shows synovial inflammation and intra-articular, loose cartilaginous bodies, consistent with synovial chondromatosis.
B. In pigmented villonodular synovitis, magnetic resonance imaging would show a soft-tissue mass.
C. In synovial sarcoma, magnetic resonance imaging would show a heterogeneous mass.
D. A chondrosarcoma affects the bone, not the intra-articular structures.

3 / 10

Spine

Which of the following is the approximate percentage of vertebral compression fractures that are not identified on standard radiographs?

Remediation:
A - D   According to the IMPACT study, the rate of missed diagnoses of osteoporosis in women over the age of 50 years is 45% when using standard radiographs.

4 / 10

Shoulder and Elbow

When compared with single-stage revision arthroplasty for a periprosthetic shoulder infection with Cutibacterium acnes, which of the following best describes reported outcomes after two-stage revision?

Remediation:
A. There are several studies that show inferior patient-reported outcomes after two-stage revision arthroplasty.
B. The rate of eradication of infection for single-stage and two-stage revision arthroplasty are similar in short-term to mid-term follow-up.
C. In addition to subjecting patients to a second procedure, two-stage revision is associated with a higher complication rate (wound healing, spacer fracture or dislocation, loss of cuff and bone stock, and stiffness).

5 / 10

Pediatrics

A 13-year-old male patient presents with lower-extremity deformities. A clinical photograph and a standing mechanical axis radiograph are shown. He has a body mass index of 28 kg/m². The knee difference has been worsening over the past several years. He reports mild pain in both knees with ambulation, and his parents are concerned about the shape of the knees. Which of the following is the most appropriate treatment option?

Remediation:
A. The patient has bilateral adolescent Blount's disease with a worse deformity on the left. Observation is ineffective in correcting the current deformity and preventing progression with continued growth.
B. The patient has bilateral adolescent Blount's disease with a worse deformity on the left. Bracing is controversial for infantile Blount's disease and has never been shown to be effective for adolescent Blount's disease.
C. The patient has bilateral adolescent Blount's disease with a worse deformity on the left. Operative intervention consisting of an acute or gradual corrective osteotomy is preferred to improve the deformity and optimize future knee function.
D. The patient has bilateral adolescent Blount's disease with a worse deformity on the left. Complete epiphysiodesis of the proximal aspect of the tibias would, at best, halt the deformity, but would not improve it.
E. The patient has bilateral adolescent Blount's disease with a worse deformity on the left. Although one-third of patients will have an associated femoral varus, it is not the principal deformity. Complete distal femoral epiphysiodesis would not halt the progression of the deformity and would not improve it.

6 / 10

Pathology and Basic Science

A 65-year-old female patient underwent right total knee arthroplasty 3 days ago. She has minimal pain and normal postoperative swelling and skin changes. She is being treated with mechanical and pharmacological deep vein thrombosis (DVT) prophylaxis. She is anxious about developing a blood clot and requests an evaluation to rule out a DVT before she is discharged. Which of the following is the most accurate response to the patient's request?

7 / 10

Hand and Wrist

A 50-year-old male patient presents to the emergency department at 7 AM after cutting his finger last night assembling a swing set. He reports that the finger was red, swollen, and painful when he awoke this morning. On examination, there is a 5 mm wound on the volar aspect of the index finger at the level of the proximal phalanx. The finger is erythematous, swollen and there is no drainage. The patient experiences severe pain on passive extension of the finger. Which of the following is the most appropriate initial treatment for this patient?

Remediation:
A - D  The patient presents with symptoms concerning for septic flexor tenosynovitis. Since he presented within 24 hours of injury, he should be admitted for intravenous antibiotics and close observation. If there is no improvement within 24 hours, operative treatment may be indicated.

8 / 10

Foot and Ankle

A 58-year-old female patient presents with 2 years of progressive hindfoot deformity and pain. Nonoperative treatment has failed. Examination demonstrates a gastrocnemius contracture, passively correctable hindfoot valgus, and fixed forefoot varus. Pulses are palpable and sensation is normal. In addition to gastrocnemius lengthening, which of the following procedures represents the best operative intervention for this patient?

Remediation:
A. Debridement and tenosynovectomy is reserved for stage-I disease that fails nonoperative treatment.
B. Arthrodesis is performed for rigid disease/deformity.
C. Repair of the posterior tibial tendon is not performed in isolation due to historical failure.
D. A flexible deformity with residual forefoot varus is best treated with the described procedures.

9 / 10

Knee

A 38-year-old female patient presents with right knee pain and patellar instability for the past 1 year. Physical therapy, bracing, and anti-inflammatory medications were unsuccessful. Prior operative treatment included an arthroscopic chondroplasty, which found grade-II and III Outerbridge changes to her lateral and distal patellar facet, but well-preserved articular cartilage in her trochlea and medial patellar facet. Axial cuts of her computed tomography (CT) scan are shown. She has a lateral patellar tilt of 4°, a tibial tubercle-trochlear groove distance of 25 mm, and her posterior condylar axis is 3° internally rotated with respect to her transepicondylar axis. Which of the following operative treatment options would be the best option for this patient?

Remediation:
A. The trochlear groove cartilage is intact and the patient is very young. This case would be a poor candidate for a patellofemoral arthroplasty. Anteromedialization of the tibial tubercle is the best surgical option.
B. A simple lateral retinacular release is almost never indicated in isolation for patellar instability or abnormal lateral tracking of the patella. Anteromedialization of the tubercle is the treatment of choice for this patient.
C. The trochlear groove cartilage and the medial facet of the patella have intact cartilage. The tibial tubercle-trochlear groove distance is elevated (>20 mm is considered abnormal) at 25 mm, making this patient a candidate to undergo anteromedialization of the patella.
D. MPFL reconstruction is indicated for patellar instability in the absence of deformity. The tibial tubercle-trochlear groove distance is elevated at >20 mm and therefore needs to be addressed. Anteromedialization of the tubercle is the treatment of choice for this patient.
E. Trochleoplasty is rarely indicated and is used for anatomic restoration of an absent trochlear groove. On CT, this patient has an anatomically normal trochlear groove. Anteromedialization of the tubercle is the treatment of choice for this patient.

10 / 10

Hip

Which of the following radiographic findings is most likely present in the right hip shown in the radiograph?

hip

Remediation:

A - D . This image shows a hip with developmental dysplasia, which displays the characteristic findings of increased Tönnis angle and decreased lateral center-edge angle. CT scan would likely show increased femoral anteversion.

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