Table Of ContentPassport for theory, clinical and oral sections
Editor& Author Firas Arnaout MD MSc MRCS FEBOT FRCS (Tr&Orth)
University Hospital of Coventry & Warwickshire - UK
Associate Editor Siddhant Kapoor MBBS DNB (Ortho) MRCS FRCS (Tr&Orth)
University Hospital Birmingham, UK
Orthopaedic Illustrator Ahmed Elmetwaly Eltanboly MD MS (Tr & Orth)
Aljahra hospital - Kuwait
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Authors
Abdullah Hanoun MD MSc FEBOT FRCS (Tr&Orth) Rishi Dhir MBChB BSc (Hons) FRCS (Tr&Orth)
Salford Royal Hospital NHS Foundation Trust – UK Princess Alexandra hospital, Harlow - UK
Athar Muniruddin Siddiqui MBBS, MCh, FEBOT, SICOT, FRCS (Tr&Orth) Rohan Bidwai MS FEBOT FRCS (Tr&Orth)
Guys & St Thomas's NHS Trust - UK Arrowepark Hospital, Wirral - UK
Amgad Medani MBBS MRCS FEBOT MCH FRCS (Tr&Orth) Sameer Agarwal MBBS MS MCh FRCS (Tr&Orth)
University Hospitals of North Midlands, Stoke on Trent – UK Ysbyty Gwynedd Hospital, Wales – UK
David Manzi Hughes MBBS (Lond), BSc (Hons), MRCS , FRCS (Tr & Orth) Sameer Mansukhani MBBS MS DNB MNAMS FRCS (Tr&Orth)
Warwick Hospital - UK Guys & St.Thomas Hospitals, London – UK
Fouad Chaudhry MBBS, MRCSEd, MSc, FEBOT, FRCSEd (Tr & Orth) Samir Hakeem MBBCh, MSc, MRCS, FEBOT, SICOT FRCS (Tr&Orth)
Russell Hall Hospital, Dudley - UK Galway University Hospital -Ireland
Hany Elbardesy MSc MRCS FEBOT SICOT FRCS (Tr&Orth) Shafiq Arif Shahban BSc (Orth) MBChB MRCS FRCS (Tr & Orth)
Cork University Hospital - Ireland University Hospital of Coventry and Warwickshire
Haroon Majeed MBBS MRCS MSc EBOT FRCS (Tr&Orth) Shwan Fryad Henari MBBCh MCh FRCS (Tr&Orth)
Manchester University NHS Foundation Trust - UK Oxford University Hospitals Foundation Trust - UK
Husam Elbana MBBCh MSc MCh FEBOT SICOT FRCS (Tr&Orth) Suddhajit Sen D.Orth MRCS MCh FRCS (Tr&Orth)
University Hospital of Morecambe Bay - UK Noble's Hospital, Isle of Man - UK
Imran A.Ali MD MPH MRCS MSc(Orth) SICOT FEBOT FRCS(Tr&Orth) Editorial Contributor
University Hospital of Morecambe Bay - UK Mohamed Elgawadi MD MSc (Ortho and Traumatology)
Mouwasat Hospital – Saudi Arabia
Jikku Haniball MBBS, MS (Orth) MRCS FRCS (Tr&Orth) (Ed)
Tan Tock Seng Hospital – Singapore Acknowledgment
We would like to thank Dr Soliman Faqih Hospital in Saudi Arabia and
Kashif Memon FRCS (Tr&Orth), FEBOT, ChM(Ed) in particular Dr.Mohammed Al Sobeai and Dr. Mahdi Bassi for their
Ashford and St Peter Hospital NHS Trust - UK contribution to this book by sharing with us some of their X-rays
Abdullah Alali – KAU Hospital – Saudi Arabia
Medhat Zekry MCh Orth FRCS (Tr&Orth) Anas Ahmed Abdulkarim Jabr Hassan - Lister Hospital - UK
University Hospitals Coventry and Warwickshire NHS Trust – UK Hany Farid Hermina - Gamal Abd Elnaser Hospital – Egypt
Lakshmanan Prakash - Institute for Special Orthopaedics – India
Mohamed A. Imam MD MSc (Hons) DSportMed PhD FRCS (Tr&Orth) Mahmoud Al-lafi – MOH – Saudi Arabia
Ashford and St Peters NHS Foundation trust - UK Mohamad Kousa – Damascus University Hospitals – Syria
Mohammad Shashoo – Damascus University Hospital – Syria
Mohammad Usman Khattak MBBS MRCS FRCS (Tr&Orth) PGC Orth Median Yousef - Borama Regional Hospital - Somalia
Worcestershire Acute Trust - UK Muhammed Ra’fat Meda – Damascus University Hospitals –Syria
Ramy Rashed - Oxford University Hospitals – UK
Mostafa Ahmady Elgendy MD MSc FRCS (Tr&Orth) Sabah Chenow – Al-Basel Hospital - Syria
Dr.Soliman Faqih Hospital, Saudi Arabia
Nicola Walsh MBBS FRCS (Tr&Orth)
University Hospital of Morecambe Bay - UK
Prashanth Nagaraj MBBS MS (Ortho) MRCS FRCS (Tr&Orth)
London northwest NHS trust - UK
Pritom Mohan Shenoy MBBS MS Orth D.Orth FEBOT FRCS (Tr&Orth)
Wrexham Maelor Hospital – UK
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FOREWARD
To successfully fulfil the requirements of and pass a Fellowship exit examination is the aspiration of every doctor in a
speciality medical or surgical field. Yet all of us with experience in the teaching of specialised medicine or surgery realise
that it is not just appropriate knowledge and its application to patients that is the requirement, but also strategy to meet
the expectations of the examiners within the permitted time.
‘Concise Orthopaedics Notes’, authored by specialists, all who are members of the FRCS Mentor Group, is oriented
towards providing the candidate, both knowledge and know-how when appearing for this examination in the field of
Trauma and Orthopaedics. The ethos of the Group which is to ensure success of every candidate is evident throughout.
The authors emphasise the often neglected aspect of patient-approach and respect of patient-dignity during the
examination. Equal importance is given to the manner of answering the examiners’ questions, believing “there is a fine
line between confidence and arrogance”.
Though titled ‘Concise Orthopaedics Notes’, the book is extensively comprehensive in its knowledge content. In easy-to-
read font and bullet-point style, it succeeds in serving as a ready revision aid for those preparing for the United Kingdom
and International exit examinations. It has the added advantage of being contemporary with up-to date guidelines
incorporated.
The book is a welcome addition to the bank of information in Trauma and Orthopaedics and I feel extremely privileged
to be asked to write the Foreword. I have no doubt that the book will find valued acceptance by surgeons in our field.
Mr Jehangir Mahaluxmivala MS, MSc, FRCS (Tr&Orth)
Consultant Orthopaedic Surgeon
Princess Alexandra Hospital NHS Trust, UK and Rivers Ramsay Hospital, UK
Co-Director Mahaluxmivala-Sherman FRCS (Orth) Viva Course for Orthopaedic Surgeons
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PREFACE
These concise revision notes are aimed at candidates preparing for UK and international FRCS (Trauma & Orthopaedics)
exit examination as well as the European Board (EBOT) and SICOT diplomas.
The book has been written in an easy to read style, with a focus on being an exam candidate’s companion for quick
revision on the go. Candidates are usually caught between a busy job and the demands of these challenging exams. This
book covers the depth and breadth of Trauma & Orthopaedics knowledge to help candidates sail through the Fellowship
exit examinations.
We have aimed to provide a high quality one stop concise knowledge bank to cover the whole syllabus of Trauma &
Orthopaedics in a well organised bullet point style.
This will provide a useful resource for both part 1 (MCQs, EMQs) as well as part 2 (Viva and Clinical) components of the
exit examinations. It is an ideal companion to complement your preparation for the examination with the most useful
information presented in the most succinct manner.
The authors are senior members of the FRCS Mentor Group who have between them ample up to date experience and
knowledge with the Fellowship examination. They have attended most postgraduate orthopaedic courses in the UK and
internationally ,and have reviewed all relevant exam book. They have excellent track records of helping many candidates
to pass their exams.
This book is complemented by hundreds of diagrams, illustrations, radiographs and clinical images. There are QR codes
interspersed within the chapters which when scanned using your smartphone camera, link up to either the
corresponding open-access seminal paper or to a YouTube video pertaining to the topic discussed.
We look forward to the readers’ feedback that will help us immensely to improve the contents in the next edition for
the benefit of future orthopaedic aspirants. Please leave us your opinion on Amazon or write to the email below.
We also invite anyone who is interested to become an author of the next edition, or to discuss future collaboration or
sponsorship opportunities to contact the editor on: [email protected]
Love this book? Don’t forget to leave a review! Every review matters and it matters a lot!
Head over to Amazon and to BookAuthority.org to leave a review.
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COPYRIGHTS AND DISCLAIMER
All rights reserved. No part of this publication may be reproduced, distributed or transmitted in any form or by any
means, including photocopying, recording, or other electronic or mechanical methods, without the prior written
permission of the publisher, except in the case of brief quotations embodied in critical reviews and certain other non-
commercial uses permitted by copyright law.
Although the authors and publisher have made every effort to ensure that the information in this book was correct at
press time, they do not assume and hereby disclaim any liability to any party for any loss, damage, or disruption caused
by errors or omissions, whether such errors or omissions result from negligence, accident, or any other cause.
Neither the authors nor the publisher assumes any responsibility or liability whatsoever on behalf of the consumer or
reader of this material. Any perceived slight of any individual or organization is purely unintentional.
The resources in this book are provided for informational purposes only and should not be used to replace the
specialized training and professional judgment of a health care professional.
Neither the author nor the publisher can be held responsible for the use of the information provided within this book.
Please always consult a trained professional before making any decision regarding treatment of yourself or others.
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DEDICATION
This book would not have been possible without the dedicated team of talented and enthusiastic contributors who have
participated to this project. To all of them, I am deeply grateful.
I would like to thank my wife (Reem), daughter (Talia) and son (Taym) for being a source of inspiration and
encouragement, and for tolerating all those weekends and evenings I spent away from them while writing this book.
To the orthopaedic community, and to every clinician aspiring to excel in this profession, I dedicate this book.
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CONTENTS
Chapter 1 General Guidance for exams .............................................................................................................. 9
Pritom Shenoy, Athar Siddiqui, Shafiq Shahban
Chapter 2 Orthopaedic Basic Sciences .............................................................................................................. 27
Shwan Henari, Usman Kattak, Hany Elbardesy
Chapter 3 Orthopaedic Adult Pathology ......................................................................................................... 143
Abdullah Hanoun, Shafiq Shahban, Shwan Henari
Chapter 4 Paediatric Orthopaedics ................................................................................................................. 191
Nicola Walsh, Hany Elbardesy, Mostafa Elgendy
Chapter 5 Spine ............................................................................................................................................... 268
Siddhant Kapoor, Husam Elbana, Imran Ali
Chapter 6 Upper Limb...................................................................................................................................... 325
David Hughes, Abdullah Hanoun, Mahmoud Rahuma
Chapter 7 Hand & Wrist .................................................................................................................................. 394
Mehat Zekry, Kashif Memon, Suddajit Sen
Chapter 8 Lower Limb ..................................................................................................................................... 462
Jikku Haniball, Rohan Bidwai, Sameer Mansukhani
Chapter 9 Foot & Ankle ................................................................................................................................... 584
Sameer Agarwal, Samir Hakeem, Haroon Majeed, Prashanth Nagaraj
Chapter 10 Trauma ............................................................................................................................................. 644
Mohamed Imam, Amgad Medani, Fouad Chaudhry
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ABBREVIATIONS
A Artery
AAA Abdominal Aortic Aneurysm
ABx Antibiotics
AD Autosomal Dominant
ALL Anterior Longitudinal Ligament
AR Autosomal Recessive
AS Ankylosing Spondylitis
Br Branch
CSF Cerebro Spinal Fluid
COT Congenital Oblique Talus
CVT Congenital Vertical Talus
CNS Central Nervous System
DM Diabetes Mellitus
Deg Degrees
Ex Examination
GT Greater Trochanter
HA HydroxyApatite
Hx History
HTO High Tibial Osteotomy
II Image Intensifier
IN Inter-Nervous plan
IR Internal Rotation
Ix Investigations
LFC Lateral Femoral Condyle
Lig Ligament
LM Lateral Meniscus
Lt Left
MM Medial Meniscus
MT MetaTarsal
Mx Management
N Nerve
NV Neurovascular
NWB Non-Weight Bearing
PG ProteoGlycan
PNS Peripheral Nervous System
Rt Right
SB Spina Bifida
Syn Syndrome
Tx Treatment
V Vein
# Fracture
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AUTHORS
Pritom Shenoy, Athar M Siddiqui, Shafiq Shahban
FRCS (Tr & Orth)
The FRCS (Tr &Orth) examination consists of two sections. Part 1 consists of MCQ and EMQ papers, both of which are
timed and take place often in a driving test centre. You will need to choose your exam centre for section 1 and the date
for your section 2 beforehand as part of your application. Both parts will need to be paid in full on application.
Please refer to the Trauma & Orthopaedics curriculum (updated August 2018) available on the GMC website for further
guidance of the standard that you will be assessed on; please bear in mind that the syllabus is vast. Depending on your
previous level of core knowledge and current circumstances (i.e. where you work, home situation etc) anywhere
between 6–12 months of hard work and preparation is required to sit and pass this exam.
Section 1
Section 1 tests the theoretical knowledge of the candidate and is held at a test centre on a computer. You may have
people around you undergoing different tests, such as driving theory tests.
Section 1 consists of two papers held on the same day (often morning and afternoon – the JCIE endeavours to provide a
minimum of 30 minutes between each paper).
Paper 1: [2 hours] - Single Best Answer (SBA)
110 Multiple Choice Questions (Single Best Answer from a choice of 5 options)
Paper 2: [2 hours 30 minutes] Extending Matching Item (EMI)
135 Multiple Choice Questions (Extended Matching Item Format). 45 question stems with 3 sub
questions, and a list of options to choose from with each option potentially being used once, more than
once, or not at all.
You will be notified of your result (by email) within 4 weeks of sitting the exam. The score from each paper will be broken
down to give you a cumulative result. The pass mark for this exam is variable and depends on how the whole cohort
performs (often it varies anywhere between 60-70%).
Section 2
Section 2 consists of the clinical examination component and the oral component. They are held on different days either
on subsequent days or with a “free” day in between. The standard of the pass mark is set at the level of a day one
consultant in the generality of trauma and orthopaedics.
You will have as part of your examination two intermediate cases and two sets of 3 short cases (each intermediate and
each set of short cases is divided into upper and lower limb, with spine potentially cropping up in either (or both). Each
individual clinical case is marked and observed by 2 consultant examiners (a third person maybe present either as an
observing examiner or invigilator for the examiners).
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Day 1 - Clinicals
Intermediate cases
There will be two cases, each of 15-minutes duration, and each candidate will be marked in the following domains:
History Taking / Data Gathering
Summary of history and presentation / Structured approach / Logical thought process
Clinical examination / Interpretation of findings / Plan of investigation
Diagnosis (differential) / Clinical knowledge
General management plan / Discussion of treatment options / Clinical reasoning
Approach to patient / Bedside manner / Professionalism will be assessed throughout the exam
For the intermediate cases, as a general rule, the 1st 5 minutes is set aside for history taking, the 2nd 5 minutes for
examination and the 3rd 5 minutes for discussion/management. Each Examiner will have his/her own mark sheet and will
award a total of 6 times for each of the Clinical Intermediate Case examinations.
Short cases
Each short case is timed to 5 minutes, within which you are expected to (ideally) pick up on the diagnosis and move
swiftly to management, specific to that patient. Five minutes is not long at all, and given the stress and anxiety
associated with it, this time will pass quicker than anticipated. For this reason, it is important to not waste any valuable
seconds/minutes and to have your pathology specific examinations down to a tee.
Within each 5 minute short case you will be marked in the following areas:
Clinical Skills
Clinical Knowledge
The purpose of the Clinical Short Case is for you to demonstrate that your observational, examination skills, and your
knowledge, are sufficiently well-developed to make a relatively quick and accurate diagnosis for conditions that have
typical clinical presentations. For complex problems, you may not necessarily come to a diagnosis, but you should be
able to list an appropriate differential diagnosis.
The examination is rather like seeing a patient in the out-patient clinic and making a provisional diagnosis. Because of
time limitations, you may not be able to perform a full examination and may only be able to ask a few (key) questions.
However, it is important to still abide by good clinical practice and ensure that you remain polite and courteous to the
patient, to introduce yourself and to use alcohol gel on your hands.
It is likely in a short case that the examiner will give clear instruction about what to examine or focus on, such as “Please
examine this patient’s right hand” or “Please examine this patient’s forefoot”. There is no intention during this
examination to trick the candidate and candidates are strongly encouraged to do precisely what is asked of them by the
examiner. Candidates should, of course, show respect for the patient and attempt to avoid inflicting unnecessary pain
during the examination.
Depending on how well or bad you are doing the examiner will intervene appropriately to either guide you back on track
or to push you to move you on and score points. You may also be asked specifically to ask few relevant questions before
proceeding with any examination – you won’t have time for a full history and so any questions asked must be relevant.
Day 2 - VIVAs
Four 30-minute orals in:
Adult Pathology
Trauma
Paediatric Orthopaedics and Hands (15 minutes for each)
Applied basic sciences
Candidates have up to a maximum of 7 years to complete the examination process as follows:
Section 1: Candidates have 2 years (from their 1st attempt) with a maximum of 4 attempts to gain eligibility to proceed
to Section 2, with no re‐entry
Section 2: Candidates have a maximum of 4 attempts with no re‐entry
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