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All registrants to the Miller’s Orthopaedic Review Course, Oxford 2025 will receive a one-year complimentary subscription to JBJS Clinical Classroom—a leading adaptive learning tool for orthopaedic surgeons. With over 4,500 learning probes, it reinforces your knowledge and mastery of key learning objectives across all orthopaedic subspecialties. Subscription activated upon registration.

What is JBJS Clinical Classroom and how does it work?

JBJS Clinical Classroom is an adaptive learning system that observes how users learn and tailors their experience to focus on their own knowledge gaps. Importantly, Clinical Classroom identifies material in which learners are weak or need improvement. This directs individual learning as well as provides focus for faculty and residency directors when planning learning assessments.

BUILT BY EXPERTS

JBJS recruited experts across orthopaedic subspecialties to develop learning objectives that require higher-order thinking, such as an ability to evaluate and diagnose a patient’s condition and to select an appropriate treatment. Writers then developed probes to address each learning objective, provided learning resources with supporting information for the questions, and supplied references for additional information.

All questions and learning resources are peer-reviewed by several subspecialty content experts and the JBJS Editor-in-Chief then revises as needed before integrating into JBJS Clinical Classroom. The platform is updated regularly to add new learning objectives and probes, revising any material that is no longer current.

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quiz of the month JBJS

Try this Quiz for MRC Oxford

1 / 10

Trauma

Which of the following is considered a trauma-related risk factor for radioulnar synostosis?

Remediation:
A. A Monteggia fracture is a risk factor for radioulnar synostosis.
B. Head rather than chest trauma is a risk factor for radioulnar synostosis.
C. Fractures at the same level are a risk factor for radioulnar synostosis.
D. Comminution is a risk factor for radioulnar synostosis.

2 / 10

Spine

A 34-year-old male patient is visiting from out of the country and presents to the emergency department with a 3-month history of upper middle back pain, a dry cough, and unintended weight loss. Laboratory test results show a normal serum white blood-cell count. A chest radiograph shows a consolidation in the upper zone of the left lung with ipsilateral hilar enlargement suspicious for a tuberculous nodule. Which of the following radiographic characteristics helps distinguish tuberculous from pyogenic spinal infections?

Remediation:
A. Pott's disease was a common cause of acquired spinal kyphosis as TB tends to affect the anterior aspect of the spine, which leads to bony collapse and kyphosis.
B. This is a consistent feature of a tuberculous spine compared with pyogenic spinal infection.
C. Prior spinal surgery is a risk for pyogenic, not tuberculous, spinal infections. A TB spine comes from hematogenous spread of primary pulmonary TB.
D. Anterior column involvement is common for TB. Osteolysis and collapse leads to kyphosis.

3 / 10

Shoulder & Elbow

A 42-year-old male patient who is an internal medicine physician starts a new exercise program involving vigorous weightlifting, pull-ups, and rowing. He presents with 6 weeks of medial elbow pain. Plain radiographs are negative. Physical evaluation reveals pain with wrist flexion and tenderness over the medial distal humerus. A milking maneuver does not elicit pain. Initial treatment should be directed at which of the following diagnoses?

Remediation:
A. The patient has typical findings of tenderness over the medial epicondyle with pain with wrist flexion.
B. The patient has negative radiographic findings for any arthritis.
C. Although cubital tunnel syndrome can cause medial elbow pain, this patient has no paresthesias or neurogenic symptoms.
D. Although an ulnar collateral ligament tear can cause medial elbow pain, the patient has a negative milking maneuver, which would be indicative of an ulnar collateral ligament tear

4 / 10

Basic Science

You are asked to evaluate a newborn who was born at 39 weeks to a 42-year-old gravida 1, para 1 mother after the newborn was found to have hypotonia and a poor Moro reflex. Physical examination shows hypoplasia of the middle phalanx and clinodactyly of the small fingers, a single palmar crease, a wide gap and plantar crease between the great and second toes, and hypermobility of the joints. Which of the following axial skeletal conditions may also be present in a patient with this diagnosis?

Remediation:
A. This can cause coronal plane deformities of the thoracic spine regardless of syndromic presentation, but is not typical of Down syndrome.
B. While patients with Down syndrome may have atlantoaxial abnormalities, a fusion at the occipitoatlantal joint is not typical.
C. Twelve to 20% of individuals with Down syndrome (trisomy 21) have instability at the atlantoaxial joint. Screening for this instability is with flexion and extension lateral radiographs of the cervical spine.
D. This is not typical of patients with Down syndrome. Kyphosis specifically is typical of Scheuermann disease.

5 / 10

Hand & Wrist

A 2-year-old girl, recently adopted from outside the United States, presents with her parents for an initial evaluation. The diagnosis of a type IV radial longitudinal deficiency is made. Which of the following is the initial step in management?

Remediation:
A. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes.
B. The priority in a patient newly diagnosed with radial longitudinal deficiency is to evaluate for associated syndromes. This requires obtaining laboratory studies, including a complete blood-cell count and a chromosomal breakage analysis. Early detection of Fanconi's anemia can be lifesaving.
C. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes.
D. The first priority in radial longitudinal deficiency is to evaluate the patient for any associated syndromes. Creation of a one-bone forearm is not an option in type IV radial longitudinal deficiency, where the radius is completely absent.

6 / 10

Foot & Ankle

A 20-year-old female patient who is a collegiate soccer player presents for evaluation of posterolateral ankle pain. She reports that the pain started with a slide-tackle injury during a game 3 months ago. She did not initially seek evaluation because she thought it was "just a sprain," but the pain has persisted and continues to limit her ability to compete. She denies any prior significant injuries to either ankle. On physical examination, she has tenderness at the retrofibular groove and posterolateral border of the fibula. She has no other areas of tenderness about the ankle or foot. She has pain with resisted eversion of the foot but demonstrates symmetric eversion strength. Inspection and palpation of the tendons during which of the following actions will best discriminate between a tendon tear and tendon instability?

Remediation:
A. Tendon subluxation or dislocation during circumduction indicates peroneal tendon instability. Symmetric eversion strength suggests that the tendons are not torn.
B. Forced passive inversion will typically produce peroneal tendon pain that is more consistent with a tendon tear.
C. A single-leg heel rise does not discriminate between peroneal tendon tear and instability.
D. Anterior drawer testing is used to assess the competency of the anterior talofibular ligament.

7 / 10

Knee

Which of the following concepts is most consistent with kinematic alignment in total knee arthroplasty?

Remediation:
A. The transverse axis of the femoral component is aligned with the transverse axis of the native prearthritic femur.
B. The distal femoral cut is in valgus and ranges from 5° to 9°of valgus. Kinematic alignment usually has a 7° to 5° valgus distal femoral cut.
C. The tibia is cut perpendicular to the mechanical axis in the mechanically aligned knee.
D. Kinematic alignment is based on the 3-dimensional motion of the knee. It is designed to recreate the more natural kinematics of the knee about the axis of rotation of the femoral condyles.

8 / 10

Hip

A 56-year-old female patient presents for evaluation of her left hip pain. She has tried outpatient and home physical therapy, nonsteroidal anti-inflammatory drugs, and acetaminophen, with little relief. She had a corticosteroid injection 5 weeks ago, which relieved >90% of her pain for approximately 2 weeks. She has hypothyroidism and a body mass index of 30 kg/m2. When discussing operative treatment with the patient, you tell her that if she has surgery within 3 months after receiving a corticosteroid injection, she is at risk for which of the following? "

Remediation:
A. There is no evidence showing an increased risk of calcar fracture or Vancouver fracture when a corticosteroid is administered prior to total hip arthroplasty.
B. There is no evidence showing an association between length of hospital stay and when a corticosteroid is administered prior to total hip arthroplasty.
C. There are no reported increased rates of dislocation if a patient receives a corticosteroid injection within 3 months of total hip arthroplasty.
D. Multiple studies have demonstrated that an intra-articular corticosteroid injection within 3 months of a total hip arthroplasty results in significantly higher rates of infection.

9 / 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.

10 / 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.

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