VIVA:

Pediatrics and Hands

1. Perthes Disease
   • Question: Discuss the classification, prognostic factors, important points in history and examination, differential diagnosis (DD), and how to exclude infection.
   • My Answer: I described the Catterall and Herring classifications for Perthes disease. Prognostic factors included age at onset and extent of femoral head involvement. Important points in history involved the onset of limp and hip pain, while examination focused on limited hip abduction and internal rotation. To exclude infection, I mentioned blood tests and imaging, including MRI to assess joint effusion.
2. Femur Fracture in a 9-Month-Old
   • Question: No X-ray provided; discuss non-accidental injury (NAI) in detail.
   • My Answer: I emphasized the importance of considering NAI in infants with femur fractures, discussing red flags such as inconsistent history, delay in seeking treatment, and multiple fractures at different healing stages. I also mentioned involving a multidisciplinary team for assessment and safeguarding.
3. Left Thoracic Scoliosis
   • Question: Discuss history, examination, differential diagnosis, investigation, and management.
   • My Answer: I outlined a thorough history and examination focusing on the curve’s severity and progression. For investigation, I recommended a full spine X-ray and MRI. Management options included observation for mild curves, bracing for moderate curves, and surgery for severe or progressive scoliosis.
     
4. Rheumatoid Hand
   • Question: Describe the findings, history, expectations, and patient conditions.
   • My Answer: I described common deformities such as ulnar deviation, swan neck, and boutonniere deformities. History should include duration of symptoms, functional impairment, and systemic involvement. Examination would reveal joint tenderness and swelling.
5. Central Wrist Pain in a Young Patient
   • Question: Discuss differential diagnosis, history, and examination; X-ray revealed Kienböck’s disease.
   • My Answer: I listed differential diagnoses including Kienböck’s disease, TFCC injury, and scaphoid fracture. The history included pain exacerbation with activity and past trauma. Examination focused on wrist tenderness and range of motion.
6. Proximal Phalanx Fracture
   • Question: Discuss the management of a 90-degree dorsal angulated fracture.
   • My Answer: Initial management involved manipulation under sedation and possible fixation with a temporary splint or buddy taping. I discussed sedation options, local anesthesia techniques, and doses.

Basic Science

1. Compression Stress-Strain Curve of Bone
   • Question: Draw and explain the stress-strain curve for normal bone, osteomalacia, and osteoporosis.
   • My Answer: I drew the standard stress-strain curve and explained differences in osteomalacia and osteoporosis, noting decreased stiffness and strength.
2. Hip Osteolysis and Wear
   • Question: Discuss the X-ray findings and bearing surfaces.
   • My Answer: I identified osteolysis and linear wear, and discussed the types of bearing surfaces, their wear patterns, and lubrication mechanisms.
3. Anatomy of the Hand
   • Question: Identify structures in a cadaveric image.
   • My Answer: I detailed the anatomy of hand muscles, vascular arches, and compartments, and explained the surgical release techniques.
4. Non-Accidental Injury (NAI)
   • Question: Discuss NAI and consent in children.
   • My Answer: I covered the signs of NAI and the importance of multidisciplinary assessment, including Gillick competency for consent.
5. Theatre Design
   • Question: Discuss theatre ventilation and prerequisites for arthroplasty.
   • My Answer: I explained laminar flow systems, pros and cons of different ventilation types, and essential theatre requirements for arthroplasty.
6. Cartilage Defect
   • Question: Discuss arthroscopic findings and treatment options.
   • My Answer: I described cartilage structure, stages of damage, and treatments such as microfracture, autologous chondrocyte implantation, and osteochondral grafting.

Trauma

1. Neck of Femur (NOF) Intracapsular Fracture
   • Question: Discuss treatment options for different age groups.
   • My Answer: For a 73-year-old, I recommended total hip replacement (THR), discussing types, bearings, and approaches. For a 37-year-old, I suggested open reduction and internal fixation (ORIF).
2. Shoulder Dislocation
   • Question: Management of unstable shoulder dislocation.
   • My Answer: I described imaging findings, management of bony Bankart lesions, and surgical stabilization techniques.
3. Open Tibia Fracture
   • Question: Management according to BOAST guidelines.
   • My Answer: I discussed initial debridement, external fixation, and definitive fixation methods.
4. Floating Knee with Cold Pulseless Limb
   • Question: Management and surgical approach.
   • My Answer: I emphasized on-table angiography and staged external fixation during vascular repair.
5. Trimalleolar Ankle Fracture
   • Question: Discuss management and approaches.
   • My Answer: I detailed initial reduction, definitive fixation, and post-operative rehabilitation.
6. Olecranon Fracture in Elderly
   • Question: Discuss management options.
   • My Answer: I reviewed conservative management versus surgical options, considering comorbidities and functional demands.

Adult Pathology

1. Foot Ulcer with Amputated Toe
   • Question: Management and assessment.
   • My Answer: I used the SINBAD classification for ulcer severity and discussed management options, including offloading and wound care.
2. Medial Knee Osteoarthritis (OA)
   • Question: Discuss High Tibial Osteotomy (HTO).
   • My Answer: I explained indications, surgical technique, and expected outcomes of HTO.
3. Shoulder Post-Traumatic Avascular Necrosis (AVN)
   • Question: Management options.
   • My Answer: I discussed total shoulder arthroplasty (TSA) and the importance of rotator cuff integrity.
4. Primary Elbow OA
   • Question: Management options in a manual worker.
   • My Answer: I reviewed conservative treatments, arthroscopic debridement, and the option of total elbow replacement (TER) versus fusion.
5. Hip Loosening Post-THR
   • Question: Approach and differential diagnosis.
   • My Answer: I detailed the diagnostic workup, including infection assessment, and discussed revision strategies.
6. Pathological Subtrochanteric Fracture
   • Question: Management in metastatic RCC.
   • My Answer: I emphasized the importance of staging with bone scans and PET scans, and discussed surgical management for solitary versus multiple metastases.

Final Thoughts

Reflecting on my FRCS experience, the journey was challenging but immensely rewarding. The preparation and exam process enhanced my orthopedic knowledge and clinical skills. For those preparing for the FRCS, remember that consistency, thorough preparation, and support from peers and mentors are key to success. Keep pushing forward, as the rewards are truly worth the effort.

The FRCS exam is known for its rigorous standards and comprehensive evaluation of a candidate’s knowledge and clinical skills. Having gone through this challenging yet rewarding journey, I aim to share my experience to help future candidates navigate their preparation and exam process.

VIVA:

Trauma:

1. Open Tibia Fracture:
   • Question: How would you manage an open tibia fracture?
   • My Answer: This was a straightforward case where I discussed the initial management, including debridement, stabilization, and antibiotics.
2. ACJ Dislocation:
   • Question: How would you manage an ACJ dislocation?
   • My Answer: This was another straightforward question, where I discussed conservative and surgical treatment options.
3. Shoulder Pain in a 50-Year-Old Man Post-Trauma:
   • Question: What is your differential diagnosis?
   • My Answer: I listed traumatic cuff tear, frozen shoulder, cervical spine issues, and biceps tendinitis. When asked about the investigation, I suggested MRI for detailed assessment, explaining that it would show cuff retraction, muscle atrophy, and other pathologies. The examiner was not fully convinced and pressed further.
4. Hypertrophic Non-Union of the Humerus:
   • Question: How would you manage a 10-week-old closed fracture with hypertrophic non-union and angulation?
   • My Answer: I suggested ORIF without bone graft initially but added that an iliac autograft might be necessary if the condition persisted for six months.
5. Posterior Hip Dislocation with Sciatic Palsy:
   • Question: How would you manage this case?
   • My Answer: I would perform an open reduction if closed reduction failed. When asked about my approach, I detailed the Kocher-Langenbeck approach and emphasized preserving femoral head vascularity and exploring the nerve during the same session.
6. Ankle Fracture Dislocation:
   • Question: What are the critical steps in managing this condition?
   • My Answer: I highlighted the importance of identifying the posterior malleolus fracture, obtaining a CT scan, and understanding the classification of posterior malleolus fractures.

Adult Pathology:

1. Infected Loose Charnley Hip:
   • Question: What are the risk factors for infection?
   • My Answer: I categorized them into general (e.g., diabetes, RA) and local factors. I discussed diabetes management using HbA1c levels and the impact of RA medications like NSAIDs, steroids, and DMARDs.
2. Hallux Valgus in a 50-Year-Old Lady:
   • Question: How would you manage this condition?
   • My Answer: I detailed history, examination, and investigation steps. For treatment, I suggested fusion for arthritic joints but also discussed SCARF, ATKIN, and lateral release for non-arthritic cases. When complications like metatarsalgia were introduced, I mentioned troughing and first CMC hypermobility as potential causes.
3. Necrotizing Fasciitis:
   • Question: Explain the classification, causative organisms, and management.
   • My Answer: I covered the classification, listed causative organisms, and detailed management, including LRINEC scoring and surgical debridement.
4. Degenerative Lumbar Scoliosis:
   • Question: How would you approach this condition?
   • My Answer: I discussed history, examination, and suggested full spine X-rays to assess sagittal balance before proceeding to MRI. I outlined conservative treatments and mentioned nerve root injections and surgical options.
5. Valgus Knee with OA:
   • Question: What are the treatment options?
   • My Answer: I initially suggested TKR but corrected to include varus osteotomy for earlier stages. I also detailed the steps involved in TKR.
6. Osteochondroma at the Proximal Fibula:
   • Question: How would you manage this condition?
   • My Answer: I outlined history, examination, MRI evaluation, and treatment via marginal excision.

Basic Science:

1. MRI Mechanics:
   • Question: Explain how MRI works and interpret specific sequences.
   • My Answer: I described the principles of MRI and attempted to interpret a complex cervical spine MRI, although I struggled with some technical terms.
2. Pregnancy-Related Imaging:
   • Question: How would you manage imaging in a pregnant lady with thigh pain?
   • My Answer: I suggested using precautions for X-rays and explained the guidelines for MRI use in pregnancy. Later, I discussed the management of a fracture through an aggressive lesion post-delivery.
3. Compartment Syndrome:
   • Question: What is the differential diagnosis and management of leg pain post-rugby match?
   • My Answer: I discussed compartment syndrome and detailed the cross-sectional anatomy of the leg.
4. Tendon Healing:
   • Question: What are the factors affecting tendon healing and its blood supply?
   • My Answer: I described the healing process, the role of vincula, and blood supply dynamics.
5. Kaplan-Meier Survival Analysis:
   • Question: Draw and interpret a survival curve.
   • My Answer: I explained how censoring affects the curve and mentioned alternative survival analysis methods.
6. Thenar Wasting and CTS:
   • Question: How would you examine and manage bilateral thenar wasting?
   • My Answer: I suggested NCS for routine confirmation of CTS and differentiation from cervical or double crush syndrome.

Paediatric and Hand Cases:

1. Monteggia Fractures:
   • Question: How would you manage these fractures?
   • My Answer: I provided a straightforward approach to diagnosis and treatment.
2. DDH in a 2-Month-Old Baby:
   • Question: How would you manage this condition?
   • My Answer: I discussed history, examination, management, and handling complications post-Pavlik harness application.
3. LLD and Neurofibromatosis:
   • Question: Discuss differential diagnosis and management.
   • My Answer: I mentioned neurofibromatosis and hemihypertrophy, detailing concerns and guided growth procedures.
4. Scaphoid Waist Fracture:
   • Question: What is the conservative management protocol?
   • My Answer: I discussed the SWIFT trial and management of suspected scaphoid fractures.
5. Rugger Jersey Finger:
   • Question: Describe the classification and treatment.
   • My Answer: I explained the classification, examination for FDP and FDS, and acute injury treatment. I mistakenly suggested extending the incision too far proximally.
6. Post-Op Dupuytren’s with Skin Graft:
   • Question: Explain the rationale for skin graft use.
   • My Answer: I described full-thickness grafts, donor sites, and patient examination.

Clinicals:

1. Scoliosis with Previous Leg Surgeries:
   • Question: What is your differential diagnosis?
   • My Answer: I suggested possible neurofibromatosis.
2. Shoulder Pain in a 40-Year-Old:
   • Question: How would you approach this case?
   • My Answer: I provided a history and examination but struggled to reach a definitive diagnosis due to non-specific MRI findings.
3. Lower Limb Short Cases:
   • Questions: Discuss PCL injury, tibialis posterior dysfunction with flat foot, and valgus knee with OA.
   • My Answer: I provided detailed assessments and management plans for each condition.
4. Upper Limb Short Cases:
   • Questions: Discuss high-pressure injection injuries, 1st CMC OA with STT arthritis, and hand rheumatoid arthritis.
   • My Answer: I detailed history, examination, and management for each case, including compartment syndrome and surgical options for arthritis.

Final Thoughts

The FRCS exam was challenging, but the thorough preparation and structured approach helped me succeed. Future candidates should focus on consistent study, form study groups, find mentors, and utilize multiple resources. The experience was demanding but immensely rewarding, significantly enhancing my clinical skills and knowledge.

As an orthopedic surgeon, preparing for the Fellowship of the Royal College of Surgeons (FRCS) exam was one of the most challenging and rewarding experiences of my career. Here, I recount my journey through the FRCS (Orth) exam, held from 29th April to 1st May 2018 in Northumberland, detailing the questions I encountered and how I approached them.

Clinicals:

Intermediate Cases

Lower Limb Case: 64-Year-Old Man with Left Ankle Pain

• History: The patient’s primary complaint was stiffness. He described walking as if on pebbles. He had sustained an ankle fracture 30 years prior, treated with a cast. He was diabetic, and surgery was not being offered at the time.
• Examination: The ankle was deformed with swelling on both sides and a varus heel. He stood on the lateral border of his foot with the first metatarsophalangeal joint off the floor. There was a prominent osteophyte on the lateral side with skin erosion and minimal tenderness. The ankle and subtalar movements were significantly restricted. There was a psoriasis-like patch on the shin.
• Discussion: The X-rays indicated a Charcot ankle. I discussed the stages of Charcot arthropathy, the conservative management involving offloading and custom footwear, and the indications for surgery, which include severe deformity, ulceration, or instability. The skin patch could be related to psoriasis or chronic venous stasis changes.

Upper Limb Case: 15-Year-Old Girl with Right Shoulder Issues

• History: The patient had recurrent shoulder dislocations up to ten times a day for the last four years and was diagnosed with Ehlers-Danlos Syndrome. Other family members were also affected.
• Examination: The shoulder showed a visible sulcus sign, anterior subluxed humeral head (palpable) with a posterior dip, and wobbling on active movements. Scapular movement was minimal, and provocative tests were unnecessary as dislocations occurred easily.
• Discussion: The primary issue was multidirectional instability due to Ehlers-Danlos Syndrome. Management included physical therapy to strengthen shoulder muscles and stabilize the joint. Investigations would include MRI to assess soft tissue integrity and plan surgical interventions if necessary. For an arthrogram, gadolinium could be used. Surgical options might include capsular plication or labral repair depending on the specific pathology identified.

Short Cases

Lower Limb Cases

1. Hallux Valgus:
   • Examination: I examined the left forefoot, noting the crease on the toe due to the bunion deformity.
   • Discussion: X-rays would guide the choice of surgical procedure, with options including osteotomy or fusion depending on severity and patient preference.
2. Leg Length Discrepancy:
   • Examination: I assessed the leg length discrepancy using tape measurements, the Galeazzi test, and Bryant’s triangle.
3. Complex Knee Osteoarthritis:
   • History: The patient had multiple scars on the femur and tibia, varus knee, and a short leg with a range of motion from 0-35 degrees.
   • Discussion: The primary challenges in offering total knee replacement (TKR) included previous osteomyelitis and extensive scarring. Preoperative planning and possibly staged surgery were necessary.

Upper Limb Cases

1. Left Elbow Problem:
   • Examination: The elbow showed no scars, swelling, wasting, deformity, or tenderness, but had a slight loss of extension. The patient experienced clicking.
   • Discussion: Posterolateral rotatory instability (PLRI) tests were stable, but coronal instability tests were needed for further assessment.
2. Rheumatoid Hands:
   • Examination: The left hand exhibited caput ulnae, MCP joint swellings, and an extensor pollicis longus (EPL) rupture. Functional assessment was good with no other tendon ruptures or neurodeficits.
3. Gouty Tophi in Fingers:
   • Discussion: The tophi were consistent with gout. The patient had scars on the posterior elbows and left index finger, suggesting possible previous surgeries. Other differentials included rheumatoid nodules. Tophi could also be found on the ear helix and Achilles tendon.

VIVA:

Adult Pathology

1. Loose Cemented Femoral Stem:
   • Discussion: I described the osteolysis around the cemented femoral stem and differentiated between aseptic and infected loosening using clinical and imaging criteria. Management included infection workup and revision surgery.
2. Cauda Equina Compression:
   • Discussion: The MRI showed compression, and I detailed patient assessment, types of disc prolapse, and the pathophysiology of cauda equina syndrome. Surgical decompression was essential.
3. Jehovah’s Witness Requiring TKR:
   • Discussion: Preoperative planning involved consulting with the patient and a Jehovah’s Witness liaison committee. Intraoperative strategies included blood conservation techniques and possibly using a cell saver. Postoperative care required careful monitoring.
4. Humeral Head AVN:
   • Discussion: The X-ray showed advanced osteoarthritis and collapse due to avascular necrosis (AVN), often associated with steroid use. Management options included total shoulder replacement.
5. Knee with Medial Compartment Osteoarthritis:
   • Discussion: The X-ray showed bone-on-bone contact. Surgical options included TKR, and I discussed high tibial osteotomy (HTO) versus unicompartmental knee replacement (UKR), citing relevant evidence.
6. Diabetic Foot Ulcer:
   • Discussion: The ulcer at the 2nd metatarsophalangeal joint was likely due to pressure points and previous toe amputation. Expected findings included neuropathy and poor peripheral circulation.

Trauma Cases

1. Resurfaced Hip with Displaced NOF:
   • Discussion: I discussed the management of a traumatic neck of femur fracture in a resurfaced hip, including surgical options and required equipment.
2. Displaced Galeazzi Fracture:
   • Discussion: Initial management involved stabilization, with surgical intervention planned based on the patient’s condition. The approach included open reduction and internal fixation.
3. Pelvis Fracture:
   • Discussion: The X-ray showed a bilateral pelvic fracture. I discussed associated injuries, management according to ATLS guidelines, and preparation for possible laparotomy.
4. Trimalleolar Ankle Fracture:
   • Discussion: The fracture required immediate reduction and stabilization. Post-reduction CT showed subluxation, necessitating surgical intervention.
5. Non-Union of Distal Femur Fracture:
   • Discussion: The X-ray showed a failed retrograde IM nail in a diabetic patient. Causes of non-union included poor vascularity and infection. Management involved revision surgery.
6. Distal Humerus Shaft Fracture:
   • Discussion: I identified the fracture, discussed associated complications, and outlined surgical management, including ulnar and radial nerve considerations.

Hands Cases

1. Wasted Thenar Eminence:
   • Discussion: The patient likely had carpal tunnel syndrome. Assessment included median nerve tests and differentiation from anterior interosseous nerve (AIN) syndrome.
2. Transverse Laceration on Volar PP:
   • Discussion: The injury suggested flexor tendon damage. Management included appropriate surgical repair with core suture techniques.
3. Intraarticular Base of MP Fracture:
   • Discussion: Management involved surgical fixation, with a detailed approach to the volar plate and PIP joint.

Paediatrics Cases

1. Intoeing in a 2-Year-Old:
   • Discussion: Assessment involved examining the rotational profile and measuring femoral anteversion and tibial version clinically.
2. Rigid Flatfeet in a 10-Year-Old:
   • Discussion: X-rays showed a C-sign, indicating tarsal coalition. Treatment options ranged from conservative management to surgical resection.
3. Scoliosis in a 12-Year-Old:
   • Discussion: The X-ray showed a right thoracic curve with fused ribs. I identified the apical and end vertebrae, estimated the Cobb angle, and discussed possible causes and further examination.

Basic Science Cases

1. Types of Plates:
   • Discussion: I described various plates, including locking and non-locking plates, their mechanisms, and applications in fracture fixation.
2. Cut Median Nerve:
   • Discussion: I outlined types of nerve injuries, repair techniques for different gap sizes, and the use of sural nerve grafts.
3. Large Swelling on Dorsum of Hand:
   • Discussion: Differential diagnoses included chondrosarcoma and enchondroma. Further investigation with imaging and biopsy was discussed.
4. Muscle Types:
   • Discussion: I explained unipennate and bipennate muscles, their differences, and examples.
5. Articular Cartilage Injury:
   • Discussion: I described the consequences of cartilage injury and management strategies for various defect sizes.
6. VTE Management:
   • Discussion: I outlined preoperative and intraoperative management for patients with a history of VTE, including those with PE, venacava filters, and on anticoagulants.

Conclusion

The FRCS exam was a rigorous but immensely rewarding experience. The detailed preparation and comprehensive understanding required not only enhanced my clinical skills but also provided a solid foundation for my orthopedic practice. For those preparing for the

As I prepared for the FRCS exam, I embarked on a journey of intense study and preparation, drawing from a variety of resources to ensure a well-rounded understanding of orthopaedics.

Study Materials

Books

To consolidate my knowledge, I created my own notes from a mix of several key texts:

• The Concise Orthopaedic Notes by Firas Arnaout
• The last 5 years of JAAOS review papers
• Orthobullets and Stryker Hyperguide – These provided a great source of MCQs, though not exactly like the exam questions, so they couldn’t be relied upon solely.
• The OrthoQuiz MCQs by the Orthopaedic Academy

Each of these sources provided valuable insights, but no single book was comprehensive. Together, they formed a robust foundation. Additionally, Hoppenfeld’s Surgical Exposures in Orthopaedics was crucial for viva preparation, especially the approaches I was less familiar with, like the posterior approach to the knee and shoulder. Mastering these techniques was essential, and I practiced discussing all approaches until it became second nature.

Courses

Courses booked out quickly, so I planned strategically, booking early to address deficient areas and then closer to the exam for intensive preparation. I attended several key courses:

• The FRCS Mock-Exam Course by the ORUK
• Wrightington Course – A week-long course held seven months before the exam, which was invaluable for identifying key areas to focus on.
• Norwich Course – This course had an impressive patient load and was well-organized, providing ample hands-on experience.
• Oxford Course – Though not great for patient exposure, it offered numerous viva sessions and a worthwhile practice exam.

In hindsight, I realized I might have overdone it with the number of courses, given their high cost.

Workload and Preparation

Having a study partner was invaluable. We sought out bosses willing to viva us at any convenient time, even early mornings or late evenings. Persistence was key, and although it sometimes felt humiliating, the experience was definitely worthwhile. Practicing speaking and refining viva techniques were crucial, as they made up a significant part of the exam.

Seeing patients early and often was another essential aspect of preparation. Treating each new patient in the clinic as if they were part of the exam helped refine my examination techniques and diagnostic skills, focusing on quick and accurate assessments.

MCQs and Clinicals

After the MCQs, many of us felt we had failed. It was difficult to gauge performance, so it was important not to be disheartened.

Clinical Examinations

The key to clinicals was efficiency. They expected answers within 3 minutes, with 2 minutes for questions and moving to the next patient. Functional tests often yielded more information than palpating every joint.

Upper Limb Shorts

• FPL rupture after volar distal radius plate placement – With no history or clues, functional tests were crucial.
• Dupuytren’s Contracture
• Elbow Osteoarthritis – Discussed surgical options, including the OK procedure.

Lower Limb Shorts

• PCL rupture – Again, no clues or history provided.
• Foot drop post-tumor surgery
• Stiff hip post-acetabular ORIF

Intermediate Cases

• SLAC wrist for the upper limb.
• Left leg hip and knee OA with left knee pain for the lower limb. This was my toughest station, with a complicated patient and a challenging examiner. The key takeaway was to focus on the surgical problem and not get flustered.

Vivas

Adult Pathology

• Osteomyelitis – Discussed an infected distal femur with a sequestrum.
• Loose Charnley Total Hip Replacement – Focused on ruling out infection and discussing modes of failure.
• Rheumatoid Arthritis in the Elbow – Covered types and indications for total elbow replacement, and management of soft tissue breakdown.
• Massive Disc Prolapse – Discussed indications for surgery and management of cauda equina.
• Metastatic Breast Cancer to Bone – Covered Mirel’s score and management of spinal metastasis.

Trauma

• Locked Posterior Shoulder Dislocation – Managed an acute injury with an AP view only.
• Pelvic Trauma – Detailed management of an APC pelvic fracture, including the Massive Haemorrhage Protocol.
• Comminuted Femur Fracture in a 10-Year-Old – Compared plate fixation and TENS nails.
• Lisfranc Injury – Discussed acute and operative management.
• Capitellum Fracture – Classification and operative management.

Upper Limb and Pediatrics

• CMC Osteoarthritis – Classification and management.
• SLAC Wrist Stage 3 – Classification and management.
• Cuff-Deficient Shoulder Osteoarthritis – Discussed reverse TSR principles.
• Cerebral Palsy – Covered hip problems and management of bilateral hip dislocations.
• Perthes Disease
• Swanson’s Classification – Classified various conditions and discussed a curly toe.

Basic Science

• Principles of External Fixation – Strengthening constructs.
• Biomechanics of Different Running Styles – Analyzed differences between sprinters, long-distance runners, and walkers.
• Proximal Humerus Destruction – Differentiated between infection, Charcot, and tumor.
• Stress-Strain Curve
• Osteoclast Function – Detailed mechanism and impact of bisphosphonates.
• Osteoporosis and DEXA Scan – Discussed results and management.

Final Thoughts and Advice

Throughout my orthopaedic training, I often hid in the back, avoiding questions out of fear of looking foolish. However, preparing for the FRCS exam required shedding this