FRCS (Tr & Orth) revision topics

01

Basic science

6 topics · 275 questions in the bank

Applied basic science is the science behind everyday orthopaedic decisions: the structure and healing of bone, cartilage, tendon, ligament, muscle and nerve; calcium homeostasis and metabolic bone disease; the mechanics of materials, implants and joints; tribology and the biology of wear; applied anatomy and surgical approaches; infection, thromboprophylaxis and imaging; and statistics, study design and ethics. The written paper asks most of it through a clinical frame — why a plate failed, which bearing to choose, which nerve is at risk in an approach, what a trial result means — rather than as bare recall. It is the broadest domain in our map of the syllabus and the one that repays early, repeated revision, because the same principles resurface in trauma, arthroplasty and paediatrics.

• Musculoskeletal tissues: structure & function

  Bone structure, remodelling & fracture healing · Articular cartilage, synovium & meniscus · Tendon, ligament & muscle · Peripheral nerve & intervertebral disc

  50

• Bone metabolism, arthropathies & genetics

  Calcium homeostasis & metabolic bone disease · Inflammatory & crystal arthropathies · Genetics, skeletal dysplasias & cell biology

  50

• Biomechanics & biomaterials

  Material properties & fixation mechanics · Metals, polymers, ceramics, cement & graft substitutes · Tribology, wear & osteolysis · Joint & implant biomechanics, gait

  50

• Applied anatomy & surgical approaches

  Upper limb approaches & nerves at risk · Lower limb & pelvic approaches · Spinal anatomy & approaches

  50

• Infection, thromboembolism, pain & diagnostics

  Bone & joint infection, antibiotics & theatre design · Thromboembolism, blood & perioperative care · Imaging, neurophysiology & pain

  25

• Statistics, evidence, ethics & orthotics

  Statistics & study design · Consent, ethics & quality improvement · Prostheses, orthoses & amputations

  50

02

Oncology

1 topics · 75 questions in the bank

Musculoskeletal oncology covers the assessment, staging and biopsy of a bone or soft-tissue lesion, the benign bone tumours and tumour-like lesions, the primary malignant bone tumours, soft-tissue tumours, and metastatic bone disease and myeloma. For most orthopaedic surgeons the practical skill is recognising the lesion that must not be touched before it has been discussed with a sarcoma service, and managing metastatic disease and impending fractures well. Questions typically give an age, a site within the bone and a radiographic description, and ask for the most likely diagnosis or the most appropriate next step.

• Bone & soft-tissue tumours

  Staging, biopsy & principles of treatment · Benign bone tumours & tumour-like lesions · Primary malignant bone tumours · Soft-tissue tumours · Metastatic bone disease & myeloma

  75

03

Trauma

5 topics · 300 questions in the bank

Trauma runs from the resuscitation room to the fracture clinic: polytrauma and damage control, open fractures and soft-tissue reconstruction, compartment syndrome and vascular injury, the principles of fixation and the management of non-union and fracture-related infection, and then the regional injuries of the upper limb, pelvis and acetabulum, hip and femur, knee, tibia, ankle and foot, and the spine. UK practice is codified in the British Orthopaedic Association’s BOAST standards and in NICE guidance, and the paper is set to that practice — so the timings and thresholds in those documents are worth knowing exactly. It is the largest section of our bank.

• Trauma principles, polytrauma & open fractures

  Polytrauma, resuscitation & damage control · Open fractures, soft tissue & limb salvage · Compartment syndrome, vascular & nerve injury · Fixation principles, non-union & fracture-related infection

  50

• Upper limb trauma

  Shoulder girdle & proximal humerus · Humeral shaft & elbow · Forearm, distal radius & carpus · Hand fractures, dislocations & tendon injuries

  75

• Pelvis, acetabulum, hip & femur trauma

  Pelvic ring & acetabulum · Hip fractures & dislocation · Femoral shaft, distal femur & periprosthetic fractures

  75

• Knee, tibia, ankle & foot trauma

  Knee, patella & tibial plateau · Tibial shaft & pilon · Ankle · Hindfoot, midfoot & forefoot

  75

• Spinal trauma

  Cervical spine injuries · Thoracolumbar injuries · Spinal cord injury & clearance

  25

04

Hip

2 topics · 125 questions in the bank

The hip domain is dominated by arthroplasty: planning and templating, fixation and bearing choice, the surgical approaches and what each puts at risk, and then the complications — dislocation, infection, aseptic loosening, bone loss and periprosthetic fracture — and how revision surgery deals with them. The second half is the young adult hip: femoroacetabular impingement, dysplasia and hip preservation surgery, and avascular necrosis. Questions are usually clinical: a radiograph described in words, a patient’s age and demands, and a decision.

• Hip arthroplasty

  Primary THA: planning, bearings & fixation · Dislocation, infection & other complications · Revision, bone loss & periprosthetic fracture

  75

• Young adult hip & non-arthroplasty

  Impingement, dysplasia & hip preservation · Avascular necrosis & other hip conditions

  50

05

Knee

2 topics · 125 questions in the bank

The knee splits into two halves. Arthroplasty and osteotomy cover alignment and the mechanical axis, bone cuts and gap balancing, constraint, unicompartmental replacement, realignment osteotomy and the complications of knee replacement — instability, stiffness, patellar maltracking, infection and revision. Soft-tissue knee covers the cruciate and collateral ligaments and the posterolateral corner, the menisci and articular cartilage, and the patellofemoral joint and extensor mechanism. The applied anatomy and biomechanics of the knee underlie both halves and are tested directly.

• Knee arthroplasty & osteotomy

  Primary TKA & unicompartmental replacement · Instability, stiffness, infection & revision · Osteotomy around the knee

  50

• Soft-tissue knee & sports injuries

  Ligament injuries & reconstruction · Meniscus & articular cartilage · Patellofemoral joint & extensor mechanism

  75

06

Foot & ankle

2 topics · 100 questions in the bank

Foot and ankle covers the forefoot — hallux valgus, hallux rigidus, lesser toe deformities, metatarsalgia and Morton’s neuroma — the diabetic foot and Charcot neuroarthropathy, arthritis of the ankle and hindfoot, tendon disorders and the adult acquired flatfoot, and the cavus foot, ankle instability and sports injuries. Much of it rests on understanding deformity: which joints are flexible and which are fixed, what is driving the deformity, and therefore whether a soft-tissue procedure, an osteotomy or a fusion is appropriate.

• Forefoot & the diabetic foot

  Hallux valgus & hallux rigidus · Lesser toes, metatarsalgia & neuroma · Diabetic foot & Charcot neuroarthropathy

  50

• Ankle & hindfoot

  Ankle & hindfoot arthritis · Tendon disorders & the adult flatfoot · Cavus foot, instability & sports injuries

  50

07

Spine

2 topics · 100 questions in the bank

Spine for the general orthopaedic surgeon is about recognising what is urgent and localising what is wrong. The degenerative half covers cervical radiculopathy and myelopathy, lumbar disc prolapse, spinal stenosis and spondylolisthesis, together with the emergencies — cauda equina syndrome, spinal infection and metastatic cord compression. The deformity half covers scoliosis and kyphosis in children and adults, and the inflammatory, metabolic and paediatric spine. Spinal trauma sits in the trauma domain of our syllabus map, but the neurological examination and the cord syndromes belong equally here.

• Degenerative spine & spinal emergencies

  Cervical radiculopathy & myelopathy · Lumbar disc disease, stenosis & spondylolisthesis · Cauda equina, infection & tumour

  50

• Spinal deformity & inflammatory spine

  Scoliosis & kyphosis · Inflammatory, metabolic & paediatric spine

  50

08

Shoulder & elbow

2 topics · 125 questions in the bank

Shoulder covers the rotator cuff and subacromial pain, instability and labral pathology, arthritis and the choice between anatomic and reverse arthroplasty, frozen shoulder, and the acromioclavicular joint, long head of biceps and scapula. Elbow covers instability and the stabilisers of the joint, stiffness and arthritis, tendinopathy, distal biceps rupture and the nerve compression syndromes around the elbow. In both joints the examination findings are specific enough to be the discriminator in a written question, so learn each test with the structure it isolates.

• Shoulder

  Rotator cuff & impingement · Instability & labral pathology · Arthritis, arthroplasty & frozen shoulder · ACJ, biceps & scapula

  75

• Elbow

  Instability, stiffness & arthritis · Tendinopathy, distal biceps & nerve compression

  50

09

Hand & wrist

2 topics · 125 questions in the bank

Hand covers compression neuropathy and nerve injury, osteoarthritis and the rheumatoid hand, Dupuytren’s disease, tendon disorders and infection. Wrist and brachial plexus covers carpal instability and scaphoid non-union, the distal radioulnar joint and triangular fibrocartilage complex, Kienböck’s disease, brachial plexus injury and the principles of tendon transfer. It is the domain where anatomy is examined most directly: almost every question can be answered from knowing what runs where and what each muscle does.

• Hand

  Compression neuropathy & nerve injury · Arthritis & the rheumatoid hand · Dupuytren's disease, tendon disorders & infection

  75

• Wrist & brachial plexus

  Carpal instability & scaphoid non-union · DRUJ, TFCC & Kienbock's disease · Brachial plexus & tendon transfers

  50

10

Paediatrics

4 topics · 150 questions in the bank

Paediatric orthopaedics covers the three hip conditions of childhood — developmental dysplasia, Perthes disease and slipped upper femoral epiphysis — the foot, rotational and angular deformity and limb-length discrepancy, cerebral palsy and the neuromuscular conditions, children’s fractures and physeal injury, bone and joint infection, and the skeletal dysplasias, syndromes and congenital limb differences. Age is the organising principle: the same limp has a different differential at two, six and thirteen, and the same hip condition is treated differently at each age.

• The paediatric hip

  Developmental dysplasia of the hip · Perthes disease · Slipped upper femoral epiphysis

  50

• Foot, lower limb deformity & neuromuscular

  Clubfoot & foot deformities · Rotational & angular deformity, limb length · Cerebral palsy & neuromuscular conditions

  50

• Paediatric trauma

  Upper limb & physeal injuries · Lower limb, spine & non-accidental injury

  25

• Infection, syndromes & congenital conditions

  Bone & joint infection, inflammatory conditions · Skeletal dysplasias, syndromes & congenital limb

  25