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

May 2024

1 / 10

Trauma

You are called to the emergency department to assess a 45-year-old female patient whose radiograph is shown. Which of the following is the optimal management for this patient's distal femoral fracture?
trauma

Remediation:
A. Open reduction and internal fixation with a plate and screws is the most appropriate treatment choice. This will allow for early motion and provide the best chance of obtaining an anatomic reduction.
B. Although this is a treatment option, this option will not allow early knee motion and provides limited stability to the fracture
C. Knee braces or splints can be used for the initial stabilization of a distal femoral fracture but is not a definitive treatment choice.
D. Total knee arthroplasty is not indicated for a young patient with a distal femoral fracture.

2 / 10

Sports Medicine

A 24-year-old male patient presents with left foot pain. He reports medial pain for approximately 3 months that worsens with an increased activity level. He has never been evaluated for this problem. On examination, he has pain along the posterior tibial tendon, and standing alignment demonstrates a hindfoot valgus with a "too many toes" sign. Radiographs are shown. The patient returns 3 months later. He tried orthotics and physical therapy as prescribed, but still has substantial pain along the posterior tibial tendon. Which of the following would be the next appropriate step in management?
Sports Medicine

Remediation:
A. Flatfoot reconstruction surgery aims to correct the deformity associated with posterior tibial tendon dysfunction (PTTD)
B. This is for more advanced dysfunction.
C. He has failed nonoperative management. Surgery should be considered.
D. This would not address the hindfoot valgus/flatfoot.

3 / 10

Spine

Which of the following risk factors are associated with the development of proximal junctional kyphosis (PJK) in the setting of Adult Spinal Deformity?

Remediation:
A. Risk factors of proximal junctional kyphosis development include increased age, fusion to the sacrum, combined anterior spinal fusion/posterior spinal fusion (ASF/PSF), and nonanatomic restoration of thoracic kyphosis or lumbar lordosis.
B. Same as A
C. Long-segment fusion is typically defined as 5 or more levels of fusion. Long-segment fusion is a prerequisite for adult spinal deformity surgery and, as such, it is not an independent risk factor for PJK.
D. Correction of the SVA to sagittally balance the spine is a goal of adult deformity surgery; however, the magnitude of correction is related to the risk of PJK. When the SVA is corrected more than 5 cm, the incidence of PJK increases.

4 / 10

Shoulder and Elbow

Which of the following patients would be appropriate for arthroscopic stabilization of a first-time anterior shoulder instability episode?

Remediation:
A. Multidirectional instability is usually atraumatic and best treated initially with physical therapy.
B. Due to the high risk of recurrent instability in this patient, early surgery is effective in reducing recurrent dislocation rates.
C. Seizures should be under control before considering surgery. If they are not under control, the seizure can lead to recurrent dislocations.
D. Patients who are <20 years old have a substantial risk of recurrent instability. Early surgery is effective in reducing the risk of recurrent dislocations.

5 / 10

Pediatrics

A 12-year-old boy fell while riding his bicycle. He had immediate right knee pain and informed the emergency department physician that he thinks his kneecap dislocated and then spontaneously reduced. Anteroposterior and lateral radiographs of the right knee are shown. Which of the following is the most appropriate management of this patient?

Remediation:
A. The case describes a displaced patellar sleeve avulsion fracture. Open reduction and internal fixation is recommended. Nonoperative management is likely to result in substantial extensor lag.
B. Same as A
C. Same as A
D. Same as A

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

Hand and Wrist

A 34-year-old male patient presents with marked ulnar nerve dysfunction. He sustained a laceration at the level of the proximal wrist crease 1 year ago and underwent nerve repair. His hand is now held in metacarpophalangeal (MCP) joint extension and interphalangeal (IP) joint flexion. Which of the following physical examination maneuvers will best determine whether a static or dynamic transfer is required?

Remediation:
A. With Bouvier's maneuver, MCP extension is blocked and IP joint extension is evaluated. If IP joint extension is preserved, then only a static transfer is required.
B. The Elson test is used to examine central slip competency in extensor tendon lacerations about zone 3.
C. The Boyes test is used to examine central slip competency in extensor tendon lacerations about zone 3.
D. This is not a described test. The Wartenberg sign is 5th finger digital abduction that is seen in ulnar nerve dysfunction.

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. An isolated soleus contracture is not demonstrated with this examination. Additionally, this type of contracture is difficult to demonstrate.
B. Knee flexion relaxes the gastrocnemius. This degree of increased motion with the knee flexed suggests the presence of an isolated gastrocnemius contracture.
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

A 64-year-old male patient presents with severe pain 7 years after left total knee arthroplasty. Radiographs show osteolysis affecting the proximal aspect of the tibia. Intraoperative photographs demonstrate bony involvement. The tibial defect involves both the medial and lateral plateaus and compromises the metaphysis bone stock, which is damaged but not deficient. The cortical rim is intact. The collateral ligaments and extensor mechanism are intact. Femoral bone loss is minimal, with no metaphyseal compromise, and the defects can be filled with cement. According to the Anderson Orthopaedic Research Institute (AORI) Classification of Bone Defects, this patient's classification would be which of the following?

Remediation:
A. The tibia is a type-2B defect because it involves both sides of the plateau.
B. Same as A
C. The AORI classification is broken up into 3 types for both the tibia and the femur separately. Type 1 has an intact metaphseal bone stock. Type 2 defects involve the metaphyseal bone and are further divided into A (one condyle/side of the plateau is involved) and B (both condyles/sides of the plateau are involved).  Type-3 defects have major metaphyseal bone involvement and have compromise to the collateral ligaments.
D. The tibia is a type-2B defect because it involves both sides of the plateau. The collateral ligaments are intact.
E. The femur is a type-1 defect because there is no metaphyseal involvement.

10 / 10

Hip

A 68-year-old male patient presents with a limb-length discrepancy that he has noticed over the past few years. The patient is a cigarette smoker, has hypertension, coronary artery disease, hepatitis C, and had a syphilis infection 20 years ago. He is a poor historian, but does not recall any previous operative procedures on his hips or any infections requiring intravenous antibiotics. Imaging is shown. On examination, he has an unsteady gait and is unable to walk without an assistive device. His right leg is shorter than the left, he has no pain in either hip with passive range of motion, and he has decreased sensation throughout both lower extremities There are no operative incisions about the hips. His previous medical records show a recent serum erythrocyte sedimentation rate, a C-reactive protein level, and a right hip aspiration that are not concerning for infection. Which of the following is the most likely diagnosis?

hip

Remediation:
A. Charcot arthropathy is a joint pathology associated with a neurological condition such as syringomyelia, neurosyphilis, or diabetic neuropathy. It is most commonly seen in the foot or the ankle in a patient with diabetic arthropathy but may present in the hip. Radiographic findings include femoral head resorption as well as bony debris in the acetabulum. It is important to rule out infectious etiology in these patients.
B. This patient presents with Charcot arthropathy of the hips. Charcot arthropathy is a joint pathology associated with a neurological condition such as syringomyelia, neurosyphilis, or diabetic neuropathy. It is most commonly seen in the foot or the ankle in a patient with diabetic arthropathy but may rarely present in the hip. Radiographic findings include femoral head resorption as well as bony debris in the acetabulum. In this patient with normal serum inflammatory markers and a negative joint aspiration, septic arthritis is unlikely.
C. While severe hip dysplasia can present with femoral head resorption on imaging, there is typically a long-standing history of deformity and it is not usually associated with any neurological deficits. In addition, the bony debris and hypertrophy seen on these images are more commonly associated with Charcot arthropathy.
D. Osteoarthritis of the hip does not usually present with femoral head resorption, bony debris, and limb shortening as with this patient. In addition, this patient's history of syphilis and neurological deficits suggest a diagnosis of Charcot arthropathy.

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