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 2025

1 / 10

Trauma

Which of the following is the most common type of Monteggia fracture pattern in adults?

Remediation:
A. Bado type 1 fractures are defined by an anterior angulation of the ulnar fracture with anterior dislocation of the radial head. This Monteggia lesion is the most common form in the pediatric population and is thought to result from a fall on an extended and hyperpronated arm. In adults, Bado type-2 injuries are most common.
B. Bado type 2 fractures are defined as posterior angulation of the ulnar fracture and posterior dislocation of the radial head. In adults, Bado type-2 injuries are most common.
C. Bado type 3 fractures are defined as proximal ulnar metaphysis fractures and lateral dislocations of the radial head. Bado type 2 fractures are the most common Monteggia injuries seen in adults.
D. Bado type 4 fractures are characterized by fractures of both the proximal aspect of the ulna and the radius. The radial head is also dislocated, typically anteriorly. Bado type-2 fractures are the most common Monteggia injuries seen in adults.

2 / 10

Sports

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. Advanced 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.

3 / 10

Spine

An 8-year-old boy with early-onset scoliosis presents with a 68° right thoracic curve. Imaging is shown. He is a Risser 0 and has open triradiate cartilages. When planning a growth-sparing procedure, which of the following amounts of annual growth in overall height (T1 to S1) is expected postoperatively?

spine

Remediation:
A. With growing rods, the expected growth in overall height per year is 1.0 to 1.5 cm.
B-E. Same for all answer choices

4 / 10

Shoulder and Elbow

A 40-year-old male patient is brought to the emergency department after a tonic-clonic seizure. He complains of left shoulder pain. Imaging shows a comminuted fracture of the scapula with 3 separate fracture lines through the glenoid exiting medially, superiorly, and laterally, respectively (shown). Based on the Ideberg classification of glenoid fractures, this fracture should be classified as an Ideberg:

shoulder

Remediation:
A. Type IA fractures involve the anterior rim. This patient has a comminuted glenoid fracture with multiple fracture lines.
B. Type V fractures involve a comminuted glenoid fracture with multiple fracture lines.
C. Type II fractures have a fracture line through the glenoid fossa exiting the scapula laterally.
D. Type III fractures have a fracture line through the glenoid fossa exiting the scapula superiorly.
E. Type IV fractures have a fracture line through the glenoid fossa exiting the scapula medially.

5 / 10

Pediatrics

The parents of a 4-year-old boy with postaxial toe polydactyly desire surgery to improve the cosmetic appearance of the foot. Which of the following general operative principles should be applied?

Remediation:
A. The border digit tends to be the more hypoplastic and angulated digit and is the appropriate digit to excise.
B. This would not improve the aesthetics of the foot.
C. Ray resection is a larger procedure than necessary. The border digit tends to be the more hypoplastic and angulated digit and therefore is typically the digit to amputate.
D. Flexor tenotomy is indicated for curly toe, not duplicated toe.

6 / 10

Basic Science and Pathology

Which of the following types of RNA does not play a natural regulatory role in normal human osteoblast homeostasis?

Remediation:
A. mRNA molecules are essential for encoding key proteins needed for osteoblast differentiation and activity.
B. microRNA molecules regulate mRNA expression and are important for maintaining homeostasis of osteoblastic genes.
C. lncRNA molecules have been shown to regulate the translation of mRNAs and are thus capable of regulating osteoblast homeostasis.
D. siRNA molecules are used in the laboratory setting and currently are being studied as therapeutic agents. They do not play a role in the normal regulation of osteoblast homeostasis.

7 / 10

Hand and Wrist

A 27-year-old male patient sustained a right thumb fracture after falling on some stairs. Imaging is shown. Which of the following sequences of actions represents the correct maneuver for closed reduction of this injury?

hand

Remediation:

A. The correct reduction maneuver is performed by applying traction, palmar abduction, and pronation with external pressure over the metacarpal base.
B. Palmar abduction (not palmar adduction) is required along with traction, pronation, and external pressure over the metacarpal base.
C. Pronation (not supination) is required along with traction, palmar abduction, and external pressure over the metacarpal base.
D. Palmar abduction (not palmar adduction) and pronation (not supination) is required along with traction and external pressure over the metacarpal base.

8 / 10

Foot and Ankle

A 56-year-old male patient presents with gradually worsening pain at the lateral aspect of the 5th metatarsal head. You make the diagnosis of a bunionette. A radiograph is shown. His bunionette deformity would be classified as which of the following?

Remediation:
A. Type I deformity is characterized by an enlarged 5th metatarsal head or a lateral exostosis of the head.
B. Type II deformity is characterized by lateral bowing of the 5th metatarsal, with a normal intermetatarsal angle (IMA).
C. Type III deformity is characterized by an increased 4-5 intermetatarsal angle (IMA).
D. Type IV bunionette was added to the original classification and has been described as any combination of two or more deformities found in Types I-III.

9 / 10

Knee

A 58-year-old male patient with knee osteoarthritis undergoes injection of autologous adipose tissue-derived mesenchymal stem cells (AD-MSCs). Which of the following outcomes would be expected at 6 months following the injection?

Remediation:
A. Study results suggest that mesenchymal stem cells have the ability to improve pain and function of the knee joint that is affected by osteoarthritis. It has been shown that 6 months to 1 year following a mesenchymal stem cell injection, knee arthritis and meniscal tears have improved based on radiographic, magnetic resonance imaging, and arthroscopic findings.
B. Study results suggest that mesenchymal stem cells have the ability to improve pain and function of the knee joint that is affected by osteoarthritis. It has been shown that 6 months to 1 year following a mesenchymal stem cell injection, knee arthritis and meniscal tears have improved based on radiographic, magnetic resonance imaging, and arthroscopic findings.
C. A 32% reduction of size of the cartilage defect has been seen in cartilage defects on the medial femoral condyle.
D. A 32% reduction of size of the cartilage defect has been seen in cartilage defects on the medial femoral condyle. Complete resolution of the cartilage defect has not been seen.

10 / 10

Hip

A 64-year-old female patient with rheumatoid arthritis has a 2-year history of continued left hip and groin pain following left total hip arthroplasty (THA). She has undergone 3 rounds of physical therapy and is still taking opioids occasionally for pain. She denies any other problems following the surgery. Serum inflammatory markers are mildly elevated but at baseline for her. Which of the following should be the next step in management?

Remediation:
A. Pain management may be helpful for this patient over the long term if an organic cause of her pain cannot be determined, but without aspiration, infection cannot be definitively ruled out.
B. A bone scan may come into play for this patient if there is some concern for loosening or equivocal evidence for infection, but the first option is to aspirate the hip for a synovial white blood-cell (WBC) count and cultures.
C. If this patient had a metal-on-metal bearing THA, then MARS MRI would likely be part of her workup, but given the information provided with the continued pain and elevated inflammatory markers in the setting of rheumatoid arthritis, aspiration is warranted to rule out infection.
D. Despite the fact that this patient's inflammatory markers are "baseline for her," due to her inflammatory disease, continued pain despite physical therapy, and occasional use of opioids, there should be an investigation with aspiration for possible infection.
E. A serum white blood-cell count has not been found to be a useful part of diagnosing periprosthetic joint infection. A synovial white blood-cell count and cultures will provide more definitive information.

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