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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

July 2024

1 / 10

Trauma

A 45-year-old male patient sustained a midshaft clavicle fracture 2 years ago and now presents with persistent pain and mobility at the fracture site with no history of recent trauma. Which of the following complications does this patient most likely manifest?

Remediation:
A. Malunion will not present with movement at the fracture site.
B. The fracture has been present for more than 1 year with no signs of healing; therefore, it is a nonunion rather than a delayed union.
C. The clinical history and examination (pain and mobility at the fracture site) are consistent with a fracture nonunion.
D. With no history of recent trauma, this is unlikely to be the case.

2 / 10

Sports

A 19-year-old male patient who is a football running back sustains a knee injury followed by an acute hemarthrosis. A plain radiograph of the knee is shown, demonstrating a displaced osteochondral fragment. Which of the following would be an appropriate next step in management?

Remediation:
A. The patient has a large loose body that should be removed, and the fracture should be treated with fixation.
B. Same as A
C. Same as A
D. Same as A

3 / 10

Spine

A 55-year-old female patient presents with neck pain and headaches. She has a 20-year history of rheumatoid arthritis. On examination, she is neurologically intact. Sagittal computed tomography and magnetic resonance imaging and a radiograph are shown. Which of the following radiographic measurements indicate atlantoaxial instability and basilar invagination?

Remediation:
A. This patient has atlantoaxial instability and basilar invagination secondary to rheumatoid arthritis. A posterior atlantodens interval (PADI) ≤14 mm indicates atlantoaxial instability and can serve as an indication for surgery.
B. The cervicomedullary angle (CMA) is the angle between a line parallel to the long axis of the brainstem and a line parallel to the cervical spinal cord. A normal CMA is between 135° to 175°. An angle <135° indicates basilar invagination and is associated with neurological deficits.
C. The Ranawat C1-C2 index is drawn across the transverse axis of the atlas, and a connecting line is drawn through the vertical axis of the odontoid from the center of the C2 pedicle radiographic shadow. A measurement <15 mm in men or <13 mm in women is diagnostic for basilar invagination.
D. In the Redlund-Johnell method, a line is drawn between the McGregor line and the midpoint of the inferior endplate of C2. A value <34 mm in men or <29 mm in women is diagnostic for atlantoaxial impaction.

4 / 10

Shoulder and Elbow

After lateral ulnar collateral ligament reconstruction for chronic posterolateral rotator instability of the elbow, the immediate postoperative position of immobilization of the elbow for protection of the reconstruction is which of the following?

Remediation:
A. Immobilizing the arm in full supination results in the highest stress on the ligament reconstruction.
B. Immobilizing the arm in full pronation results in the lowest stress on the ligament reconstruction.
C. Immobilizing the arm in full pronation results in the lowest stress on the ligament reconstruction.

5 / 10

Pediatrics

An 8-year-old girl with sickle cell anemia presents with right knee pain and swelling. Radiographs of the knee show multiple radiolucent lesions with sclerotic patches and an effusion. Which of the following should you consider when determining next steps for this patient?

Remediation:
A. Bone infarct and elevated inflammatory markers can occur concomitantly.
B. Bone infarct lesions in the case of sickle cell anemia will show decreased radionucleotide uptake due to the poor blood supply, while osteomyelitis does not impair the blood supply initially and will have normal or increased uptake at the site of the radiographic lesions.
C. Infection should be ruled out with knee pain and effusion as it can occur concomitantly with a sickle cell crisis.
D. Magnetic resonance imaging will provide the most information about joint inflammation and effusion, osteomyelitis, abscess, and areas of bone infarct.

6 / 10

Basic Science and Pathology

Which of the following factors influences mechanically assisted crevice corrosion at the femoral head-neck junction in a total hip arthroplasty implant?

Remediation:
A. Using a ceramic femoral head rather than a metallic femoral head should decrease mechanically assisted crevice corrosion.
B. Trunnion design affects mechanically assisted crevice corrosion.
C. Fretting current, indicative of mechanically assisted crevice corrosion, increases with the magnitude of the applied load.
D. Impaction technique has not been verified as having any influence on mechanically assisted crevice corrosion.
E. Thickness of the acetabular liner has not been verified as having any influence on mechanically assisted crevice corrosion.

7 / 10

Hand and Wrist

A 44-year-old male patient with a history of alcohol abuse presents to the emergency department with a warm, swollen wrist joint. He is afebrile with stable vital signs. Imaging and serum and synovial laboratory test results are shown. The joint is aspirated. Which of the following is the appropriate treatment for this patient?

Remediation:
A. Allopurinol would be appropriate for maintenance after a gout flare, but this patient has an acutely septic wrist requiring drainage.
B. Nonsteroidal anti-inflammatory drugs would be appropriate for treatment of a gout flare, but this patient has an acutely septic wrist requiring drainage.
C. Drainage (arthroscopic or open) is appropriate for this patient with septic arthritis of the wrist.
D. A corticosteroid injection would be appropriate for treatment of a gout flare, especially in a patient with renal compromise. However, this patient has an acutely septic wrist, which may worsen with corticosteroids. Drainage is indicated.

8 / 10

Foot and Ankle

Which of the following osteotomies can help offload the medial compartment of the ankle in the setting of asymmetric varus ankle arthritis as noted in the image shown?

Remediation:
A. A lateral distal closing wedge osteotomy is appropriate for addressing varus eccentric arthritis. A fibular osteotomy may be necessary, especially with larger corrections.
B. A lateralizing calcaneal osteotomy may be necessary for addressing significant varus malalignment.
C. A medial closing wedge osteotomy has no role in treating varus eccentric arthritis. A medial opening wedge osteotomy has a role but may be limited by impaired healing and potential for stretch injury to medial structures.
D. This supramalleolar osteotomy is not appropriate in the treatment of varus eccentric arthritis.
E. This osteotomy is used for the treatment of residual forefoot varus, usually after adult-acquired flatfoot reconstruction.

9 / 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.

10 / 10

Hip

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

Remediation:
A. 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.
B. Same as A
C. Same as A
D. This type of implant would not be appropriate for a pelvic discontinuity because it would not provide enough structural support to promote healing.

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