As in all other areas of the viva examinations, knowing basic definitions gives you an easy starting point when answering questions and gives the impression to the examiners that you have both a logical and clear thought process, and are in command of the subject matter.

A growth or swelling, which enlarges by cellular proliferation more rapidly than surrounding normal tissue and continues to enlarge after the initiating stimuli cease. Usually lacks structural organization and functional coordination with normal tissues and serves no useful purpose to the host.

Mode 1: Wear from two articulating surfaces that are intended to rub together, such as the femoral head and the poly.

Mode 2: Wear from an articulating surface and a non-articulating surface, such as the femoral head and the shell.

Mode 3: Third-body wear, which is particles coming between bearings.

Mode 4: Wear between non-articulating surfaces such as the neck and the edge of the shell.

In this section, we follow the exam format with a simple question around a clinical picture, X-ray or a video clip, followed by increasingly difficult questions to explore candidate depth and breadth of knowledge. Some of the questions are made deliberately difficult and beyond average candidate level, some are easy and the majority are average. We also support some of the answers with clinical photographs to create mental images to aid recall information during the exam. The online version of this book will have more cases, videos and discussion. This section complements the first edition of this book, the postgraduate paediatric orthopaedic book (the green book) [1] and the third edition of the parent book. Candidates are strongly encouraged to read all of them to have a better overview of the paediatric section of the exam.

The stress–strain curve is a triple A-list subject. It always seems to be asked in viva examinations and is a definite top 10 core basic science question. In recent years this topic has been reinvented as it was becoming too predictable. We make no apologies for including the question in all of its various guises.

Many examinees approach medical statistics with a lot of apprehension. This is justified in most circumstances as we do not regularly practise statistics, nor do we study it on a regular basis. Examiners are not different and appreciate this very well. You should remember that when you are asked questions related to medical statistics you are not expected to demonstrate the knowledge of a statistician. The examiners simply wish to satisfy themselves that as an inquisitive orthopaedic surgeon you understand the basic statistical concepts well enough to be able to scrutinize the published orthopaedic evidence. It is very unlikely that you will be asked esoteric questions (unless you do really well). Statistics of direct relevance (for example NJR survival analysis) are very popular with examiners and are frequently asked. Of the six basic science viva questions most of you would probably be asked at least one question related to Medical Statistics.

The FRCS (Tr & Orth) structured oral viva is a daunting prospect because of its high-stakes nature and the uncertainty surrounding it. The aim of this chapter is to consolidate insights from successful former candidates as well as the perspective of a senior examiner to guide you through the difficult challenges and achieve exam success!

The FRCS (Tr & Orth) represents the standard of knowledge and aptitude required for clinical practice by a day one consultant in the generality of Trauma and Orthopaedics. Passing the exam is an important milestone which symbolizes the pinnacle of a stressful period of intensive study. It is also seen as an opportunity to demonstrate the learning and knowledge you have accumulated over many years of training!

Drawing has always been an integral part of the FRCS examination, be it as a method to understand a complex process during revision or as a tool for explanation in the viva itself. In order to use drawings in the viva exam the candidate must be able to draw, explain and answer questions simultaneously. Thus, practice and understanding are essential.

In this chapter, we have selected the drawings that we think are most useful, having recently been through the examination or taught on this subject for many years.

The structured oral (viva) examinations are the second component of Section 2 of the Intercollegiate examinations, usually occurring over a two-day period after the clinical section, but for any individual candidate the four vivas will occur on the same day. It is perhaps worth putting the vivas into context: between them the vivas contribute 48 of the 96 marking episodes in Section 2. The clinicals (intermediate and short cases) together make up the other 48 episodes, but in general it is more common for a poor mark in the vivas to be compensated for by a good mark in the clinicals than vice versa. Employing the training principles of a heptathlete, effort may be better spent on the weaker disciplines than becoming better at one’s strengths.

A 53-year-old man was involved in a road traffic accident. He was driving the car and was wearing a seat belt. This is the radiograph obtained in casualty (Figure 15.1a). What does it show?

This is a plain lateral radiograph of the cervical spine that shows anterior translation of the C6 vertebra on C7. This translation is more than 25% so this is likely a bifacet dislocation. The inferior facets of C6 can be seen to lie anterior to the superior facets of C7. This is a bifacet dislocation. The C7/T1 border is not clearly seen and therefore this is an inadequate radiograph.

A 38-year-old left-hand dominant lady fell on to her right arm when out drinking and attended the accident and emergency department the next day at 4 pm as the pain in the right shoulder had not settled down. These are the X-rays of her right shoulder (Figure 12.1a). What is your diagnosis?

Anterior dislocation of the right shoulder with an associated greater tuberosity (GT) fracture. Complete loss of joint congruence is demonstrated on the AP view, while the anterior displacement is best demonstrated on the axial view. There is no visible evidence of fracture through the anatomical neck, although this occurs in about 10% of cases. This pattern of injury is more in keeping with this patient’s age than surgical neck fracture, which is more typically seen in an older demographic.

Fracture biomechanics can be tough-going for most candidates and yet it is definitely an A-list topic. Textbook chapters can be too complicated and detailed to understand whilst short note sections may appear incomplete as biomechanical assumptions have not been fully explained or the brevity of the notes makes them difficult to fully understand, never mind encouraging any higher-order thinking.

We hope this chapter uncomplicates a difficult area of the syllabus that a lot of candidates find offputting.

Orthotics and prosthetics is a subject often neglected during revision, but is an important topic because various aspects may be incorporated into other topics, such as gait, hand injuries or amputations.

This chapter attempts to cover the concepts that have been tested previously in the FRCS (Tr & Orth) exam. The questions and answers provide a high-order thinking framework to build on your answer in the exam oral tables.

Candidates are likely to be shown a clinical photograph, followed by a starting question. You are not normally marked on the starting question – it serves to melt the ice and give you confidence to get going.

Sterilization is the process that destroys all forms of microbial life and is carried out in healthcare facilities by either chemical or physical methods. Disinfection, however, is a process that eliminates all pathogenic microorganisms, except bacterial spores or viruses.

Cleaning is a physical process that removes contamination but does not necessarily destroy microorganisms.

This 10-year-old boy was hit by a car while crossing the road and sustained a closed head injury with GCS 8/15. He has been intubated because he is combative. A secondary survey has revealed this associated limb injury (Figure 16.1).

I can see a shoulder trauma series with an AP and an attempted shoot-through or trans-scapular view. It’s not quite a lateral Y-view I’m suspecting as the radiographer couldn’t get the correct projection. There’s a transverse fracture of the metaphysis, which is angulated medially due to the pull of the pectoralis major. If he was conscious I would specifically look at the axillary nerve function.

The average orthopaedic trainee about to sit the FRCS (Tr & Orth) exam requires a basic knowledge of genetics.

This doesn’t need to be encyclopaedic, but candidates will need to have a sound grasp of disease inheritance and genetic disorders. Trainees should be able to draw a family pedigree of single gene inheritance and know the gene mutations of the more common orthopaedic conditions.

By comparison, mention genetic viva questions to any examiner and you get a slightly puzzled look back. Safe to say, it is not a major A-list topic for the vivas and probably doesn’t even make the B-list. However, the subject does intermittently appear in the vivas and therefore it is definitely worthwhile knowing how the questions will run in order to uncomplicate a potentially complicated topic.