FRCSOrthExam Education Viva Topics

TRAUMA

    1) Type 3 periprosthetic fracture

2) THR presents with a first time dislocation

3) Posterior dislocation with a fractured acetabulum

4) Osteochondral fracture of the knee

5) 15 year old boy club football player with acute ACL injury

6) Segmental tibial fracture with ipsilateral tibial plateau fracture

7) Open book pelvic fracture that is very haemodynamically unstable

8) Draw Hamilton Russell traction for a femoral fracture.

9) Diagram of oblique fracture, Where do you place the lag screw and why?

10) Pelvis fracture and inferior hip dislocation & pneumothorax

11) 18 year old with subtalar dislocation

12) 32 year old with midshaft tibial fracture and chest injury

13) Clavicle fracture mid shaft in a young adult, Non-union

14) Inferior shoulder dislocation

15) Burst fracture T12, no neurology

16) Treatment of distal biceps rupture and describe surgical approach.

17) Mangled extremity. Limitations of MESS

18) Spinal fracture. Need for steroids. NASCIS studies

19) IM nails biomechanics.

20) Displaced intracapsular NOF# in a 42 year old, classification (Garden & Pauwell's angle)

21) Lateral C-spine XR with C7/T1 subluxation, paraplegic, application of halo & discussion of respiration in C-spine injuries

22) Pelvic fixator in place with pins not in the pelvis on one side

23) Anterior #-dislocation shoulder

24) Tibial tuberosity avulsion in a child

25) Salter Harris type II injury of proximal phalanx of little finger

26) Open comminuted tibial #

27) Midshaft ulna #

28) Volar Barton #

29) Torus versus greenstick #

30) Post fracture dislocation shoulder

31) Distal radius with scaphoid fracture

32) Segond #

33) Median nerve laceration

34) Comminuted proximal humerus fracture

35) Distal femoral fracture in elderly

36) Secondary prevention of osteoporosis and effects on bone healing

37) Clinical picture mangled leg

38) Segmental loss tibia, Limb salvage versus reconstruction

39) Weber C ankle

40) Displaced intracapsular fracture in young male

41) Elbow dislocation with radial head fracture

42) Intracapsular NOF in a 70 year old

43) Open supracondylar femoral fracture with pelvic fracture

44) Salter Harris type 4 fracture proximal phalanx great toe

45) Grade 3 (Ruedi's) tibial pilon fracture

46) Transverse humeral fracture in a 2 month old

47) Pelvic Fracture

48) Acetabular fracture

49) Distal Femoral fracture intra-articular

50) Supracondylar elbow fracture/Baumann’s angle

51) Compartment Syndrome

52) Open fracture Gustilo C

53) Lisfranc injury

54) Shaft femur with neck of femur

55) Periprosthetic fracture around knee

56) Ankle instability

57) Unstable inter-trochanteric fracture               

58) Galeazzi #                 

59) Pathological # Humerus

 

 

ADULT PATHOLOGY

 

 

1) 50 year old man with symptomatic hip OA, failed conservative management. Which hip would you do and can you support this with any literature or joint registry findings

2) Paget’s disease, THR

3) Valgus rheumatoid knee

4) X-ray appearances of OA, RhA and gout.

5) Infected THR 

6) Osteochondroma proximal femur, differential, management, risks

7) Meniscal injury and repair

8) Ankylosing spondylitis with painful bilateral hips with 30 degrees FFD

9) Ewing’s sarcoma

10) Biopsy for a bone tumour

11) Isolated renal metastases in the femur

12) RSA analysis for implants

13) Guidelines for doing MIS for hip surgery

14) Bilateral mild hip dysplasia in 18 year old 

15) Degenerative spine. What are worrying reg flag signs.

16) MRI of PCL deficient knee

17) 56 year old with OA hip. What implant are you going to use and why?

18) Conversion hip arthrodesis to THR

19) C-spine x-ray. Destroyed C5, no neurological signs in a 70 year old male (Myeloma)

20) Chronic osteomyelitis in adult tibia

21) Fibrous dysplasia with Shepherd's crook deformity

22) Freiberg's of a 2nd MT head

23) Unicortical # in a patient with Paget's disease. D/D & treatment (problems with nailing)

24) Loose Charnley THR. Discussion of diagnosis, investigations and treatment

25) Fibrous cortical defect in distal tibia

26) Pelvic X-ray with diffuse lytic pelvic lesion & a sclerotic iliac lesion

27) Bilateral varus knees, bone-on- bone

28) Correctable flat foot picture with 'too many toes' sign

29) Lytic lesion over greater trochanter

30) Foot photo 6 months after  weber B fracture treated in POP with RSD/CRPS

31) Glass eye due to retinoblastoma as a child. X-ray of knee showed osteosarcoma

32) Elbow x-ray with multiple loose bodies

33) Rheumatoid forefoot

34) Lytic lesion femoral neck in a 32 year old woman

35) Young patient pelvis with Cemented THR one side & severe dysplastic OA hip on other side

36) Mechanism of loosening / wear / osteolysis

37) Risks of allogenic bone graft

38) Rotator cuff tear

39) Rotator cuff arthropathy

40) Meniscal tears, MRI features, types, structure of meniscus and blood supply

41) Protrusio hip

42) Rheumatoid foot

43) Hallux valgus

44) Dislocated MTPJ’s in Rheumatoid foot, management surgical options 

45) Spondylolysis

46) Gangrenous foot post-op

47) Syme’s, Chopart’s and B/K amputation, design of B/K amputation prosthesis

48) Chondrosarcoma

49) Osteomyelitis

50) Septic loosening

51) Spondylolisthesis and Spondyloptosis

52) Acute calcific tendonitis of the shoulder

53) Psoas abscess (on CT)

54) AVN

55) Multiple Myeloma

56) Looser’ s zones

57) Synovial chondromatosis

58) Paget’s with THR and protrusion

59) Spinal stenosis

60) Fowler’s operation

BASIC SCIENCES

 

          1) Draw a hip free body diagram

2) Posterior approach of the hip

3) Pathogenesis of osteoarthritis and rheumatoid arthritis

4) Biomechanics of hip fracture fixation devices

5) What would you do if you had 5 consecutive THR that became acutely infected whilst still an inpatient.

6) Survivorship curve

7) Posterior approach to the knee

8) Indications for disarticulation of the knee as an amputation

9) Define wear and give me examples.

10) Define hoop stresses and give me some examples in the body

11) Biomechanical priciples and material properties of an Exeter & Charnley stem

12) Problem in the 3M capital hip disaster

13) Summary of the recent National Joint registry report and tell me the features of the NJR compared with other joint registries

14) Draw the compressive and tensile trabecullae in the proximal femur

15) What is a hypothesis

16) How do you go about setting up a clinical trial

17) What does central tendency mean (mean, median, mode)

18) What is dispersion (Standard deviation, interquartile range)

19) Why do we use a P-value of 5%?

20) When do you use a parametric test and when do you use a non parametric test?

21) What is a meta analysis?

22) Given a diagram of a box and whisker plot, asked to describe all points , lines etc

23) What is your DVT prophylaxis and why. What is the evidence behind it.

24) Describe the different forms of lubrication.

25) What properties of ceramic make it good for lubrication.

26) How does MRI, X-ray, US, CT, bone scan, DEXA scan work?

27) X-ray on a 25 year old pregnant female, steps you take to reduce the dose

28) How do you do an arthrogram. What are the contra-indications to using the contrast.

29) Radiation dose they will get from an isotope bone scan

30) Design a new plate for fracture fixation. What features in the plate will you incorporate into your design.

31) You have been asked to design a new hip replacement / knee replacement. What features will you incorporate into your design.

32) DCP plate is very strong. Why does it need to be this strong.

33) What are the material properties of tendon & ligament

34) How is polyethelene manufactured.

35) Draw the structure of a nerve and what do you repair in a digital nerve repair and a median nerve repair.

36) Name some outcome scores used in orthopaedics

37) What do you know about metal on metal articulation. How do the current generation of implants differ from those used in the 70's (McKee-Farrar)

38) Tourniquets. How to apply & use.

39) Screws, describe different types and how they work etc

40) Locking plates, principles

41) Humeral plating, why done posteriorly, principles tension band

42) Draw brachial plexus

43) Set up a bone bank (Consent, testing, storage etc)

44) X-sectional anatomy of carpal tunnel

45) Chronic regional pain syndrome.

46) Creep and stress relaxation curves

47) Zones of growth plate, blood supply & relevance to osteomyelitis

48) Types of ossification & bones in which these occur

49) Shown unmarked axial drawing of a vertebra

50) Lumbar discogram with normal discogram at L3/4 & abnormal at L4/L5

51) Structure of intervertebral disc & what happened with age

52) Shown a drawing of the ulnar bursa of the hand

53) Hysteresis loops (one for elastin and one for collagen)

54) Cross section of nerve. Tell me about the structure of a nerve

55) How does the nerve vary along its course  

56) Nerve Conduction Studies

57) Osteogenesis Imperfecta

58) Dwarfism

59) Torticollis

60) Osteoid Osteoma

61) Syringomyelia

62) Horner’s syndrome

63) Rickets

64) Fracture healing

65) Nerve injuries

66) Piriformis muscle anatomy

67) Prosthesis, A/K prosthesis

68) Bone grafts

69) Tourniquets

70) Screw design and function/ lag screw principle

71) Structure peripheral nerve/nerve conduction studies 

72) Brachial plexus injury with Horner

73) Henry approach to radius

74) Course of nerves & muscles innervated in upper and lower limbs

75) Design of knee brace for valgus deformity

76) Four bar linkage mechanism of ACL/PCL

77) Difference between osteoporosis and osteomalacia

78) Causes of secondary tumours to bone and mechanism of metastases

79) Parts of a THR

80) Ceramic-mechanical properties

81) Stainless steel-mechanical properties, manufacture

82) Titanium -mechanical properties

83) Draw X-sectional anatomy at mid-thigh level

84) Course of the sciatic nerve from roots to foot

85) Course of the lateral cutaneous nerve of thigh

86) Draw articular cartilage, viscoelasticity, lubrication, effect of laceration, loading and unloading

87) Articular cartilage defects and repair methods

88) Draw an osteoclast

89) Meniscus structure / function / biomechanics / discussion on hoop stresses

90) Structure of proteoglycan

91) Mendelian inheritance, sex-linked recessive/dominant

92) Theatre design (Laminar flow, Ex flow, air changes, HEPA filter, size of particles)

93) Failure mechanisms prostheses. Interfaces

94) Bacterial organisms. Use of prophylactic antibiotics and mechanism of action

95) Open fractures

96) Gas gangrene

97) Talus & calcaneum to describe anatomy

98) Bone graft substitutes properties

99) Confidence intervals and relative risk

100) Wear mechanisms

101) Subsurface delamination of polyethylene

102) Traction

103) MRI principle

104) Stress-strain curve

105) Phyeal injuries

106) Palacos cement

107) Highly Cross-Linked polyethylene

108) Ex-fix construct

 

 

HANDS & PAEDS

 

 

1) Finger tip injury with bone exposed

2) Radial club hand

3) Madelung’s deformity of distal radius

4) # 4th and 5th Metacarpals minimally displaced

5) Bilateral club foot

6) Neurofibromatosis (I & II) and pseudoarthrosis of tibia

7) Tibia vara

8) Blounts disease

9) Acute displaced scaphoid fracture

10) Kienbock’s disease

11) STT OA

12) Clinical slide of a hypothenar eminence haemangioma

13) Clinical slide of recurrent Dupuytren's contracture

14) Boutonniere deformity

15) Tibial spine avulsion

16) Arthrogram in an 18 month old DDH

17) Clinical picture of anterolateral bowing tibia in a toddler with café au lait spot

18) Clinical photograph of an adolescent pes planus

19) Calcaneonavicular tarsal coalition

20) Extra-articular distal radius fracture management options

21) Ulnar Collateral Ligament injury of the thumb and management options

22) Mucous cyst

23) Monteggia Fracture dislocation with unreduced radial head

24) Scapholunate ligament injury and management – acute vs chronic, Kirk-Watson’s instability test

25) LLD and causes, Management of predicted 9cm LLD in a normal child

26) Management of missed DDH in 18 month old

27) DDH in newborn

28) Perthes’ disease

29) SUFE                                                

30) CTEV                                                

31) Cavovarus foot                              

32) Physiological variants                 

33) Neuromuscular disease              

34) Limb lengthening and deformity correction  

35) Juvenile Arthritis

36) Non-accidental Injury

37) Paediatric knee

38) Skeletal Dysplasias

39) Spinal disorders

40) Oncology

41) Infection

42) Supracondylar fracture

43) Lateral condyle

44) Mallet finger

45) Fight bite

      

46) Fibular hemimelia

47) EPL rupture

48) De Quervain’s disease

49) Perilunate dislocation

50) Osteochondral defect of the knee

51)

52) Dorsal PIPJ fracture dislocation

53) Undisplaced scaphoid fracture

54) Pes cavus with claw toes

55) Grease gun injury

56) Old Monteggia's fracture

57) Bipartite patella

58) Galeazzi's fracture

59) Ewing’s sarcoma

60) Boutonniere and swan neck deformities

61) Examiner puts glove on. Draw on the glove and talk about incisions for the hand

62) Management of 1st MTPJ OA. Conservative and operative.

63) How do you repair a flexor tendon injury in Zone 2, different post-op regimes

64) Describe the zones for flexor and extensor tendon injuries of fingers and thumb

65) Picture of winging scapula. What are causes.

66) Menigococcal septicaemia

67) Diaphyseal aclasia

68) Scaphoid non union

69) Gross crush injury to hand. Management fasciotomies

70) Enchondroma of the proximal phalanx with #, Treatment

71) Climber with rupture of all flexor pulleys of finger. Reconstruction principles

72) Clinical photo of a nail bed injury

73) Malunited Frykman's type VIII distal radial #, options for DRUJ reconstruction (osteotomies), Darrach's, Suave-Kapandji & ulnar head replacement

74) Clinical photo of a traumatic amputation through MCPJ's of all fingers

75) Asked about the different types of hand grip

76) Between proportionate and non proportionate dwarfism.

77) Principles in the management of CP

78) Three ways bone form and grow

79) Physes in the hand metacarpals, and phalanges

80) AVN rate in pavlic harness

81) Basic requirements for a good screening test.

82) What screening do we have for DDH in the UK

83) Gait analysis, gait cycle, and what are the prerequisites for normal gait

84) Causes of bowing of tibia

85) Osteogenesis imperfecta, and draw me a genetic table demonstrating the genetics

86) Differences in medial and anterior approaches for DDH

87) Setting up a pavlik harness

88) Picture of congenital vertical talus. What are the associations

89) Cavo-varus foot

90) Changes in Child's knee varus and valgus with age (Selenius graph)

91) SUFE, causes, classification, management. Discussion about recent review from Southampton

92) Fibular hemimelia and PFFD

93) Clinical photo of pair of varus knees in a 2 year old child 

94) Picture of Gallow's traction 

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