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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

April 2025

1 / 10

Trauma

Which of the following blood vessels provides the majority of the blood supply to the femoral head in an adult?

Remediation:
A. The artery of the ligamentum teres provides the blood supply to the femoral head from birth to approximately 3 months of age.
B. The medial femoral circumflex artery is the major blood supply to the femoral head and enters the femoral neck posteriorly.
C. The lateral femoral circumflex artery is not the major blood supply to the femoral head.
D. The lateral epiphyseal arteries supply blood to the femoral head through adolescence.

2 / 10

Sports Medicine

A male patient who is a college football player has suffered his third burner this season. You obtain radiographs which demonstrate a Torg-Pavlov ratio of 0.70. Which of the following would you say when counseling this athlete?

Remediation:
A. Spinal canal stenosis is correlated with recurrent burners/stingers
B. A Torg-Pavlov ratio of <0.80 is consistent with spinal canal stenosis, which increases his risk for additional injuries.
C. A Torg-Pavlov ratio of <0.80 is consistent with spinal canal stenosis.
B. Same as C

3 / 10

Spine

A 62-year-old female patient with worsening chronic low back pain reports intermittent, radiating right leg pain over the past 1 year. Plain radiographs are shown. Which of the following best describes the patient's likely outcomes after 2 years of nonoperative treatment?

Remediation:
A. 25% of patients have serious adverse events unrelated to their spine condition after long-term nonoperative treatment.
B. There is no substantial change in patient-reported function and pain after long-term nonoperative treatment.
C. There is no substantial change in patient-reported function and pain after long-term nonoperative treatment.
D. There is no increased risk of worsening neurological symptoms or deficits after long-term nonoperative treatment.

4 / 10

Shoulder and Elbow

Which of the following is an independent risk factor for instability following a reverse total shoulder arthroplasty?

Remediation:
A. male sex is not an independent risk factor for instability.
B. A high body mass index is an independent risk factor for instability.
C. A medialized design prosthesis is not an independent risk factor for instability.
D. Revision surgery is an independent risk factor for instability.

5 / 10

Pediatrics

A 9-year-old girl has been having pain at the base of the fifth metatarsal for the past 3 to 4 weeks since starting a new soccer season. She does not recall any traumatic event precipitating the pain. A radiographs is shown. Which of the following is the most likely diagnosis?

pediatrics

Remediation:
A. Iselin disease is an apophysitis of the base of the 5th metatarsal. Radiographs are unremarkable for the condition, and the diagnosis is clinical based on tenderness and pain in this area.
B. A Jones fracture is a 5th metatarsal base fracture that is more distal than the area of concern in the radiograph.
C. Kohler disease is osteonecrosis of the navicular, which is not suggested by this image.
D. Sever's disease is calcaneal apophysitis, which is associated with heel pain and unremarkable radiographs
E. Freiberg disease is osteonecrosis of the metatarsal head, which is not suggested by these radiographs.

6 / 10

Basic Science and Pathology

A 12-month-old child is referred for short stature. The child has a history of frequent respiratory tract infections. Examination reveals a short neck, coarse facies, and claw hands. Radiographs indicate flaring of the ribs and medial clavicle, anterior vertebral wedging, and odontoid hypoplasia. Which of the following is most likely to limit this child’s mobility?

Remediation:
A. Chronic knee dislocations may be found in several conditions, including arthrogryposis and Larsen syndrome. Hurler syndrome has occasionally been associated with dislocations of the hips.
B. Hurler syndrome is commonly associated with joint stiffness, notably of the hips, that mostly affects hip extension that is required for fluid gait.
C. While children with Hurler syndrome may have a deceleration in cognitive development, this disorder is not typified by neurological deterioration.
D. Hurler syndrome is characterized by hip stiffness but not hip dysplasia.

7 / 10

Hand and Wrist

A 22-year-old male patient who is right-hand dominant and a tennis player presents with right ulnar-sided wrist pain and a "snapping" feeling when he rotates his wrist, particularly against resistance. On examination, his extensor carpi ulnaris (ECU) tendon translates volarly when his wrist is brought into supination. He was treated with a splint in pronation for 6 weeks without any improvement in symptoms. Operative treatment would include which of the following?

Remediation:
A. Debridement of ECU split tears and tubularization of the tendon do not address ECU instability.
B. Reduction of the ECU and tenodesis to the ulnar head is not the standard treatment for ECU instability. Tenodesis of the ECU to the ulnar head takes away its ability to act as a wrist extensor.
C. ECU subsheath reconstruction with a radially based extensor retinaculum flap is the appropriate operative treatment of acute ECU instability once immobilization has failed.
D. Reconstruction of the volar and dorsal radioulnar ligaments alludes to triangular fibrocartilage complex reconstruction. This might be performed for DRUJ instability, but is not relevant to this scenario.

8 / 10

Foot and Ankle

A 49-year-old female patient presents with ankle pain on weight-bearing. Magnetic resonance imaging is shown. She has tried 9 months of offloading and a local anesthetic ankle injection without improvement. She has sickle cell disease. Which of the following is the most appropriate intervention?

foot

Remediation:
A. Core decompression for osteonecrosis without collapse is an appropriate treatment after failed nonoperative treatment. The failed injection suggests that the pain is coming from the bone.
B. Collapse is not demonstrated. The talus disease is not extensive enough to merit tibiotalocalcaneal (TTC) fusion with a bulk allograft.
C. Ankle arthroplasty is typically not performed in the setting of osteonecrosis of the talus.
D. Ankle fusion may be performed eventually. Without collapse, core decompression should be performed initially in order to spare the joint, especially if the pain is coming from the bone.

9 / 10

Knee

A 60-year-old male patient with severe bone-on-bone arthritis and a 20° flexion contracture is scheduled for total knee arthroplasty. During the surgery, in addition to the standard measured resection distal femoral cut to compensate for the flexion contracture, another 4 mm is resected. This additional resection may cause which of the following postoperatively?

Remediation:
A. Resecting more of the distal aspect of the femur can potentially lead to mid-flexion instability
B. Elevation of the joint line by resecting more of the femur can lead to a loss of range of motion.
C. Resecting more of the distal aspect of the femur can lead to a loss of range of motion by elevation of the joint line.
D. Same as C

10 / 10

Hip

A 58-year-old female patient presents with a painful right total hip arthroplasty. Her serum erythrocyte sedimentation rate and serum C-reactive protein level are both elevated; however, two aspiration attempts one week apart both fail to produce any fluid. A radiograph is shown. Which of the following is the best next step?
hip

Remediation:
A. It is unclear whether or not the patient has an infection. The elevated erythrocyte sedimentation rate and C-reactive protein level are concerning but not diagnostic of infection. Additional intra-operative data are necessary to diagnose or exclude a periprosthetic joint infection.
B. Same as A
C. It is unclear whether or not the patient has an infection. The elevated inflammatory markers are concerning but not diagnostic of infection. Additional intra-operative data are necessary prior to subjecting the patient to a 2-stage revision.
D. A periprosthetic joint infection has not been excluded, and single-component revision cannot be advocated at this time.

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