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 2023

1 / 10

Hip

When revising an acetabular component in total hip arthroplasty, which of the following are appropriate treatment options for pelvic discontinuity?

Remediation:
A-C. Cup-cage construct, posterior column plating, and custom triflanges are all potential options for treating a pelvic discontinuity depending on the exact nature of the surrounding bone loss.
D. This type of implant would not be appropriate for a pelvic discontinuity because it would not provide enough structural support to promote healing.

2 / 10

Knee

Patients most often report difficulty with which of the following activities following total knee arthroplasty?

Remediation:
A -D. A patient's most common complaint following TKA is navigating stairs.

3 / 10

Trauma

A 32-year-old male patient presents to the emergency department after a 15-foot fall from scaffolding. The patient noted immediate right shoulder pain and right-sided back pain. Radiographs and a computed tomography scan of the right shoulder demonstrate a glenopolar angle of 10°, 1 mm of step-off at the glenoid, and a minimally displaced fracture of the inferior angle of the scapula. Which of the following parameters are indications for operative fixation of the glenoid?

Remediation:
A. The normal glenopolar angle is 22° to 25°. This is the bisector formed by a line tangential to the glenoid surface and one tangential to the lateral border of the scapula. A decreased glenopolar angle is associated with impingement of the shoulder on the lateral border of the scapula.
B. Fractures with >2 cm of medialization are associated with increased impingement, and operative intervention is indicated.
C. Articular step-off of >4 mm is an operative indication for glenoid fractures.
D. Most scapular fractures are treated nonoperatively, especially a minimally displaced fracture.

4 / 10

Foot and Ankle

A 58-year-old male patient presents with a painful arthritic midfoot with significant deformity 10 years after nonoperative treatment for a Lisfranc fracture-dislocation. He is unable to work or walk more than 50 feet without severe pain. He has failed nonoperative treatment. His radiographs are shown. Which of the following are the most appropriate treatment options for this patient?
foot ankle

Remediation:
A. This radiographs demonstrate 1st tarsometatarsal joint and naviculocuneiform arthritis, with substantial deformity. Both locations should be surgically addressed.
B. This patient requires corrective arthrodesis, especially in the setting of the midfoot collapse as demonstrated on the lateral radiograph.
C. The arthritic midfoot is symptomatic and would benefit from arthrodesis at the middle column.
D. Lateral midfoot arthrodesis is poorly tolerated and frequently results in complications.
E. Pantalar fusion is poorly tolerated even when indicated. In this case, pantalar arthrodesis is inappropriate for the primarily midfoot disease.

5 / 10

Hand and Wrist

Rapid-onset dense median neuropathy can be seen in patients with which of the following?

Remediation:
A. Idiopathic carpal tunnel syndrome is a slowly progressive compressive neuropathy. Upper-extremity neuropathies are associated with laborers who use vibratory tools. Evidence does not definitively support an association with jobs involving typing.
B. Severe poison ivy exposure on the dorsum of the wrist and forearm is not associated with rapid-onset carpal tunnel syndrome.
C. Poorly controlled rheumatoid arthritis can lead to rapid-onset median neuropathy due to space-occupying flexor tenosynovitis in the carpal tunnel.
D. Gouty arthropathy can lead to rapid-onset median neuropathy due to inflammatory flexor tenosynovitis in the carpal tunnel.

6 / 10

Pathology and Basic Science

Which of the following most likely increases the risk of developing mechanically assisted crevice corrosion following total hip arthroplasty?

Remediation:
A. Using a ceramic femoral head rather than a metallic femoral head should decrease mechanically assisted crevice corrosion.
B. Using a ceramic femoral head rather than a metallic femoral head should decrease mechanically assisted crevice corrosion.
C. Titanium modular necks may have higher fretting corrosion than cobalt-chromium modular necks.
D. Titanium modular necks may have higher fretting corrosion than cobalt-chromium modular necks.
E. Taper-trunnion mismatch may increase mechanically assisted crevice corrosion.

7 / 10

Pediatrics

Both hypophosphatasia and Vitamin D-resistant rickets are commonly associated with which of the following?

Remediation:
A. Both conditions present with genu varum and short stature.
B. Serum alkaline phosphatase levels are decreased in hypophosphatasia and normal or elevated in Vitamin D resistant rickets.
C. Dental caries not a feature of hypophosphatasia or rickets.
D. Both conditions present with genu varum and short stature.

8 / 10

Shoulder and Elbow

A 45-year-old female presents with worsening lateral elbow pain. Magnetic resonance imaging is shown. Which of the following accurately describes the findings seen on the patient's magnetic resonance imaging?
Shoulder and elbow jbjs

Remediation
A. The magnetic resonance imaging shows a partial tear of the extensor carpi brevis tendon.
B. The magnetic resonance imaging shows a partial tear of the extensor carpi brevis tendon.
C. The magnetic resonance imaging shows a partial tear of the extensor carpi brevis tendon.
D. The magnetic resonance imaging shows a partial tear of the extensor carpi brevis tendon.

9 / 10

Spine

A 19-year-old female patient is transferred from another hospital after being involved in a motorcycle crash. She has no other injuries except the one shown in the imaging. The integrity of the posterior ligamentous complex is uncertain. Her neurological examination is normal except for bilateral buttock and thigh pain while sitting. Which of the following is her Thoracolumbar Injury Classification and Severity (TLICS) score?
spine

Remediation:
A-D. Her TLICS score is 6 because burst fracture (2) + equivocal posterior ligamentous complex (PLC) involvement (2) + right hip pain (radiculopathy) (2) = 6

10 / 10

Sports Medicine

A 24-year-old male patient presents with left foot pain. He reports medial pain for approximately 3 months that worsens with an increased activity level. He has never been evaluated for this problem. On examination, he has pain along the posterior tibial tendon, and standing alignment demonstrates a hindfoot valgus with a "too many toes" sign. Radiographs are shown. Which of the following is the next appropriate step in management?

Remediation:
A. Initial treatment for posterior tibial tendon dysfunction should be nonoperative and include orthotics and physical therapy.
B. Initial treatment for posterior tibial tendon dysfunction should be nonoperative and include orthotics and physical therapy. Surgery should only be considered if nonoperative management fails.
C. Initial treatment for posterior tibial tendon dysfunction should be nonoperative and include orthotics and physical therapy. A triple arthrodesis would be appropriate for more severe disease.
D. Initial treatment for posterior tibial tendon dysfunction should be nonoperative and include orthotics and physical therapy.

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