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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

March 2023

1 / 10

Trauma

A 35-year-old male patient who is right-hand dominant and works as an accountant is seen in the emergency department with closed radial and ulnar shaft fractures. He has insulin-dependent diabetes and his current HbA1c is 5.8%. The radial fracture is comminuted and has 5 mm of displacement, but is not shortened. The ulnar shaft fracture has no comminution. The elbow and wrist joints are reduced and well-aligned. Which of the following would be the appropriate definitive management for this patient's fractures?

Remediation:
A. A long-arm cast is not indicated for both-bone forearm fractures in adults as it would result in unnecessary elbow and wrist stiffness.
B. Optimal treatment to maximize functional outcome in both-bone forearm fractures in adults aims to restore length, rotation, alignment, and the interosseous space. Open reduction and stable plate fixation allows for this, as well as allowing early mobilization and rehabilitation.
C. While intramedullary fixation may be indicated in children, it is generally not indicated in adults.
D. While intramedullary fixation may be indicated in children, it is generally not indicated in adults.

2 / 10

Sports

In which of the following situations can an athlete return to play the same day?

Remediation:
A. Headache is a symptom of concussion, and recommendations state that an adolescent athlete cannot return to play if a concussion is suspected.
B. Blurred vision is a symptom of concussion, and recommendations state that an adolescent athlete cannot return to play if a concussion is suspected.
C. Loss of consciousness is associated with a concussion, and recommendations state that an adolescent athlete cannot return to play if a concussion is suspected.
D. The history is consistent with a "stinger" injury due to nerve stretch, and not a concussion. The player may return once symptoms have resolved and as long as there is no weakness or nerve pain.

3 / 10

Spine

A 36-year-old male patient who is in the Coast Guard undergoes primary lumbar microdiscectomy for left leg and back pain. He has done well for 2 years since his initial surgery and now presents with recurrent pain and radicular symptoms in the left leg. Imaging demonstrates recurrent disc herniation. Which of the following is the most common complication following operative management of a recurrent disc herniation?

Remediation:
A. While postoperative infection can occur during a revision lumbar discectomy, the rate of deep surgical site infection following discectomy is <2%. The most common complication is durotomy.
B. While nerve root injury can occur during a revision lumbar dissection, this is a very rare outcome. The most common complication is durotomy.
C. The most common complication following revision discectomy is iatrogenic durotomy (4%-10% for primary discectomy and >10% for revision). The index discectomy procedure can lead to substantial epidural adhesion, leading to a high risk for dural tear during revision lumbar discectomy.
D. When re-herniation occurs after the index or revision lumbar discectomy surgery, it is usually at the same level. Different level re-herniation is not a common complication after revision lumbar discectomy.

4 / 10

Shoulder & Elbow

A 19-year-old male patient who is a pitcher on his college baseball team presents with persistent pain and loss of throwing velocity. He has a decreased total arc of motion and an internal rotation deficit on examination. He has failed several months of nonoperative management, including stretching, rest, and return to a throwing program. Which of the following operative treatments is indicated for this patient?

Remediation:
A. A Bankart repair and remplissage is an option for a traumatic anterior dislocation with a large Hill-Sachs lesion.
B. Pancapsular plication can be performed for multidirectional instability in select cases.
C. Interval closure can be performed as part of a stability operation for atraumatic anterior or multidirectional instability.
D. A tight posterior-inferior capsule has been implicated as a cause for glenohumeral internal rotation deficit. A limited release of the posterior-inferior capsule can help the athlete regain a normal total arc of motion.

5 / 10

Pediatrics

A 4-year-old boy presents to the emergency department with bilateral olecranon fractures after tripping and falling while running. The olecranon fractures are closed and minimally displaced. The child has a normal neurovascular examination and no other injuries. He is otherwise healthy but has had 2 wrist buckle-type fractures last year. Which of the following is the most appropriate treatment option?

Remediation:
A. Minimally displaced olecranon fractures can be treated closed with serial observation. Bilateral olecranon fractures in the setting of a low-energy mechanism should raise suspicions for osteogenesis imperfecta, and a referral to a geneticist for evaluation is indicated.
B. ORIF is not necessary for a minimally displaced olecranon fracture.
C. Bilateral olecranon fractures in the setting of a low-energy mechanism should raise suspicions for osteogenesis imperfecta. Evaluation of this possibility is critical for the patient's general management, especially since these are not his first fractures.
D. Olecranon fractures are not a typical fracture of abuse, especially for a child with a witnessed injury (school) and no other identifiable injuries on physical examination. Patients with osteogenesis imperfecta frequently are evaluated by child protective services for possible abuse as the mechanism of injury often does not match the fracture pattern.

6 / 10

Basic Science

Which of the following are critical steps during the reparative phase of secondary bone healing?

Remediation:
A. This is part of the remodeling phase.
B. This is one of the final steps of the remodeling phase.
C. This is part of the reparative phase and occurs following the acute inflammatory phase.
D. This occurs rapidly after the initial fracture event and initiates the acute inflammatory phase.

7 / 10

Hand & Wrist

A 27-year-old male patient sustains a left index finger fracture-dislocation while playing basketball. Radiographs show a volarly displaced distal phalanx with no evidence of osteochondral fragments in the joint. After performing a digital blockade and attempting reduction, the joint remains dislocated. Which of the following is the next step in the management of this patient?

Remediation:
A. Magnetic resonance imaging is unnecessary. The collateral ligaments can be assessed during open reduction.
B. Given the persistent dislocation, the next step with this patient is open exploration with possible internal fixation. Several structures can block reduction, including the volar plate that is avulsed from the middle phalanx, the flexor digitorum profundus (FDP) tendon dislocating dorsally, and osteochondral fragments
C. Computed tomography scanning is unnecessary. The plain radiographs show no evidence of bony interposition and additional imaging is not indicated.
D. Repeat reduction with sedation is contraindicated. There is likely some soft-tissue structure preventing reduction. Sedation will not improve the success of a closed reduction attempt.

8 / 10

Foot & Ankle

A 42-year-old patient with a long second toe presents with forefoot pain. Radiographs demonstrate no bony changes or dislocation at the metatarsophalangeal (MTP) joints. Which of the following physical examination findings supports the diagnosis of plantar plate injury?

Remediation:
A. Pain at maximal plantar flexion is not typically associated with plantar plate injury.
B. Metatarsal squeeze pain is associated with interdigital (or Morton's) neuroma.
C. Mulder's click is associated with interdigital (or Morton's) neuroma.
D. A positive drawer test is indicative of plantar plate insufficiency, which is associated with 2nd MTP joint synovitis.

9 / 10

Knee

Traditional mechanical axis total knee arthroplasty involves which of the following?

Remediation:
A. A line dropped from the center of the femoral head through the knee and the center of the ankle is the mechanical axis. The knee is thought to be well-balanced if this line travels through the center of the knee. The true mechanical axis actually passes slightly more medially through the medial tibial spine.
B. Placing the femoral component parallel to the transepicondylar axis will create a symmetrical flexion gap.
C. The distal femoral cut is cut in 5° to 7° of valgus and is perpendicular with the mechanical axis.
D. This is consistent with anatomic placement of the total knee. The mechanical axis involves cutting the tibia parallel with the ground.

10 / 10

Hip

A 73-year-old male patient presents with left-sided hip pain following total hip arthroplasty. Based on magnetic resonance imaging findings and elevated serum metal ion levels, a diagnosis of trunnionosis is made. The patient is concerned about what will happen to his function and metal ion levels following revision surgery. Which of the following should you tell the patient that he can expect after revision surgery?

Remediation:
A. Once the source of the metal ions is removed by either removing debris from the head-neck junction or revising the femoral stem if necessary, and replacing the metal head with a ceramic head, his metal ion levels should decrease, and Harris hip score should increase.
B. While Harris hip scores usually increase after revision procedures for trunnionosis, metal ion levels usually decrease.
C. Metal ion levels should decrease after revision procedures for trunnionosis since the source of the metal ions is removed, and Harris hip scores increase as pain and function improve.
D. While metal ion levels will decrease after revision procedures for trunnionosis, Harris hip scores usually increase.

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