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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

December 2023

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Pathology and Basic Science

Anteroposterior and lateral radiographs of a reduced fracture through a fibrous cortical defect at the midpart of the femoral diaphysis are shown. The oblique, spiral failure pattern suggests that torsion was the mode of failure. The fracture might have been avoided with prophylactic treatment. The best method for predicting the risk of an impending fracture in such a long bone with a defect is based on a combination of which of the following?

 

Remediation:
A. Risk is related to geometric factors like lesion diameter and length that are easily measured on plain radiographs, but a better measure is bending or torsional stiffness as derived from CT based structural analysis.
B. Diameter of the defect is not sufficient information to estimate its size. The best predictor combines an area measurement with a material property measurement.
C. Best predictors of fracture risk are related to the stiffness (or rigidity) of the bone in the region of the defect, which combines a cross-sectional geometric parameter (area moment of inertia) with a material parameter (elastic modulus of the bone around the lesion). These parameters are derived from CT measures.
D. The best predictor combines an area measurement with a material property measurement.

2 / 10

Hand and Wrist

A patient with a high ulnar nerve palsy is likely to experience which of the following?

Remediation:
A-D.  With a high ulnar nerve palsy, there is loss of function in the flexor carpi ulnaris and the flexor digitorum profundus tendons in the ring and little fingers. This causes diminished grip strength as well as the loss of ulnar deviation with wrist flexion.

3 / 10

Hip

When compared with staged, bilateral total hip arthroplasty (THA), which of the following is a potential disadvantage of single-anesthetic bilateral THA?

Remediation:
A. Some studies have shown an increased systemic complication rate after single-anesthetic bilateral total hip arthroplasty.
B. No association has been found between single-anesthetic bilateral total hip arthroplasty and wound complication rates.
C. No association has been found between single-anesthetic bilateral total hip arthroplasty and postoperative dislocation rates.
D. Studies have found that single-anesthetic bilateral total hip arthroplasty is associated with a shorter total length of hospital stay.

4 / 10

Pediatrics

A 12-year-old boy presents with right knee pain and swelling off and on for the past 1 month. He is very active in soccer and does not recall any injury to the knee except for some minor twist injuries that all have resolved on their own. His parents brought plain radiographs and magnetic resonance images from another institution that show a stable osteochondritis dissecans lesion in the medial femoral condyle. After 6 months of nonoperative management, the patient complains that the pain and swelling have been worsening. New magnetic resonance images are shown. The lesion measures about 25 x 16 mm at its maximal diameter. Which of the following describe appropriate treatment options?

Remediation:
A. Microfracture is a good first line of treatment.
B. Osteochondral autograft transfer is indicated for larger lesions.
C. Loose or unstable fragments with subchondral bone have some healing potential and can be internally fixed.

5 / 10

Knee

Which of the following total knee arthroplasty components has the best long-term track record for fixation?

Remediation:
A. Cementless tibial components have improved in design and clinical performance but, when compared to cemented components, the rate of loosening remains higher.
B. Cemented components by definition do not provide biologic fixation due to cement being placed at the bone-prosthesis interface.
C. Early metal-backed patellar components were prone to catastrophic failure and metallosis.
D. Cementless femoral components have excellent success in achieving fixation with low rates of loosening.

6 / 10

Foot and Ankle

A female patient presents with Achilles tendon pain and is diagnosed with Achilles tendinopathy. She was recently treated with an oral antibiotic and you suspect that this antibiotic contributed to her Achilles tendon pain. Which of the following antibiotics did she most likely receive?

Remediation:
A. There is no association between this medication and Achilles tendon disease. More commonly, patients experience gastrointestinal and neurological side effects with trimethoprim/sulfamethoxazole.
B. Fluoroquinolones are associated with Achilles tendinitis and rupture. The Food and Drug Administration (FDA) has added a "black box" warning to these antibiotics, and patients should be counseled regarding this associated complication.
C. This first-generation cephalosporin is associated with gastrointestinal upset and hypersensitivity adverse effects.
D. This antibiotic is commonly used as an alternative to cefazolin in patients with sensitivity to penicillin. Patients should be counseled of the increased risk of developing Clostridioides difficile

7 / 10

Shoulder and Elbow

A 21-year-old male patient sustained an elbow injury while skiing when he fell down an 8 ft drop, landing on his outstretched arm. He has pain and deformity of the elbow, but this is an isolated injury. On presentation to the emergency department, the elbow is swollen and bruised but the skin remains closed, and he is neurovascularly intact in the arm. Pre-reduction and post-reduction radiographs are shown. A "terrible triad" injury consists of which of the following components?

Remediation:
A-C A terrible triad injury consists of an elbow dislocation with a radial head fracture and a coronoid tip fracture.
D. A terrible triad injury includes the coronoid tip but not the anteromedial facet coronoid fracture.
E.  A terrible triad injury consists of an elbow dislocation with a radial head fracture and a coronoid tip fracture. An olecranon fracture occurs in a Monteggia injury.

8 / 10

Spine

A 31-year old male patient is brought to the emergency department after being stabbed in the left upper back. He is found to have a left pneumothorax, and his neurological examination demonstrates a complete loss of left lower-extremity motor function and right lower-extremity loss of pain and temperature sensation. Which of the following is the patient's diagnosis?

Remediation:
A. Brown-Sequard syndrome is an incomplete spinal cord injury, resulting from unilateral or hemi-transection of the spinal cord, which typically occurs with penetrating trauma (e.g., stab wound, gunshot wound) and results in loss of motor function on the ipsilateral side and pain and temperature sensation on the contralateral side.
B. Anterior cord syndrome typically results in bilateral motor deficits and bilateral loss of pain and temperature sensation.
C. Posterior cord syndrome typically results in bilateral loss of proprioception, deep touch, and vibration sensation.
D. Guillain-Barré syndrome is an autoimmune disorder affecting the peripheral nerves and can result in weakness, numbness and tingling, vision changes, and difficulty swallowing/speaking/chewing, often preceded by an infectious illness.

9 / 10

Sports Medicine

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?
shoulder

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

10 / 10

Trauma

During a dual medial-lateral incision for a lower extremity fasciotomy, the deep posterior compartment is decompressed:

Remediation:
A. The posteromedial incision should be placed 2 cm posterior to the medial edge of the tibia for the release of the superficial posterior and deep posterior compartments. The soleus muscle in the superficial compartment attaches to the posteromedial aspect of the tibia and by detaching the soleus bridge, the deep posterior compartment is entered.
B. With the two-incision technique, the posterior compartments are accessed with the posteromedial incision.
C. The posteromedial incision allows visualization of the superficial posterior compartment consisting of the gastrocnemius and the soleus muscle. A common pitfall is developing the interval between the soleus and the gastrocnemius without accessing the deep posterior compartment.
D. The dual-incision technique uses the posteromedial incision to decompress the superficial and deep posterior compartments.

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