Postgraduate Orthopaedics: Viva Guide for the FRCS (Tr & Orth) Examination

Half title
Title page
Imprints page
Contents
Contributors
Preface
Acknowledgements
Abbreviations
Interactive website
Section 1 The FRCS (Tr & Orth) Oral Examination
	Chapter 1 General guidance
		Introduction
			Overall structure of Section 2
		Marking scheme
		Practicalities
		Examiner behaviour
		Who are the examiners?
		How are marks allocated?
		What do the marks mean?
			Overall professional capability/patient care
			Knowledge and judgement
			Quality of response
		Answering questions
		Preparation
		On the day
		Summary
	Chapter 2 Candidate guidance
		Introduction
		The structured, standardized oral exam
		Viva preparation
			1. Aptitude and mind set
			2. Speech and communication in the viva
			3. Study group practice
			4. Assigned educational supervisor practice
			5. FRCS viva courses
		General approach and what to do when things go wrong
			Formulating answers to oral questions
		Quoting the literature
		Final advice
		References
Section 2 Adult Elective Orthopaedics and Spine
	Chapter 3 Hip
		Introduction
		Structured oral examination question 1
		Structured oral examination question 2
		Structured oral examination question 3
			Acetabular bone loss
			Gross and associates classification system ()
			Paprosky acetabular bone loss classification
			Structured oral examination question 4
		Structured oral examination question 5
			Osteonecrosis (ON)
			AS IT GRIPS 3Cs (mnemonic)
			Graft site complication
		Structured oral examination question 6
		Gold medal candidates
		Structured oral examination question 7
			Gold medal candidates
		Structured oral examination question 8
		Structured oral examination question 9
			Periprosthetic fracture (PPF) around the hip
		Structured oral examination question 10
		Structured oral examination question 11
		References
	Chapter 4 Knee
		Structured oral examination question 1
			TKA in valgus knee
		References
		Structured oral examination question 2
			Basic science: anatomy
		References
		Structured oral examination question 3
			Meniscus
		References
		Structured oral examination question 4
			Infected total knee arthroplasty (TKA)
		References
		Structured oral examination question 5
			Unicondylar knee arthroplasty (UKA) vs high tibial osteotomy (HTO)
			References
		Structured oral examination question 6
			Dislocated UKA PE spacer
		Structured oral examination question 7
			Posterior cruciate ligament and anterior cruciate ligament reconstruction
		References
		Structured oral examination question 8
			Revision knee replacement
		References
		Structured oral examination question 9
			Patellar instability
		References
		Structured oral examination question 10
			Pain after TKA
		References
		Structured oral examination question 11
			Osteotomies around the knee
		References
	Chapter 5 Foot and ankle
		Structured oral examination question 1
			Lateral ligament instability of the ankle
		Structured oral examination question 2
			Ankle arthritis
		Structured oral examination question 3
			The rheumatoid foot
		Structured oral examination question 4
			Cavus foot
		Surgery
			1. Soft-tissue releases
				Plantar fascia release
				Gastrocnemius/Achilles lengthening
			2. Tendon transfers
			3. Osteotomies
			4. Fusion
		Structured oral examination question 5
			Acquired adult flatfoot
		Structured oral examination question 6
			Hallux valgus
		Structured oral examination question 7
			Hallux rigidus
		References
	Chapter 6 Spine
		Introduction
		Describing an X-ray
			Describe what X-ray it is first
			Lateral X-ray
			AP view
			Detecting the correct level
		History and examination
		Contents
		Structured oral examination question 1
			Infection (discitis)
		Structured oral examination question 2
			Metastases
		References
		Structured oral examination question 3
			Benign lesion
		Structured oral examination question 4
			Cervical spondylotic myelopathy
		References
		Structured oral examination question 5
			Lumbar disc prolapse with cauda equina
		References
		Structured oral examination question 6
			Spondylolisthesis
		References
		Structured oral examination question 7
			Ankylosing spondylitis
			Radiological criterion
		Structured oral examination question 8
			Idiopathic scoliosis
		Structured oral examination question 9
			Non-idiopathic scoliosis
		Structured oral examination question 10
			Cervical prolapse disc
		References
	Chapter 7 Shoulder
		Introduction
		Shoulder
		Structured oral examination question 1
			Tuberculosis shoulder
		Reference
		Structured oral examination question 2
			Rotator cuff tear
		Structured oral examination question 3
		Structured oral examination question 4
		Structured oral examination question 5
	Chapter 8 Elbow
		Introduction
		Elbow
		Structured oral examination question 1
			Tennis elbow
		Suggested reading
		Structured oral examination question 2
			Osteochondritis dissecans
		Suggested reading
		Structured oral examination question 3
			Rheumatoid arthritis elbow
		Suggested reading
		Structured oral examination question 4
			Post-traumatic OA elbow
		Suggested reading
		Structured oral examination question 5
			Posterolateral rotatory instability of the elbow
		Suggested reading
Section 3 Trauma
	Chapter 9 General principles and fracture biomechanics
		Introduction
		Structured oral examination question 1
			IM nail biomechanics
		Structured oral examination question 2
			Area and polar moment of inertia
			Controversial topic
		Structured oral examination question 3
			IM nail
		Structured oral examination question 4
			Biomechanics IM nail
		Structured oral examination question 5
			IM nails
		Structured oral examination question 6
			Plates
		Structured oral examination question 7
			Fracture healing
		Structured oral examination question 8
			Fracture healing
		Structured oral examination question 9
			Screws
				Introduction
					Head
					Countersink
					Run out
					Shaft
					Thread geometry
					Thread pitch
					Thread depth
					Thread shape
					Lead
					Diameters
					Flutes
					Tip
		Structured oral examination question 10
		Structured oral examination question 11
			Screw
		Structured oral examination question 12
			Lag screw
		Structured oral examination question 13
			Design features of a screw
		Structured oral examination question 14
			Design features of a plate
			Constructing an answer
		Notes
	Chapter 10 Lower limb trauma I
		Introduction
		Structured oral examination question 1
			Femoral neck fracture in the young
		Structured oral examination question 2
			Fractured neck of femur in the elderly
		Structured oral examination question 3
			Hip dislocation
		Structured oral examination question 4
			Femoral shaft fracture
		Structured oral examination question 5
			Distal femur (periprosthetic) fractures
		Structured oral examination question 6
			Knee dislocation
		Structured oral examination question 7
			Open fractures of the lower limb
		Structured oral examination question 8
			Tibial plateau fractures
		Structured oral examination question 9
			Tibial plafond fractures
		Notes
	Chapter 11 Lower limb trauma II
		Introduction
		Structured oral examination question 1
			Minute 1
			Minute 2
			Minute 3
			Minute 4 (yes, you are still going …)
			Minute 5
			Evidence base
		Structured oral examination question 2
			Minute 1
			Minutes 2 and 3
			Minute 4
			Minute 5
			Evidence base
		Structured oral examination question 3
			Minutes 1 and 2
			Minute 3
			Minute 4
			Minute 5
			Evidence base
		Structured oral examination question 4
			Minute 1
			Minute 2
			Minute 3
			Evidence base
		Structured oral examination question 5
			Minute 1
			Minute 2
			Minute 3
			Minutes 4–5
			Evidence base
		Structured oral examination question 6
			Minute 1
			Minute 2
			Minute 3
			Minute 4
			Minute 5
			Evidence base
		Structured oral examination question 7
			Minute 1
			Minute 2
			Minute 4
			Minute 5
			Evidence base
		Structured oral examination question 8
			Minute 1
			Minute 2
			Minutes 3–4
			Minute 5
		Structured oral examination question 9
			Minute 1
			Minute 2
			Minute 3
			Minute 4
			Minute 5
		Structured oral examination question 10
			Minute 1
			Minute 2
			Minute 3
			Minutes 4–5
			Evidence base
		Structured oral examination question 11
			Minute 1
			Minute 2
			Minute 3
			Minutes 4–5
			Evidence base
		Structured oral examination question 12
			Minute 1
			Minute 2
			Minutes 3–4
			1 Mechanical instability, excessive motion at the fracture site
			2 Inadequate vascularity
			3 Poor bone contact
			4 Infection
			Minute 5
		Structured oral examination question 13
			Minute 1
			Minutes 2–3
			Minute 4
			Minute 5
		Evidence base
		Notes
	Chapter 12 Upper limb trauma I
		Structured oral examination question 1
			Fracture dislocation shoulder
		Structured oral examination question 2
			Right wrist fracture
		Structured oral examination question 3
			Comminuted elbow fracture
		Structured oral examination question 4
			Monteggia fracture
		General reading
		Structured oral examination question 5
			Galeazzi fracture
		Topic reference
		Structured oral examination question 6
			Humeral shaft fracture
		Structured oral examination question 7
			Clavicle fracture
		Structured oral examination question 8
			ACJ dislocation
		Structured oral examination question 9
			Proximal humerus fracture
		Structured oral examination question 10
		Notes
	Chapter 13 Upper limb trauma II
		Structured oral examination question 1
			Lunate dislocation
		References
		Structured oral examination question 2
			Jersey finger
		References
		Structured oral examination question 3
			Scaphoid fracture
		References
		Structured oral examination question 4
			Mallet finger
		Reference
		Structured oral examination question 5
			Animal bite
		References
		Structured oral examination question 6
			Boxer’s fracture
		Reference
		Structured oral examination question 7
			Fight bite
		Reference
	Chapter 14 Pelvic trauma
		Introduction
		Structured oral examination question 1
			Pelvic fractures
			Acetabular fractures
		Structured oral examination question 2
		Structured oral examination question 3
		Structured oral examination question 4
		Structured oral examination question 5
		Structured oral examination question 6
		Structured oral examination question 7
		Structured oral examination question 8
		Notes
	Chapter 15 Spinal trauma
		Structured oral examination question 1
			Bifacet dislocation
		References
		Structured oral examination question 2
			Incomplete cord injury
		References
		Structured oral examination question 3
			Thoracolumbar burst fractures
		References
		Structured oral examination question 4
			Odontoid peg fractures
				Introduction
		References
		Structured oral examination question 5
			Hangman’s fracture
		References
		Structured oral examination question 6
			Chance fractures
			Associated injuries
			Management
		References
		Structured oral examination question 7
			Incomplete spinal injury
		Reference
		Structured oral examination question 8
			Application of a halo
		References
		Structured oral examination question 9
			Cauda equina syndrome
		References
		Structured oral examination question 10
			Spinal trauma assessment
		Reference
		Notes
	Chapter 16 Paediatric trauma
		Structured oral examination question 1
		Structured oral examination question 2
		Structured oral examination question 3
		Structured oral examination question 4
		Structured oral examination question 5
		Structured oral examination question 6
		Structured oral examination question 7
		Structured oral examination question 8
		Structured oral examination question 9
		Structured oral examination question 10
		References
Section 4 Children’s Orthopaedics/Hand and Upper Limb
	Chapter 17 Hand and upper limb
		Structured oral examination question 1
			Distal radius fracture and malunion
		References
		Structured oral examination question 2
			Extensor pollicis longus (EPL) tendon rupture
		Structured oral examination question 3
			Transscaphoid perilunate fracture–dislocation
		Structured oral examination question 4
			Scaphoid fracture
		References
		Structured oral examination question 5
			Scaphoid fracture (proximal pole)
		Reference
		Structured oral examination question 6
			Rheumatoid hand
		References
		Structured oral examination question 7
			Thumb carpometacarpal (CMC) joint arthritis
		References
		Structured oral examination question 8
			Flexor tendon sheath infections
		References
		Structured oral examination question 9
			Flexor tendon injury
		References
		Structured oral examination question 10
			Enchondroma
		References
		Structured oral examination question 11
			Wrist ganglion
		Structured oral examination question 12
			Dupuytren’s disease
		References
		Structured oral examination question 13
			Kienbock’s disease
		Reference
		Structured oral examination question 14
			Ulnar collateral ligament (UCL) injury of thumb
		Structured oral examination question 15
			Boutonnière deformity
		Structured oral examination question 16
			Swan-neck deformity
				Complications related to surgery
				Complications related to medications
				Complications related to systemic diseases
	Chapter 18 Children’s orthopaedics
		Introduction
		Candidate 1
		Candidate 2
			Total Score (TS) 0–6
		Candidate 3
		Candidate 4
		Candidate 5
		Candidate 6
		References
Section 5 Applied Basic Sciences
	Chapter 19 Anatomy and surgical approaches
		Introduction
		Structured oral examination question 1
			Approach to hip for total hip arthroplasty
			Posterior
			Lateral (Hardinge)
			Anterolateral (Watson-Jones approach)
		Structured oral examination question 2
			Approach to the hip for drainage
		Structured oral examination question 3
			Henry’s/anterior approach to arm
				For score 7/8
		Structured oral examination question 4
			Posterior approach to the knee
		Structured oral examination question 5
			Posterolateral approach to the ankle
				Score 7
				Score 8
		Structured oral examination question 6
			Anterior approach to the cervical spine
		Structured oral examination question 7
			Shoulder fracture dislocation
		Structured oral examination question 8
			Compartment syndrome of leg
		Further reading
		Structured oral examination question 9
			Anatomy of tarsal tunnel
		Structured oral examination question 10
			Extensor compartments of wrist
		Structured oral examination question 11
			Anatomy of carpal tunnel
	Chapter 20 Structure and function of connective tissue
		Introduction
		1. Bone structure and function
			Structured oral examination question 1
			Structured oral examination question 2
			Structured oral examination question 3
			Structured oral examination question 4
		2. Structure and function of cartilage: (a) articular
			Introduction
			Props
			Structured oral examination question 1
				Tidemark
				Chondrocytes
				Water
				Collagen
				Proteoglycans
				Steps that occur INSIDE the cell
				Steps that occur OUTSIDE the cell
			Structured oral examination question 2
			Structured oral examination question 3
			Structured oral examination question 4
		2. Structure and function of cartilage: (b) meniscus
			Introduction
			Structured oral examination question 1
				Lateral meniscus
				Medial meniscus
					Location of tear
					Age of tear
					Age of the patient
					Ligament stability
			Structured oral examination question 2
			Structured oral examination question 3 ()
			Structured oral examination question 4
		3. Invertebral disc structure and function
			Introduction
			Structured oral examination question 1
			Structured oral examination question 2
			Structured oral examination question 5
		4. Muscle structure and function
			Structured oral examination question 1
			Structured oral examination question 2
		5. Structure and function of tendons and ligaments
			Introduction
			Structured oral examination question 1
			Structured oral examination question 2
				Growth factors
				Mesenchymal stem cells
			Structured oral examination question 3
			Structured oral examination question 5
				Stress–strain curve for ligament
			Structured oral examination question 6
				Mark 4 – poor fail.
				Mark 5 – fail
				Mark 6 – pass
				Mark 7 – good pass
				Mark 8 – excellent Pass
		6. Structure and function of the nervous system
			Introduction
			Structured oral examination question 1
				Neuropraxia
				Axonotmesis
				Neurotmesis
			Structured oral examination question 2
			Structured oral examination question 3
			Structured oral examination question 4
				Central cord syndrome (MUD-E)
				Anterior cord syndrome
				Brown–Sequard syndrome
			Structured oral examination question 5
			Structured oral examination question 6
				Neuron
				Cell body
				Dendrites
				Axon hillock
				Axon
				Glial cells
				Myelinated larger axons
				Unmyelinated axons
				Myelin
				Nodes of Ranvier
			Structured oral examination question 7
		References
	Chapter 21 Design of implants and factors associated with implant failure (wear, loosening)
		Introduction
		Structured oral examination question 1
			Clinical photograph of explanted poly cup with wear and cement
		Structured oral examination question 2
			Wear and osteolysis
		Structured oral examination question 3
			Wear in THA
		Structured oral examination question 4
			Wear in TKA
		Reference
		Structured oral examination question 5
		Structured oral examination question 6
			Charnley THA
				Highly cross-linked PE:
				Score 7
				Gold medal
		Structured oral examination question 7
			TKA loose implant
		Structured oral examination question 8
			Cementing technique THA
				1. Canal preparation
				2. Cement preparation
				Score 8 candidates
		Structured oral examination question 9
			Wear in TKA
		Structured oral examination question 10
			Osteolysis
		Structured oral examination question 11
			Implant materials
				Stainless steel
				Cobalt chromium
				Titanium
		Structured oral examination question 12
			Wear and osteolysis
		References
	Chapter 22 Orthotics and prosthetics
		Introduction
		Orthotics
			Prosthetics
	Chapter 23 Pain, analgesia and anaesthesia
		Introduction
		Structured oral examination question 1
			Pain
				Score 7/8 candidate
				1. Single dimensional scale
				2. Multidimensional scale
		Structured oral examination question 2
			Managing neuropathic pain
		Structured oral examination question 3
			WHO pain ladder
		Structured oral examination question 4
			Complex regional pain syndrome
		Structured oral examination question 5
			Intravenous regional anaesthesia (Bier’s block)
		Structured oral examination question 6
			Pain
		Structured oral examination question 7
			Pain pathways
			First-order neuron
			Second-order neurons
			Third-order neurons
		Structured oral examination question 8
			Local anaesthetic
		Structured oral examination question 9
			General anaesthesia
			Analgesia
	Chapter 24 Musculoskeletal oncology
		Definitions
			Neoplasm/tumour:
			Malignant tumour:
			Benign tumour:
			Sarcoma:
		Generic structured oral examination question 1
			Biopsy
		Generic structured oral examination question 2
			Staging
		Structured oral examination question 1
			Osteochondroma
				General advice:
		Structured oral examination question 2
			Enchondroma
		Structured oral examination question 3
			Non-ossifying fibroma
		Structured oral examination question 4
			Chondrosarcoma
		Structured oral examination question 3
			Chondrosarcoma
		Structured oral examination question 6
			Osteosarcoma []
		Structured oral examination question 7
			Aneurysmal bone cyst
		Structured oral examination question 8
			Ewing’s sarcoma []
		Structured oral examination question 9
			Lipoma
		Bibliography/Further reading
	Chapter 25 Tribology and biomaterials
		Structured oral examination question 1
		References
		Structured oral examination question 2
		Structured oral examination question 3
			Bone
		Structured oral examination question 4
			Bone grafts
		References
		Structured oral examination question 5
			THA stem design
		Reference
		References
		Structured oral examination question 6
			Articular cartilage
		Structured oral examination question 7
			Fracture fixation
		Structured oral examination question 8
			Osteoporosis
		References
		Structured oral examination question 9
			Antibiotic prophylaxis
		Structured oral examination question 10
			Theatre suite
		References
		Structured oral examination question 11
			VTE
	Chapter 26 Biomechanics
		Introduction
		Structured oral examination question 1
			Stress–strain curve
		Structured oral examination question 2
			Stress–strain curve
				1. Proportionality limit
				2. Elastic limit
				3. Yield point
		Structured oral examination question 3
			Stress–strain curve
		Structured oral examination question 4
			Stress–strain curve
		Structured oral examination question 5
			Stress–strain curve
		Structured oral examination question 6
			S-N curve
		Structured oral examination question 7
		Structured oral examination question 8
			Stress–strain curves for different materials
		Structured oral examination question 9
			Free body diagrams: elbow
		Structured oral question 10
			Hip FBD
		Structured oral question 8
			Spine
		Notes
	Chapter 27 Genetics and cell biology
		Introduction
		General information
			Nucleic acid structure ()
			Pedigree charts
		Structured oral examination question 1
			Autosomal dominant (AD) inheritance
			Achondroplasia
			Osteogenesis imperfecta
		Structured oral examination question 2
			Autosomal recessive (AR) inheritance
			Sickle cell disease
				Clinical features
		Structured oral examination question 3
			X-linked inheritance
				Clinical features
			Duchenne muscular dystrophy (DMD)
				Clinical features
		Structured oral examination question 4
			Stem cells
		Notes
	Chapter 28 Diagnostics
		General radiology viva advice
		Structured oral examination question 1
			Radiographs
		Structured oral examination question 2
			Ultrasound
		Structured oral examination question 3
			CT scanners
		Structured oral examination question 4
			MRI scanners
				Larmor equation
		Structured oral examination question 5
			Bone densitometry
		Structured oral examination question 6
			Bone scanning
		Structured oral examination question 7
			Nerve conduction studies
		Structured oral examination question 8
			Nerve conduction studies
		Structured oral examination question 9
			EMG
		Structured oral examination question 10
			Motor action potential
		Structured oral examination question 11
			Nerve conduction studies
		Structured oral examination question 12
			Nerve conduction studies
		Structured oral examination question 13
			Nerve conduction studies
		Structured oral examination question 14
			Nerve conduction studies
		Structured oral examination question 15
			Nerve conduction studies
		Notes
	Chapter 29 Clinical environment
		Structured oral examination question 1
			Sterilization
		Structured oral examination question 2
			Tourniquet use
		Structured oral examination question 3
			Sutures
		Structured oral examination question 4
			Electrosurgery
		Structured oral examination question 5
			Infection control
		Structured oral examination question 6
			Theatre design
		Structured oral examination question 7
			Ventilation
		Structured oral examination question 8
			Theatre etiquette
		Structured oral examination question 9
			Perioperative bleeding
		References
	Chapter 30 Statistics and evidence-based practice
		Introduction
		Structured oral examination question 1
		Structured oral examination question 2
		Structured oral examination question 3
		Structured oral examination question 4
		Structured oral examination question 5
		Structured oral examination question 6
		Structured oral examination question 7
		References
Section 6 Drawings for the FRCS (Tr & Orth)
	Chapter 31 Drawings for the FRCS (Tr & Orth)
		Tips on drawing
		Anatomy
			Upper limb
				Brachial plexus (Figure 31.1)
				Dorsal root ganglion (Figure 31.2)
				Erb’s point (Figure 31.3)
				Humeral spaces (Figure 31.4)
				Humerus cross-section (Figure 31.5)
					Schematic drawing (Figure 31.6)
				Mid-forearm cross-section (Figure 31.7)
					Schematic drawing (Figure 31.8)
				Approaches to the midshaft radius (Figure 31.9)
			Radius muscle insertions
			Hand and wrist
				Carpal tunnel
				Extensor compartments (Figure 31.12)
				Ulnar canal (Figure 31.13)
				Sites of ulnar nerve compression (Figure 31.14)
				Finger cross-sectional anatomy
				Nail anatomy (Figure 31.16)
			Lower limb
				Blood supply to neck of femur (Figure 31.17)
				Femoral triangle (Figure 31.18)
				Hip cross-section anatomy (Figure 31.19)
				Approaches to the hip (Figure 31.20)
				Adductor/Hunter’s canal (Figure 31.21)
				Mid-thigh cross-section (Figure 31.22)
					Schematic (Figure 31.23)
				Lower leg cross-section (Figure 31.24)
					Schematic (Figure 31.25)
		Basic science
			Biological materials
				Articular cartilage (Figure 31.26)
				Differences in ageing and osteoarthritis
				Proteoglycans (Figure 31.28)
				Bone (cortical) (Figure 31.29)
				Overlying structure of nerve/muscle/tendon
				Nerve
				Nerve cross-section (Figure 31.32)
				Nerve action potential (Figure 31.33)
				Nerve injuries (Figure 31.34)
				Muscle (Figure 31.35)
				Actin and myosin (Figure 31.36)
				Neuromuscular junction (Figure 31.37)
				Embryology – spinal development (Figure 31.38)
				Embryology – limb bud development (Figure 31.39)
			Implant science
				Stress–strain curve (Figure 31.40)
				S-N curve (Figure 31.41)
				Viscoelastic behaviour (Figure 31.42)
				Screws (Figure 31.43)
				Tension band (Figure 31.44)
				Cement zones (Figure 31.45)
		Spinal pathology
			Spinal cord anatomy (Figure 31.46)
			Schematic (Figure 31.47)
			Vertebral disc (Figure 31.49)
				Prolapsed intervertebral discs (Figure 31.50)
		Paediatrics
			Physis (Figure 31.51)
			Salenius and Vankka graph (Figure 31.52)
Index