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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

October 2025

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Trauma

When considering the approach for open reduction and internal fixation of a patellar fracture, a lateral parapatellar approach decreases the risk of injury to which of the following areas of blood supply to the patella?

Remediation:
A. The lateral parapatellar approach decreases the risk of injury to the inferomedial blood supply.
B-D. Same as A

2 / 10

Sports

A 17-year-old male patient who is a wrestler presents with the following skin findings in his axilla. Which of the following are your recommendations regarding return to play?
sports

Remediation:
A. Please see answer choice
B. This condition is contagious, and the athlete cannot play since he is a wrestler and it cannot be covered adequately.
C. This condition is contagious and this is too soon to return to play.
D. Same as B

3 / 10

Spine

A 37-year-old male patient has had 6 weeks of radicular leg pain. Magnetic resonance imaging (MRI) demonstrates concordant disc herniation. Nonoperative treatment is recommended. When compared with similar patients treated with surgery, which of the following outcomes is this patient more likely to have 2 years after nonoperative treatment?

Remediation:
A. The Spine Patient Outcomes Research Trial (SPORT) was a multicenter study that randomized patients presenting with MRI findings of a disc herniation and at least 6 weeks of concordant symptoms to discectomy vs. nonoperative treatment. Results for 2, 4, and 8 years have been published. The 2-year results favored surgery in all primary and secondary outcomes as treated. There was a high crossover following treatment allocation, watering down the effect size determined from an intention-to-treat analysis.
B. Discectomy resulted in greater improvement in bodily pain scores.
C. Beyond the first 6 weeks (convalescent period), there was no difference in return-to-work rate between discectomy and nonoperative treatment. Length of time of work is the most predictive of return to work after treatment, regardless of treatment method.
D. While the treatment effect in favor of discectomy reduced over time, due to reductions in late-term outcome scores for the discectomy group, at 2 and 4 years, symptom improvement was significantly better for discectomy.
E. Discectomy was associated with a statistically significant great level of satisfaction at 2, 4, and 8 years compared to nonoperative treatment, especially in the observational arm of the Spine Patient Outcomes Research Trial (SPORT). The SPORT included both a randomized controlled trial and a prospective observational cohort.

4 / 10

Shoulder and Elbow

A 52-year-old male patient who is right-hand dominant presents with a 2-month history of right lateral elbow pain. He reports difficulty with daily activities, secondary to the pain, and says that simple activities, such as lifting a coffee mug, produce severe pain. Examination reveals pain with palpation over the extensor carpi radialis brevis origin as well as pain with resisted finger extension and passive wrist flexion. When compared with placebo, which of the following nonoperative interventions has improved long-term outcomes in regards to pain and function?

Remediation:
A. Nonoperative treatment options have not shown better long-term outcomes when compared with placebo for the treatment of lateral epicondylitis.
B - E. Same as A

5 / 10

Pediatrics

A 12-year-old boy was playing soccer when he was slide tackled by another player. He twisted his knee and had immediate pain and swelling. He was taken to the emergency department, where radiographs (shown) are obtained. Definitive management of this patient's injury should consist of which of the following?

Remediation:
A. The radiographs demonstrate a fracture, not a tumor.
B. Closed reduction is unlikely to provide anatomic reduction, postoperative casting may result in stiffness, and there may be an interposed meniscus.
C. The fracture should first be reduced and stabilized to allow early range of motion.
D. ORIF is indicated in order to reduce and stabilize the fracture and also to allow early motion.
E. While the ACL may be stretched, reconstruction is rarely necessary.
F. The fragment should be fixed, not excised.

6 / 10

Pathology and Basic Science

Which of the following noncollagenous proteins interacts with aggrecan and other cartilage extracellular matrix (ECM) proteins and is associated with the skeletal disorder pseudoachondroplasia?

Remediation:
A. Fibronectin is a glycoprotein of the extracellular matrix that binds to membrane-spanning receptor proteins called integrins.
B. Hyaluronic acid is an extracellular matrix molecule with multiple physical and biological functions found in many tissues, including cartilage; it is not implicated in pseudoachondroplasia.
C. COMP is a glycoprotein that interacts with cartilage ECM components; mutations in COMP can result in pseudoachondroplasia.
D. Cartilage intermediate layer protein (CILP) is a cartilage-related protein that resides in the middle layer of the cartilage matrix; it is not implicated in pseudoachondroplasia.

7 / 10

Hand and Wrist

A 35-year-old male patient who is a plumber presents with a trigger finger of the nondominant ring finger for approximately 8 weeks. On examination, there is triggering that needs to be passively corrected once the digit is locked in flexion. The patient has a 15° contracture of the proximal interphalangeal joint of the affected finger. He has tried splinting and multiple corticosteroid injections without any lasting relief. In addition to an A1 pulley release, which of the following should be done at the time of surgery to address his contracture?

Remediation:
A. In this patient who has a small contracture that is not long-standing, an A1 release alone should be sufficient.
B. With a small contracture that is not long-standing, an isolated A1 pulley release is likely to adequately address the contracture.
C. An ulnar superficialis slip resection is more appropriate for positional contracture that is long-standing or does not correct after A1 release and physical therapy.
D. With a small contracture that is not long-standing, an isolated A1 pulley release is likely to adequately address the contracture.

8 / 10

Foot and Ankle

A 54-year-old male patient is admitted to the intensive care unit with pneumonia and sepsis. He has a history of multiple gout flares. Yesterday, his ankle became acutely painful and swollen, and today he is unable to move it. A joint aspiration is performed, and fluid analysis shows 110,000 nucleated cells, 94% polymorphonucleocytes, and monosodium urate crystals. Which of the following is the most appropriate initial treatment?

Remediation:
A. Corticosteroid injections are not recommended for a patient with a septic joint.
B. The patient has a septic joint in addition to gout. He should be treated with operative debridement.
C. The patient has a septic joint in addition to gout. He should be treated with operative debridement. Additionally, allopurinol would not be recommended in the setting of an acute gout flare.
D. The patient's synovial fluid cell count is associated with a high likelihood of a septic joint. Operative treatment is appropriate.

9 / 10

Knee

A 62-year-old female patient presents with right knee pain and instability following a right cruciate-retaining total knee arthroplasty (TKA) several years ago. On examination, she has laxity in flexion and midflexion and is stable in extension with a range of motion of 5° to 115°. Her radiographs are shown. During revision knee arthroplasty, her components were loose and removed without difficulty. When the trial components were placed, her knee was loose in flexion again and stable in extension. Which of the following is the next best step to achieve stability of her TKA?

Remediation:
A. Augmenting the tibia will affect both the flexion and extension gaps.
B. Translating the femur posteriorly or increasing the component size will tighten the flexion gap without compromising the extension gap. The radiographs demonstrate a lack of posterior condylar offset.
C. Placing a posterolateral augment will externally rotate the femur and can tighten just the lateral joint space in flexion.
D. Polyethylene thickness tightens both the flexion and extension gaps.
E. Augments on the distal aspect of the femur will tighten the extension gap.

10 / 10

Hip

A 63-year-old female patient who underwent acetabular component revision for right hip instability at another hospital presents to the emergency department 1 week postoperatively after feeling a pop in the operative hip while moving in bed. A radiograph is shown. Which of the following is the least likely cause of her symptoms?

Remediation:

A - D. According to a 2019 review of 2,500 revision total hip arthroplasty procedures performed between 2005 and 2015, the most common reasons for failure/rerevision were 1) instability, 2) periprosthetic fracture, and 3) aseptic loosening. Polyethylene wear had decreased to around 3%, compared with historical data that showed polyethylene wear as a more common reason for revision failure.

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