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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 2023

1 / 10

Sports Medicine

You are evaluating a 22-year-old male patient who is a hockey player with persistent anterior groin pain with activity. He has pain with resistive sit-ups and hip adduction. Magnetic resonance imaging demonstrates injury to the rectus abdominis and the adductor magnus. He has tried rehabilitation for the past 8 weeks and his season is now over. Which of the following is the best next step in management?

Remediation:
A. The patient has tried nonoperative management without success and should now be referred for possible operative treatment.
B. Curettage may be appropriate for osteitis pubis but not for a sports hernia.
C. A corticosteroid injection for a sport hernia is not indicated. If nonoperative management has failed, operative treatment is indicated.
D. This patient has tried 8 weeks of physical therapy without success. Referral for additional treatment is needed.

2 / 10

Hand & Wrist

A 35-year-old male patient presents to the emergency department 2 days after the injury shown (clinical photograph shown). The patient is holding the finger in a flexed position and reports drainage that started today. On examination, the finger feels boggy, there is fusiform swelling, pain on passive extension of the digit, and tenderness along the flexor tendon sheath. You suspect pyogenic flexor tenosynovitis. Which of the following is the most appropriate treatment option for this patient?

hand wrist

Remediation
A-D. The patient has 4 out of 4 Kanavel signs indicating a high likelihood of infectious flexor tenosynovitis. According to the Michon classification, the patient is at risk of septic necrosis and should undergo operative treatment.

3 / 10

Pediatrics

Which of the following are diagnostic features of nursemaid's elbow as seen on radiographs?

Remediation:
A-D. Radiographs are unremarkable for nursemaid's elbow.

4 / 10

Trauma

Which of the following percentage of the posterior aspect of the humerus can be accessed via a triceps sparing posterior approach?

Remediation:
A. A traditional posterior approach with splitting of the triceps muscle allows for approximately 50% visualization of the distal portion of the posterior aspect of the humerus.
B. A traditional posterior approach with splitting of the triceps muscle without radial nerve mobilization allows for approximately 50% visualization of the distal portion of the posterior aspect of the humerus.
C. Mobilization of the radial nerve with a traditional triceps splitting approach to the posterior aspect of the humerus allows for 75% exposure of the posterior aspect of the humerus.
D. The modified posterior approach to the humerus with medial mobilization of the medial and lateral heads of the triceps muscle and mobilization of the radial nerve with release of the intermuscular septum allows for over 90% visualization of the posterior aspect of the humerus.

5 / 10

Foot & Ankle

67-year-old male patient presents with approximately 1 year of pain in the big toe. His pain is relieved when wearing a rigid shoe that prevents dorsiflexion of the forefoot. His anteroposterior radiograph is shown. Which of the following is the most common location of cartilage loss associated with this patient's condition?
foot ankle

Remediation:
A. Cartilage loss in hallux rigidus typically involves the metatarsal head before the proximal phalanx.
B. Cartilage loss typically begins at the dorsal metatarsal head and eventually involves the central metatarsal head in more advances stages which is the reason for pain with a grind test in later stages.
C. Cartilage loss in hallux rigidus typically starts at the dorsal aspect of the metatarsal head which is the reason for pain at the end range of motion in early stages.
D. The patient's presentation is consistent with hallux rigidus which involves the metatarsophalangeal joint and not the interphalangeal joint.

6 / 10

Basic Science

Which of the following defines a highly specific test?

Remediation:
A. This is the definition of sensitivity.
B. A test with high specificity is used to rule out a disease.
C. Highly specific tests may have a large number of true-negative results.
D. A test with high sensitivity is used to confirm a disease.

7 / 10

Spine

A 62-year-old female patient with worsening chronic low back pain reports intermittent, radiating right leg pain over the past 1 year. Plain radiographs are shown. Which of the following best describes the patient's likely outcomes after 2 years of nonoperative treatment?

spine

Remediation:
A. 25% of patients have serious adverse events unrelated to their spine condition after long-term nonoperative treatment.
B. There is no substantial change in patient-reported function and pain after long-term nonoperative treatment.
C. There is no substantial change in patient-reported function and pain after long-term nonoperative treatment.
D. There is no increased risk of worsening neurological symptoms or deficits after long-term nonoperative treatment.

8 / 10

Shoulder and Elbow

Which of the following would be the appropriate classification of this patient's humeral nonunion?

Remediation:

A. The patient does not have an abundance of callus formation, which is present in a hypertrophic nonunion.
B. The patient has some callus formation but has a nonunion due to poor healing potential and continued motion at the fracture site.
C. The patient has some callus formation. An atrophic nonunion has no callus due to poor biologic healing potential.
D. There is no evidence of an infection based on the laboratory findings.

9 / 10

Knee

A 50-year-old male patient is scheduled for total knee arthroplasty in 1 month following unsuccessful nonoperative treatment, including corticosteroid injections. The patient is in severe pain and wants to know whether he can have another injection to help decrease his pain until surgery. You tell the patient that he will be at increased risk for which of the following after surgery if he has an injection now?

Remediation:
A. There is no evidence to suggest a longer postoperative stay following a total knee arthroplasty if the patient has had an injection within the past month.
B. A deep vein thrombosis is not associated with recent intra-articular corticosteroid injections.
C. Arthrofibrosis is not associated with recent intra-articular corticosteroid injections.
D. There is evidence supporting an increased rate of infection in those patients undergoing total knee arthroplasty following a corticosteroid injection.

10 / 10

Hip

A 65-year-old male patient presents with the shown radiograph. He is inquiring about the possibility of obtaining a hyaluronic acid injection into his hip similar to the one he received in his knee several years ago. According to the most recent American Academy of Orthopaedic Surgeons (AAOS) Clinical Practice Guidelines, which of the following is the current recommendation regarding hyaluronic acid injection for alleviation of pain and stiffness for this patient's condition?

hip

Remediation:
A. The most recent AAOS Clinical Practice Guidelines are strongly against intra-articular hyaluronic acid injection because of the lack of evidence that it performs better than placebo in patients with symptomatic osteoarthritis of the hip.
B. The most recent AAOS Clinical Practice Guidelines are strongly against intra-articular hyaluronic acid injection because of the lack of evidence that it performs better than placebo in patients with symptomatic osteoarthritis of the hip.
C. The most recent AAOS Clinical Practice Guidelines are strongly against intra-articular hyaluronic acid injection becasue of the lack of evidence that it performs better than placebo in patients with symptomatic osteoarthritis of the hip.
D. The most recent AAOS Clinical Practice Guidelines are strongly against intra-articular hyaluronic acid injection because of the lack of evidence that it performs better than placebo in patients with symptomatic osteoarthritis of the hip.

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