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.

/10
196
Created on
QUIZ of the Month Title Image with Orthopaedic Icons

August 2024

1 / 10

Trauma

Which of the following factors are associated with poorer functional and clinical outcome with closed treatment of scapular body fractures?

Remediation:
A. DASH (Disabilities of the Arm, Shoulder and Hand) and Constant scores are positively correlated with the glenopolar angle. Patients with glenopolar angles of >20° have better functional outcomes than those with glenopolar angles of <20°.
B. Altman, et al. showed that associated rib fractures were an independent risk factor for worse DASH (Disabilities of the Arm, Shoulder and Hand) scores in their evaluation of 49 nonoperatively treated scapular body fractures.
C. Altman, et al. and Gosens, et al. demonstrated that there was a correlation between DASH (Disabilities of the Arm, Shoulder and Hand) scores and SF-36 (Short Form Survey-36) physical function scores in patients with polytrauma and in those with increasing Injury Severity Scores.
D. Same as A
E. Glenoid medialization of >2 cm relative to the lateral border of the scapula is a relative indication for operative intervention. There are currently no data demonstrating that medialization of <5 cm is associated with poor functional outcomes.

2 / 10

Sports Medicine

A patient sustains the injury shown in the radiograph. Which of the following is the most common structure that may block reduction of this joint?

Remediation:
A. A medial subtalar dislocation is shown. The most common block to reduction in a medial dislocation is the extensor digitorum brevis.
B. A medial subtalar dislocation is shown. The most common block to reduction in a medial dislocation is the extensor digitorum brevis, followed by the peroneal tendons and the talonavicular capsule. The most common blocks to reduction in a lateral dislocation are the flexor hallucis longus, the flexor digitorum longus, and the posterior tibial tendon.
C. Same as B
D. Same as B

3 / 10

Spine

In a patient with osteoporosis, bone density decreases over time and is caused by increased:

Remediation:
A. Osteoporosis results from an imbalance in bone turnover, resulting from increased osteoclast activity.
B. Decreased estrogen levels lead to increased osteoclast activity through a decrease in osteoprotegerin production. This decrease results in increased binding of RANK ligand to RANK and increased osteoclast activity.
C. Decreased estrogen levels lead to osteoporosis.
D. Osteoprotegerin levels are decreased in osteoporosis.

4 / 10

Shoulder and Elbow

The double bubble sign (also known as the double arc sign) on a lateral elbow radiograph is pathognomonic for which of the following?

Remediation:
A. This is seen on magnetic resonance imaging in the early stages. In later stages, plain radiographs reveal a fragment or collapse of the capitellum on anteroposterior and lateral radiographs.
B. This is seen as a fragment off of the coronoid on lateral radiographs. Larger facet fractures can be seen on anteroposterior radiographs if they extend to the sublime tubercle.
C. The double bubble sign is indicative of a shear of the articular surface (the capitellum or the trochlea).
D. This represents a fracture line extending medially into the trochlear groove.

5 / 10

Pediatrics

A 15-year-old male patient has an overlapping 5th toe that is painful with shoe wear. The toe is flexible and there is no corn or callus formation. Which of the following is the best initial treatment?

Remediation:
A. Nonoperative modalities should be tried first.
B. Same as A
C. Noninvasive modalities such as shoe modifications should be tried first.
D. Shoe modification is the first line of treatment.

6 / 10

Basic Science and Pathology

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 Oct4, Sox2, c-Myc, and Klf4.
B. iPSCs are produced artificially from differentiated somatic cells.
C. Same as B
D. Same as B

7 / 10

Hand and Wrist

A 63-year-old male patient who is right-hand dominant presents for evaluation of bilateral hand pain and discomfort. He recently retired from his job as a mechanic. He has weakness and pain in both hands, especially while gripping tools. He has pain, particularly at the base of his thumb, while opening jars and doorknobs. His symptoms have progressed to the point where he can no longer comfortably handle many of his tools. He has mild numbness and tingling in the thumb, index, and long fingers. Imaging is shown. Which of the following is the approximate percentage of the general population that will demonstrate radiographic changes at the carpometacarpal joint by age 60?

Remediation:

A-D. Approximately 60% of the general population demonstrate radiographic osteoarthritis in the hand by age 60, most often seen in the distal interphalangeal (DIP) joints, followed by the thumb carpometacarpal (CMC) joints. Radiographic thumb CMC osteoarthritis is more prevalent in women than men. Association with hand pain and disability is weak to modest.

8 / 10

Foot and Ankle

Which of the following types of bunionette is seen on the shown radiograph?

Remediation:
A. A type-1 bunionette is characterized by prominence of the fifth metatarsal head without an increased fourth/fifth intermetatarsal angle.
B. A type-2 bunionette is characterized by lateral bowing of the fifth metatarsal, which is seen on this radiograph.
C. A type-3 bunionette is characterized by an increased fourth/fifth intermetatarsal angle without a lateral bow of the metatarsal.

 

9 / 10

Knee

While research is still ongoing regarding long-term survivorship of cementless vs. cemented fixation for TKA, which of the following patients would likely benefit most from cemented TKA fixation, according to findings in the 2023 American Joint Replacement Registry (AJRR) annual report?

Remediation:
A-D.  In the 2023 AJRR annual report, cementless and hybrid fixation were found to be associated with decreased cumulative percent revision compared to cemented fixation in males for both <65 and 65 and older cohorts in the AJRR database. Conversely, cemented fixation was found to have significantly lower cumulative revision
in females aged 65 and older; no significant difference was found in young females.

10 / 10

Hip

A 57-year-old male patient presents with left hip pain (radiograph shown). He has a body mass index of 38 kg/m², hypertension, benign prostatic hyperplasia with increased urinary frequency, and type 2 diabetes mellitus that is well controlled with oral antihyperglycemics. When determining whether to schedule this patient for inpatient or outpatient total hip arthroplasty, you know that with an outpatient procedure, the patient is at higher risk for which of the following complications?

hip

Remediation:
A. This patient's benign prostatic hyperplasia and increased urinary frequency places him at risk for postoperative urinary retention, causing an unplanned overnight admission after outpatient total hip arthroplasty.
B. While the patient does have evidence of a previous spinal fusion on the radiograph, and spinal fusion has been shown to be correlated with prosthetic instability after total hip arthroplasty, this complication would not be specifically associated with outpatient total hip arthroplasty.
C. While this patient does have diabetes, which has been shown to be associated with increased risk of prosthetic joint infection, this complication would not be specifically associated with outpatient total hip arthroplasty.
D. This patient does not have any risk factors listed that would place him at increased risk for venous thromboembolism after outpatient total hip arthroplasty. His benign prostatic hyperplasia and increased urinary frequency increase his risk for postoperative urinary retention requiring an unplanned overnight admission after outpatient total hip arthroplasty.

0%

Menu