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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

February 2024

1 / 10

Trauma

You are called to assess a 19-year-old male patient who sustained a right ankle injury while snowboarding and is found to have a noncomminuted lateral talar process fracture with 3 mm of displacement. Which of the following is the best management for his injury?

Remediation:
A. Fragment excision is reserved for comminuted lateral talar process fractures.
B. A below-the-knee walking cast is not recommended for a lateral talar process fracture in order to avoid symptomatic nonunion and ankle instability.
C. Operative repair with open reduction and internal fixation is indicated for a lateral talar process fracture that is >2 mm displaced.
D. Lateral talar process fractures with <2 mm of displacement can be treated with a below-the-knee cast, or boot, with non-weight-bearing for 6 weeks.
E. An ankle brace is not indicated for any lateral talar process fractures.

2 / 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 is 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 door knobs. 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. 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.
B. Same as A
C. Same as A
D. Same as A

3 / 10

Sports Medicine

You are seeing a 21-year-old male patient who is a college football player in the training room 3 weeks after he sustained an iliac crest contusion (hip pointer). Imaging was negative for fracture. He has been treated with physical therapy and nonsteroidal anti-inflammatory drugs. He is no longer making progress and cannot return to full participation due to discomfort over his iliac crest. Advnaced imaging shows no fracture.  Which of the following is the next most appropriate step in management?

Remediation:
A. The patient still has discomfort, so an injection with a corticosteroid or local anesthetic would be appropriate.
B. Something should be changed as the current treatment is not providing results. A corticosteroid injection is the next likely step.
C. There is rarely any indication for surgery for an iliac crest contusion. Healing and return to play is individual for each patient.
D. A computed tomography scan is unlikely to change management since a fracture has already been excluded.

4 / 10

Spine

A 55-year-old male patient presents with a new onset of bilateral symmetrical diffuse hand numbness with neck pain. He denies weakness or balance problems. Physical examination reveals symmetrical 2+ upper and lower-extremity reflexes, 5 of 5 upper and lower-extremity motor strength, normal gait without balance disturbance, downgoing Babinski, and no clonus. He has a negative Lhermitte phenomenon. Electromyography with nerve conduction velocity (EMG/NCV) testing shows no evidence of peripheral nerve entrapment or neuropathy. Magnetic resonance imaging (MRI) shows spinal cord compression at C5-C6 from disc-osteophyte complex. There is no cord signal change or myelomalacia on the MRI. Which of the following is the appropriate next step for this patient?

Remediation:
A. This patient has bilateral symmetrical diffuse hand numbness without any other sign or symptom of radiculomyelopathy. Despite having a normal electromyography with nerve conduction velocity (EMG/NCV) study for peripheral nerve entrapment or neuropathy, the next best step is to perform a physical examination and further evaluate for peripheral nerve disease since EMG/NCV can, at times, yield false-negative results.
B. This patient has bilateral symmetrical diffuse hand numbness without any other sign or symptom of radiculomyelopathy. Although the MRI shows cord compression at the C5-C6 level from disc-osteophyte complex, his symptoms are not consistent with his MRI findings. Thus, he needs further workup, not an anterior cervical discectomy and fusion.
C. This patient has bilateral symmetrical diffuse hand numbness without any other sign or symptom of radiculomyelopathy. Although the MRI shows cord compression at the C5-C6 level from disc-osteophyte complex, his symptoms are not consistent with his MRI findings. Thus, he needs further workup, not a corpectomy.
D. This patient has bilateral symmetrical diffuse hand numbness without any other sign or symptom of radiculomyelopathy. Although the MRI shows cord compression at the C5-C6 level from disc-osteophyte complex, his symptoms are not consistent with his MRI findings. Thus, he needs further workup, not a laminectomy at C5-C6.

5 / 10

Shoulder and Elbow

A 23-year-old male patient who is a professional baseball pitcher reports pain in his throwing shoulder that is worse during the late-cocking phase of throwing. He has no pain at rest, and denies symptoms of instability and neurological symptoms. Examination shows normal glenohumeral range of motion and no rotator cuff strength deficits. He demonstrates a positive dynamic labral shear test and a positive O'Brien test. His neurological examination is normal. Radiographs are normal and his magnetic resonance arthrogram is shown. The musculoskeletal radiologist's report indicates a type II superior labrum anterior to posterior (SLAP) tear. Using the classification system described by Snyder, for which of the following classes of superior labrum anterior to posterior (SLAP) tears is arthroscopic repair potentially indicated?

shoulder

Remediation:
A. If requiring surgery, type I SLAP tears are typically treated with labral debridement.
B. For a specific subset of patients, arthroscopic repair is indicated for type II SLAP tears.
C. If requiring surgery, type III SLAP tears have an intact biceps anchor and only require labral debridement.
D. If requiring surgery, type IV SLAP tears typically need debridement with or without biceps tenotomy/tenodesis.

6 / 10

Pediatrics

A 14-year-old male patient is involved in a motor vehicle collision and presents with back pain. He is neurologically intact, and spine radiographs reveal anterior compression of T12 of about 20% and about 10° of kyphosis at T12-L1. Which of the following treatments would you recommend?

Remediation:
A. This is a stable injury and amenable to nonoperative management. Immediate mobilization is associated with lower complications.
B. This is a stable injury and amenable to nonoperative management. Immediate mobilization is ideal to prevent complications.
C. This is a stable injury and operative stabilization is unnecessary.
D. This is a stable injury and operative stabilization is unnecessary.

7 / 10

Basic Science

Which of the following accurately describes the effects of estrogen on bone metabolism?

Remediation:
A. Estrogen deficiency results in increased bone turnover; it is shown at the tissue level by an increased number of activated bone remodeling units.
B. Estrogen acts on bone mainly by inhibiting recruitment of osteoclasts, and osteoclast apoptosis is regulated by estrogens.
C. Estrogen deficiency inhibits osteoclast apoptosis.
D. Osteoblasts synthesize RANKL (receptor activator of NF-kappaB ligand), which is necessary for osteoclast formation and function, and osteoprotegerin (OPG), its decoy receptor; this process is mediated by estrogen.

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?

foot ankle

Remediation:
A. 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.
B. This supramalleolar osteotomy is not appropriate in the treatment of varus eccentric arthritis.
C. This osteotomy is used for the treatment of residual forefoot varus, usually after adult-acquired flatfoot reconstruction.
D. A lateral distal closing wedge osteotomy is appropriate for addressing varus eccentric arthritis. A fibular osteotomy may be necessary, especially with larger corrections.
E. A lateralizing calcaneal osteotomy may be necessary for addressing significant varus malalignment.

9 / 10

Knee

Which of the following factors are predictors of patient dissatisfaction following primary total knee arthroplasty (TKA)?

Remediation
A. Severe osteoarthritis is not a predictor of postoperative patient satisfaction
B. Preoperative pain with simple ROM is a predictor for poor patient satisfaction following TKA.
C. Preoperative expectations of returning to high-impact activities is a predictor for poor patient satisfaction following TKA.
D. Minimal osteoarthritis is a predictor for poor patient satisfaction following TKA.

 

10 / 10

HIP

An 81-year-old male patient presents with recurrent instability of his left total hip arthroplasty secondary to polyethylene wear (imaging shown). His primary procedure was performed in 1999 with ultra-high molecular weight polyethylene (UHMWPE). He undergoes successful revision surgery with a modern highly cross-linked polyethylene acetabular liner. Which of the following are techniques that may have been used to reduce or eliminate residual free radicals that were formed during the cross-linking of the polyethylene?

Remediation:
A. One method of stabilizing the residual free radicals in UHMWPE is annealing below the peak melting point of the irradiated polymer. Another method is melting, and a third is the incorporation of the antioxidant vitamin E in radiation.
B. Incorporation of vitamin B is a not a method by which residual free radicals are reduced or eliminated. Incorporation of vitamin E may reduce free radical formation.
C. Freezing is a not a method by which residual free radicals are reduced or eliminated.
D. One method of stabilizing the residual free radicals in UHMWPE is annealing below the peak melting point of the irradiated polymer. Another method is melting, and a third is the incorporation of the antioxidant vitamin E in radiation.

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