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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

January 2024

1 / 10

Trauma

An 80-year-old female patient presents with sudden-onset right thigh pain. She reports no history of trauma but she has not been able to bear weight on her right lower extremity since the onset of the pain. Radiographs are shown. This patient's fracture is commonly associated with which of the following types of medications?

Remediation:
A. There is no evidence of an association between calcium channel blockers and atypical femoral fractures.
B. There is no evidence of an association between insulin and atypical femoral fractures.
C. There is no evidence of an association between beta blockers and atypical femoral fractures.
D. There is no evidence of an association between antidepressants and atypical femur fractures.
E. Bisphosphonates increase the risk of atypical femoral fractures.

2 / 10

Sports Medicine

You are in the operating room with a patient who has a peroneal brevis tear. On examination of the tendon, you find that there are multiple longitudinal tears with substantial degeneration. Which of the following is your next step in the procedure?

Remediation:
A. For multiple tears and/or a degenerative tendon (>50%), excision of the diseased tendon and a longus to brevis tenodesis should be performed.
B-D. For single longitudinal tears, debride, repair, and tubularize the tendon. For multiple tears and/or a degenerative tendon (>50%), excision of the diseased tendon and a longus to brevis tenodesis should be performed.

 

3 / 10

Spine

A 45-year-old male patient who works as an investment banker presents with 2 weeks of severe back and left leg pain after finishing an intense exercise workout. The patient is seen in the emergency department, and lumbar spine magnetic resonance imaging is obtained (shown). The patient has which of the following at L4-L5?

Remediation:
A-D. The image demonstrates a left far lateral disc herniation and is defined based on location of the disc herniation lateral to the lateral border of the pedicle.
E. The image demonstrates a far lateral disc herniation and is defined based on location of the disc herniation lateral to the lateral border of the pedicle. Degenerative disc disease is not an accurate diagnosis.

 

4 / 10

Shoulder and Elbow

A 44-year-old male patient who is a carpenter presents with a 4-year history of progressively worsening elbow discomfort and increasing limitations to his range of motion. He denies previous injury. He has no pain on rest and denies paresthesias. He says his elbow "locks" intermittently. Examination reveals a loss of the terminal 30° of extension of the elbow with flexion to 110°. Pronation and supination are preserved. His ulnar nerve function is intact. He has tried nonsteroidal anti-inflammatory drugs and a corticosteroid injection with limited benefit, and he remains functionally limited at work. He would like to proceed with operative management. Which of the following are acceptable initial operative interventions for the patient?

Remediation:
A. Total elbow arthroplasty has worse results and short longevity in young patients with osteoarthritis. The permanent lifting restrictions would prevent the patient from returning to work.
B-C. Arthroscopic and open debridement with capsular release have been shown to improve symptoms to return to heavy work demands.
D. While this is a last resort option in a young laborer, the initial treatment indication is arthroscopic or open debridement with capsular release.
E. This can help with radiocapitellar symptoms but will not address the ulnohumeral arthritis.

5 / 10

Pediatrics

Acceptable alignment for pediatric distal radius fractures varies in the literature. However, if a patient has <2 years of growth remaining, which of the following parameters are acceptable?

Remediation:
A-D. Acceptable parameters for this more mature patient are equivalent to that of adults, since remodeling is not reliable. General parameters: volar tilt between 0-20° with minimal loss of radial height/inclination and translation. The distal radioulnar joint relationship should be maintained with a gap of < 5mm.

6 / 10

Basic Science

A 45-year-old female patient had a giant cell tumor involving her distal femur that was treated with local curettage and cement 1 year ago. Follow-up radiographs show recurrent tumor contained within the distal femur. Which of the following is the most appropriate treatment at this time?

Remediation:
A. Giant cell tumor of bone has a high rate of local recurrence, which may be decreased by local adjuvant therapies such as high-speed bur, cryoablation, argon beam coagulation, or PMMA. The treatment of a contained local recurrence can often be effectively done with repeat intralesional treatment with further local adjuvant therapy.
B. The use of phenol is not justified due to systemic toxicity and lack of evidence that it provides any added benefit.
C. Local curettage with local adjuvant therapy provides adequate local control for most patients, and wide resection is not needed.
D. Denosumab may be considered for challenging or nonresectable tumors.

7 / 10

Hand and Wrist

A 23-year-old female patient sustained a knife injury to her long finger while removing the pit from an avocado. She had a laceration of both the flexor digitorum superficialis and flexor digitorum profundus tendons within zone 2. She undergoes repair of both tendons with 6 core sutures and an epitendinous suture. An intraoperative photograph is shown. A rehabilitation protocol is scheduled to begin on postoperative day 5. Which of the following postoperative protocols is associated with the greatest arc of motion given the type of this patient's repair?

Remediation:
A. Passive motion is associated with acceptable outcomes but approximately 30° of less motion.
B. Casting is reserved for children or patients who cannot comply with rehabilitation protocols.
C. Delayed passive motion is likely to result in substantial tendon adhesions and limited range of motion.
D. Early active motion results in the greatest total active motion with equivalent re-rupture rates.

8 / 10

Foot and Ankle

A 65-year-old female patient presents with an adult-acquired flatfoot. On physical examination, her passive ankle range of motion is assessed. With the knee extended, she demonstrates 5° of dorsiflexion. With the knee flexed, she demonstrates 15° of dorsiflexion. Which of the following is the likely cause of her decreased ankle motion?

Remediation:
A. Knee flexion relaxes the gastrocnemius. This degree of increased motion with the knee flexed suggests the presence of an isolated gastrocnemius contracture.
B. An isolated soleus contracture is not demonstrated with this examination. Additionally, this type of contracture is difficult to demonstrate.
C. Given the increased dorsiflexion on Silfverskiöld testing, anterior block to motion is unlikely.
D. A combined contracture is unlikely given the discrepancy between dorsiflexion with the knee flexed and extended.

9 / 10

Knee

Which of the following is the recommended number and timing of doses of oral tranexamic acid to provide the maximal reduction in blood loss for patients undergoing total hip arthroplasty?

Remediation:
A-D. One preoperative dose and 3 postoperative doses are recommended to achieve the maximum effective reduction of blood loss.

10 / 10

Hip

Which of the following accurately describes the management of periprosthetic fractures in the trochanteric area around a total hip arthroplasty?

Remediation:
A. Vancouver A2 are fractures of the medial cortex of the proximal aspect of the femur in which the stem is loose, and they are treated with fracture fixation and stem revision.
B. Vancouver A2 are fractures of the medial cortex of the proximal aspect of the femur in which the stem is loose, and they are treated with fracture fixation and stem revision.
C. Vancouver AL fractures are around the lesser trochanter and usually are treated nonoperatively.
D. Vancouver AG fractures involve the greater trochanter and are treated nonoperatively unless they are displaced >2 cm.

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