Quiz of the Month – July 2022

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quiz of the month JBJS

Quiz of the Month - July 2022

1 / 10

Which of the following radiographic features would most likely be present in a patient with adult dysplasia of the hip?

Remediation:
Adult hip dysplasia is characterized radiographically by decreased femoral head sphericity, a lateral center-edge angle of <20°and an increased femoral neck-shaft angle (coxa valga).

2 / 10

A 33-year-old female patient presents with 10 years of anterior knee pain that is progressively worsening. She has pain with weightbearing activities, when climbing stairs, kneeling, and squatting.
On examination, she has a mild knee effusion, normal knee alignment and patellar mobility, range of motion of 0° to 125°, and mild crepitus.
Radiographs show preservation of the joint space. Despite several nonoperative interventions, including daily nonsteroidal anti-inflammatory drugs, occasional corticosteroid injections, and weight loss, she continues to have pain and limitations in her activities.
Which of the additional following treatment modalities is most appropriate for this patient?

Remediation:
A.
Bracing in the absence of a ligament injury or instability has not been shown to reliably improve anterior knee pain.
B. The history and examination are consistent with patellofemoral pain. Low-impact exercises, weight loss, and activity modifications more consistently relieve pain and improve function in patients with symptomatic anterior knee pain.
C. Evidence in the efficacy of glucosamine-chondroitin supplementation is currently lacking.
D. There is no robust evidence supporting the use of stem cell therapies in the management of anterior knee pain in a young patient.

 

3 / 10

When compared with adult hallux valgus deformity, juvenile hallux valgus deformity is associated with a higher percentage of which of the following postoperative occurrences?

Remediation:
A. Osteonecrosis of the first metatarsal head may be encountered after distal chevron osteotomy, although rates are low in adults and juveniles alike.
B. Hallux varus may be encountered with excessive medial eminence resection, medial capsule tightening, lateral soft-tissue release, or fibular sesamoid excision. However, this is not more frequent in juveniles.
C. Recurrence rates are higher with operative treatment of hallux valgus in juveniles when compared with adults.
D. Infection risk is not higher with the operative treatment of juveniles when compared with adults.

4 / 10

Which of the following patients is at increased risk for contracting a Mycobacterium marinum infection in the hand?

Remediation:
A. This patient has a higher risk of a Clostridium tetani infection.
B. This patient is at higher risk because Mycobacterium marinum is present in freshwater and marine environments.
C. A puncture wound from a rose thorn would more commonly cause a fungal infection, specifically from Sporothrix schenckii.
D. This patient has a higher risk of a Clostridium tetani infection.

5 / 10

Which of the following describes appropriate diagnostic testing for Ehlers-Danlos syndrome (EDS)?

Remediation:
A. There are a wide range of EDS subtypes recognized clinically, which can be confirmed by molecular genetic testing
B. The clinical diagnosis of hypermobile EDS needs the simultaneous presence of all 3 clinical criteria.
C. Diagnosis of the vascular-type EDS (type IV), arthrochalasia-type EDS (types VIIA and VIIB), and dermatosparaxis-type EDS (type VIIC) requires a skin biopsy.
D. Mutations in at least 19 genes have been found to cause the Ehlers-Danlos syndromes. Mutations in the COL5A1 or COL5A2 gene, or rarely in the COL1A1 gene, can cause the classical type. Marked skin hyperextensibility, together with widened atrophic cutaneous scars and generalized joint hypermobility, is typical of classical EDS

6 / 10

An otherwise healthy 4-year-old girl presents for initial evaluation of a gait asymmetry of 2 years duration. Examination demonstrates limited abduction of the left hip.  Radiographs reveal a dislocated left hip with an acetabular index of 35° and there is no evidence of osteonecrosis.  Which of the following is the best treatment option for this patient?

Remediation:
A. Closed reduction is not indicated given the long-standing dislocation in a 4-year-old
B. Open reduction is indicated, but hip abduction of >60° in a spica cast is associated with the development of osteonecrosis.
C. Open reduction is likely necessary, but a shortening femoral osteotomy alone will not address the identified acetabular dysplasia in a 4-year-old.
D. All procedures are necessary to fully correct the dislocation and underlying acetabular dysplasia.  The femoral osteotomy will shorten the femur and reduce pressure across the femoral head. The pelvic osteotomy will improve the acetabular dysplasia, which will likely not improve spontaneously given the patient's age.

7 / 10

A 45-year-old male patient's glenoid track width is calculated using a circle of best fit. He is found to have an off-track lesion with a glenoid bone loss width of 30%. Which of the following operative options would be most appropriate for this patient?

Remediation:
A. An arthroscopic Bankart procedure alone for a 30% glenoid bone defect has an unacceptably high risk of recurrent instability.
B. A Latarjet procedure augments the glenoid bone to convert an off-track lesion to an on-track lesion to stabilize the glenohumeral joint.
C. The combination of an arthroscopic Bankart procedure plus remplissage is best reserved for off-track lesions with <25% of glenoid bone loss.
D. A distal tibial allograft, like the Latarjet, converts an off-track to an on-track lesion to stabilize the glenohumeral joint. Although this option may be acceptable, it is typically reserved for a revision/salvage scenario or in the setting of >40% of glenoid bone loss.

8 / 10

A 44-year-old male patient presents with L5 radiculopathy that has not responded to nonoperative treatment. Imaging demonstrates a concordant L5-S1 foraminal disc herniation with no other noteworthy spinal pathology. The patient is active and wishes to avoid a fusion procedure. You offer him a minimally invasive far lateral discectomy. Which of the following is the most common complication of this procedure?

Remediation:
A. Minimally invasive surgery (MIS) requires less soft-tissue destruction during the exposure. For this reason, MIS spine surgery is associated with lower blood loss, postoperative pain, and reduced risk of iatrogenic instability. Iatrogenic instability is more commonly seen after open spine surgery compared with MIS spine surgery. Instability is related to the amount of bone resection and preservation of the joint and joint capsule.
B. With minimally invasive surgery (MIS), the decompression is performed through a tubular retractor system. While less soft-tissue dissection is required, MIS spine surgery is technically more challenging because of difficult visualization and access. For this reason, incomplete decompression is a common complication of MIS spine surgery.
C. While injury to the major arteries and veins is rare, it can occur in both open spine and minimally invasive surgery (MIS).
D. Retrograde ejaculation is caused by injury to the superior hypogastric plexus and can occur in both open spine surgery and minimally invasive surgery (MIS). It is most commonly associated with anterior surgery of the lumbar spine.

9 / 10

A 45-year-old male patient presents with prolonged posterior ankle pain. He reports that 3 months ago he was playing basketball and felt a "pop in his ankle." His pain improved marginally, so he did not seek treatment. He reports mild pain in the area of the Achilles as well as decreased push-off strength. On examination, you observe calf atrophy, decreased plantar flexion strength, and a thickened contour of the Achilles tendon. The patient wants to remain active and feels that this injury is inhibiting his ability to do so. Which of the following is the most appropriate treatment option?

Remediation:
A. An ankle-foot orthosis would be an appropriate treatment for a low-demand patient or a patient who is a poor surgical candidate.
B. Achilles tendoscopy will be insufficient for a chronic Achilles tendon rupture.
C. This is a young, healthy male with a chronic Achilles tendon rupture. He wants to be active so surgery is indicated. Operative treatment includes repair of the tendon with possible tendon transfers or lengthening procedures depending on the size of the gap noted during surgery.
D. This is a young, healthy patient with a chronic Achilles tendon rupture. He wants to be active so operative treatment is the most appropriate. Operative treatment includes repair of the tendon with possible tendon transfers or lengthening procedures depending on the size of the gap noted during surgery.

10 / 10

A 45-year-old male patient sustained a midshaft clavicle fracture 2 years ago and now presents with persistent pain and mobility at the fracture site with no history of recent trauma. Which of the following complications does this patient most likely manifest?

Remediation:
A. The clinical history and examination (pain and mobility at the fracture site) are consistent with a fracture nonunion
B. Malunion will not present with movement at the fracture site.
C. The fracture has been present for more than 1 year with no signs of healing; therefore, it is a nonunion rather than a delayed union.
D. With no history of recent trauma, this is unlikely to be the case

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The average score is 69%

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