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Postgraduate Orthopaedics FRCS(Tr&Orth) revision courses


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FRCS (Tr&Orth) Revision Course
15 – 21st March 2015
Northumbria University, Newcastle upon Tyne & North East Surgery Centre, Queen Elizabeth Hospital, Gateshead.

The Postgraduate Orthopaedics ethos is to try and keep costs reasonably priced for candidates. We are not running the course to satisfy a financial motive and want to give something back to the book series and wider orthopaedic community. We will soon to be writing a third edition of Postgraduate Orthopaedics and we want to fund better illustrations for this venture. We are also keen to progress the website further which is a substantial financial burden.


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Postgraduate Orthopaedics FRCS(Tr&Orth) revision courses

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Postgraduate Orthopaedics FRCS (Tr&Orth) Six Day Intensive Revision course

15-21st March 2015

Lecture & Viva course
Sutherland building Northumbria University, Newcastle upon Tyne

Clinical course
Northeast surgery centre, Queen Elizabeth Hospital (QEH), Gateshead

Why Newcastle

Newcastle is a place where stunning architecture and 2,000 years of history meet world-class facilities, where fantastic travel links meet a compact destination that’s sure to leave a lasting impression; a warm welcome awaits

Newcastle/Gateshead described in three words
•Friendly, attractive, historic
•Crème de North
•Compact,friendly, accessible
•Full of life
•Inviting vibrant city
•Clean, bright, friendly
•Charming, friendly, welcoming
•Worth coming back


Northrumbria University
Based in the heart of Newcastle upon Tyne, one of the UK’s most dynamic and exciting cities, Northumbria University is the largest research and teaching university in the North East of England. Northumbria’s international reputation as a leading British university is the result of a distinctive combination of outstanding academic research and teaching, innovative programmes, traditional values and social and cultural diversity.
Northumbria has a student population of around 32,000 with 3,300 overseas students on our Newcastle campuses and a further 3,000 studying on University programmes in their own countries. Northumbria is the leading provider of high-calibre graduates to business, industry and the professions in the North East of England and one of the highest nationally.

North East Surgery Centre, Queen Elizabeth Hospital, Gateshead
The clinical component of the course will be held at the North East Surgery Centre at the Queen Elizabeth Hospital in Gateshead. This has been designed and built to provide patient care in a 21st century environment and provides one of the most modern and best-equipped surgical facilities in the region.


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Postgraduate Orthopaedics FRCS(Tr&Orth) revision courses

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Our first 6 day intensive revision course took place between  13-18th  January 2014 at Sutherland building Northumbria University and North East Surgical centre,Queen Elizabeth Hospital.

This was a major success with very positive feedback. We had a number of International candidates from Australia, Hong Kong, Egypt, Greece, Germany and Ireland.

•Very good course-thank you
•Excellent course
•Very good course-good cases and pathologies
•Good videos and demonstration of tests for paediatrics
•Very good array of patients
•Fantastic to have seen hip/knee/shoulder arthrodesis
•Faculty and patients to be commended.Case mix very valuable
•Excellent faculty
•Very good course-well organized
•Would recommend to others
•Foot and ankle –very good session
•Just to let you know we both passed the FRCS exam! Thank you so much for an amazing course






























The 2nd course content has been fully revised and revamped to take account of intensive course evaluation feedback received from previous candidates. We truly listen to what our candidates want from the course

Course Programme

Postgraduate Orthopaedics FRCS(Tr&Orth) revision courses

Previous Courses

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Course Details 

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Course programme

Below you will find a copy of our January 2014 course programme.The 2015 course will be similar to this but be significantly fine tuned from detailed analysis of feedback from our first course. Once the 2015 course has been finalised it will be published here

Day 1 Lecture presentations 13th January 2014

The lecture programme will be based on the book Postgraduate Orthopaedics.A candidates guide to the FRCS (Tr&Orth) exam. Key authors involved in writing this book will present important topics from relevant chapters to the audience.

The book was specifically written for UK orthopaedic senior trainees about to sit the exit FRCS (Tr&Orth) examination in orthopaedics. The book has also proved useful for candidates about to sit the SICOT and EBOT exams. The book adds huge insight into technique for passing the FRCS (Tr&Orth).

The 4-day lecture course will be complementary to the book and gives the authors further chance to share tips and tricks into the key essentials for success in this examination.

12.00 Registration
12.30 Welcome and introduction Mr Paul Banaszkiewicz Consultant Orthopaedic Lower Limb Arthroplasty Surgeon, QEH, Gateshead.
13.00 Shoulder Mr.Muthu Jeyam Consultant Orthopaedic Upper Limb Surgeon, Hope Hospital, Salford.
14.00 Elbow Mr. Asir Aster Consultant Orthopaedic Upper Limb Surgeon, Hope Hospital, Salford.
15.00 Coffee
15.30 Hands 1 Mr. John Harrison Consultant Orthopaedic Hand & Upper Limb Surgeon, QEH, Gateshead.
16.30 Hands 2 Miss Sarah Klenka Consultant Hand Surgeon,Sunderland Royal Infirmary.
18.00 Pub quiz The Five Swans Pub 14 St Mary’s Place Anish Kadakia &Kailash DevaliaSenior Orthopaedic Trainees,QEH, Gateshead.

 Day 2 Lecture presentations 14th January 2014

08.00 Paediatrics 1 Mr. Sattar Alshryda Consultant Orthopaedic Paediatric Surgeon,Royal Manchester Children’s Hospital.
09.00 Paediatrics 2 Mr. Sattar Alshryda Consultant Orthopaedic Paediatric Surgeon,Royal Manchester Children’s Hospital.
10.00 Coffee
10.30 Paediatrics 3 Mr. Akinwande Adedapo Consultant Orthopaedic Paediatric Surgeon, James Cook University Hospital,Middlesbrough.
11.30 Paediatrics 4 Mr. Simon Barker Consultant Orthopaedic Paediatric Surgeon, Aberdeen Royal Children’s Hospital.
12.30 Lunch
13.30 Hip Arthroplasty Mr. Paul Banaszkiewicz Consultant Orthopaedic Lower Limb Arthroplasty Surgeon, QEH, Gateshead.
14.30 Revision Hip Mr. Jonathan Loughead Consultant Orthopaedic Lower Limb Arthroplasty Surgeon, QEH, Gateshead.
15.30 Coffee
16.00 Knee Arthroplasty Mr. Abdul Bari Consultant Orthopaedic Surgeon,Tameside Hospital Ashton under Lyne.
17.00 Soft tissue Knee Professor Deiary Kader Consultant Orthopaedic Knee Surgeon,QEH & Northumbria University.
18.00 Refreshments
18.30 Brachial Plexus and peripheral nerves Mr. Asir Aster Consultant Orthopaedic Upper Limb Surgeon, Hope Hospital, Salford.
20.00 Fire Side chat Mr. Abdul Bari Consultant Orthopaedic Surgeon,Tameside Hospital Ashton under Lyne.Mr. Asir   Orthopaedic Upper Limb Surgeon, Hope Hospital, Salford.

Day 3 Lecture presentations 15th January 2014

08.00 Stats for FRCS Dr. Mick Wilkinson Senior Lecturer in Research Methods and Statistics, Northumbria University.
09.00 Biomechanics Mr. Nick Caplan Reader in Clinical Biomechanics,Northumbria University.
10.00 Coffee
10.30 Tumours Mr. Craig Gerrand Consultant Orthopaedic Tumour Surgeon,Freeman Hospital, Newcastle.
12.00 Radiology workshop  Dr Mike Newby Consultant Radiologist,QEH, Gateshead.
13.00 Lunch
14.00 Applied anatomy and Surgical Approaches 1 Lower limb Mr. Jonathan Loughead Consultant Orthopaedic Lower Limb Arthroplasty Surgeon, QEH, Gateshead
15.00 Applied anatomy and Surgical Approaches 2 Upper Limb Mr Yusef Michla Consultant Upper Limb Surgeon, Surgeon Sunderland Royal Infirmary.
16.00 Coffee
16.30 Childrens Fractures Mr. Sattar Alshryda Consultant Orthopaedic Paediatric Surgeon,Royal Manchester Children’s Hospital.
17.30 Foot & Ankle Mr. Rajesh Kakwani Consultant Foot and Ankle Surgeon,Northumbria NHS trust.
20.00 Course Dinner Akbar’s Indian Restaurant, NewcastleUnit 1 City Quadrant, Westmorland Rd.

Day 4 Lecture presentations 16th January 2014

08.00 Trauma 1 Mr. Narayan Badri Consultant Orthopaedic Trauma Surgeon,Royal Liverpool University Hospital.
09.00 Trauma 2 Professor Arkan S. Sayed-Noor Orthopaedic Surgeon, Sundsvall Teaching Hospital, Sweden.
10.00 Coffee
10.30 Deformity Correction/Non unions Mr. Narayan Badri Consultant Orthopaedic Trauma Surgeon,Royal Liverpool University Hospital.
11.30 Spine 1 Mr. Pal Lakshmanan Consultant Orthopaedic Spine Surgeon,Sunderland Royal Hospital.
12.30 Spine 2 Mr. Alex Baker Consultant Orthopaedic Spine SurgeonLancashire Teaching Hospitals NHS Trust, Royal Preston Hospital, Preston.
13.30 Lunch
14.30 Basic science 1 Professor Andrew Sprowson Consultant Orthopaedic Surgeon,University Hospital Coventry and Warwickshire NHS trust
15.30 Basic Science 2 Mr. Charalambos P.Charalambous Consultant Orthopaedic Surgeon,Victoria Hospital, Blackpool.
16.30 Coffee
17.00 Basic Science 3 Mr. Fazal Ali Consultant Orthopaedic surgeon, Chesterfield Royal Hospital.
18.00 Basic Science 4 Professor Andrew Sprowson Consultant Orthopaedic Surgeon,University Hospital Coventry and Warwickshire NHS Trust.
19.00 Coffee
19.30 Passing the FRCS Mr. Paul Banaszkiewicz Consultant Orthopaedic Surgeon, QEH, Gateshead

Day 5 Viva Course for the FRCS (Tr&Orth) 17th January 2014

The Viva Course for FRCS (Orth) will be based on the book Postgraduate Orthopaedics. Viva guide to the FRCS (Tr&Orth) exam.

Key authors involved in writing this book will present important topics from their relevant chapters to candidates in the viva setting. This means the faculty will be highly skilled in providing you with the best possible learning opportunities and environment. ?The Postgraduate Orthopaedics Viva course is designed to cover the key topics that will be examined in the FRCS (Tr & Orth) examinations and the format will be based on the viva examination blueprint. ?The marking system will closely follow that of the FRCS (TR&Orth) exam.

There will be small groups (with no more than 2 people in each viva group) and candidates will rotate through 12 full-length FRCS (Tr&Orth) vivas covering:

• Trauma

• Basic Science

• Adult elective orthopaedics and spine

• Hands

• Paediatrics

There will be 2 topics from each of the above and 2 additional ad hoc viva stations. Topics examined will be specifically orientated as to the most likely subjects that are regularly asked in the real exam setting. To make the course effective, the numbers of places are limited. ?In addition we offer you the opportunity to video part of your viva session and offer feedback on your performance with suggestions for improvement.

07.45 Registration
07.55-8.00 Welcome from Course Director Mr. Paul Banaszkiewicz,
08.00-8.45 Viva Video Mr. Stan Jones and Mr. Fazal Ali
08.45-10.15 Viva Practice I3 Stations 30 minutes each
10.15-10.30 Coffee  
10.30-12.30 Viva practice II4 Stations 30 minutes each
12.30-13.30 Lunch
13.30-15.30 Viva Practice III4 stations 30 minutes each
15.30-15.50 Coffee
15.50-16.20 Viva Practice IV /Discussion1 station 30 minutes
16.20-16.30 Feedback and Closing session   


Day 6:Advanced Clinical Examination Course 18th January 2014

The advanced clinical examination Course will be in the form of a mock clinical examination. This will involve real patients and with real clinical signs. No actors!

There will be six 15-minute lectures at the beginning of the day to set the scene.  The format will involve a mixture of short and intermediate cases very much in keeping with the arrangement in the real exam. ?There will be a course book handout to candidates summarizing important aspects of the specific examination technique for a particular joint.

There will be 11 groups of 3 candidates.

There will be 16 stations in total. There will be 8 short case stations (4 upper limb and 4 lower limb stations) 6 Intermediate case stations (3 upper limb and 3 lower limb stations), 1 Spine short case station and one paeds video station.

Each station will last 15 minutes. With the short case station each group will examine 3 short cases in the 15 minutes (1 case per candidate, other 2 candidates observing).

With the Intermediate case station it is 15 minutes per station. This consists of 5 minutes history, 5 minutes clinical exam and 5 minutes for discussion. Candidates will rotate in turn between each different part of the Intermediate case format.

To make the course effective, the numbers of places have been limited. ?The examination will take place at the North East Surgery Centre, Queen Elizabeth Hospital, Sheriff Hill Gateshead, UK.

07.45 am Registration
07.55-8.00 Welcome by Course Director Mr. Paul BanaszkiewiczConsultant Orthopaedic Surgeon
08.00-8.15 Examination of the Hip Mr. Paul Banaszkiewicz
08.15-8.30 Examination of the Knee Professor Deiary Kader Consultant Orthopaedic Surgeon
8.30-8.45 Examination of the Foot and Ankle Mr. Stan Jones,Consultant Orthopaedic surgeon
8.45-9.00 Examination of the Spine Mr. Alex Baker,Consultant Orthopaedic Surgeon
9.00-9.15 Examination of the Shoulder/Elbow Mr. Asir Aster,Consultant Orthopaedic Surgeon
9.15-9.30 Examination of the hands Mr. John Harrison,Consultant Orthopaedic Surgeon
9.30-10.00 Coffee  
10.00-13.00 Clinical Examination 19 stations
13.00-14.00 Lunch
14.00-17.00 Clinical Examination 29 stations
17.00-17.10 Feedback and Closing session


Chapter 33 Famous names in orthopaedics

Famous names in orthopaedics

When the first edition of Postgraduate orthopaedics was being written the original idea was to include a small section on famous names in surgery. The old style viva meant that old school type examiners could ask you about a famous name in orthopaedics/surgery during a viva question. A candidate would score brownie points if they knew something about that particular famous name.

Space constraints meant we had to drop this section.We asked a number of trainees if this idea should be resurrected for the second edition.The general consensus was not to include the section as it was not essential for the exam.Some candiates were a bit more forthright believing it to be outdated and not relevant.

With today’s rigid exam format it is unlikely an examiner will ask you about a famous name in orthopaedic surgery.However we found a home for this section on the additional material section of the website

Adamkiewicz, Albert [1850-1921]
Professor of Pathology at the University of Krawkow and later in Vienna.
Arterial supply of the spinal cord

Adams, William [1810-1900]
Eminent London orthopaedic surgeon of the mid-Victorian era.
His book, Club-Foot: it’s Causes, Pathology and Treatment, of 1866,received the Jacksonian Prize of the Royal College of Surgeons.

Albert, Eduard [1841-1900]
Albert was born in Bohemia and studied in Vienna. He is best known for producing “artificial ankyloses” in paralysed limbs and wrote a paper on this in 1881. Albert performed tarsal and shoulder arthrodesis for paralysis and recurrent dislocation, and was the first to use the term “arthrodesis”. Albert also described synovectomy, the transplantation of nerves, sciatic scoliosis and Achilles Bursitis.

Andry Nicholas [1658-1759]
Professor of Medicine at the University of Paris.
In 1741, at the age of 81, he published a famous book called “Orthopaedia: or the Art of Correcting and Preventing Deformities in Children. By such means that may easily be put into practice by parents themselves and all such as are employed in Educating Children”. In this book, Andry presents the word Orthopaedic, which derives from the Greek words “straight” and “child”.

Andry was interested in postural defects and this has been reflected by his famous illustration, which is known “The tree of Andry”. Andry believed that skeletal deformities were due to faults of posture and shortness of muscles. Some regard Andry as the Father of Orthopaedics, by many strongly disagree, believing that his work was un-scientific and that his only contribution was the use of the word Orthopaedics 

Baker, William [1838-1896]
A surgeon at St Bartholomew’s hospital London, U.K.He described Baker’s cyst. A popliteal swelling which usually occurs in patients over 40 years of age.

Baer, William Stevenson [1872-1931]
Baltimore orthopaedic surgeon who suggested treatment of osteomylitis with maggots in 1931.He also devised a method [Baer method] of using chromatosed pigs bladder as an interpositional material in the treatment of hip osteoarthritis

Bankart, Blundell [1898-1951]
Bankart was the first registrar of the Royal National Orthopaedic Hospital London, England and remained there and at the Middlesex Hospital all his life.

Barton John Rhea (1794-1871)
Barton was born in Lancaster, Pennsylvania, U.S.A. He studied at the Pennsylvania Hospital and later worked for Physick (the father of American Surgery) who in turn was a student of Hunter’s. It was said that Barton was ambidextrous and that once he had positioned himself for an operation, he did not move about. In 1826, he performed a subtrochanteric osteotomy of the femur for a severe flexion-adduction deformity of the hip in a 21 year old male sailor following a fracture. The operation took took 7 minutes . He encouraged early movement of the hip from three weeks post operatively and the patient ended up with a painless pseudoarthrosis at 4 months and was able to walk with a useful range of movement.
Barton is best known for his innovative corrective osteotomies for ankylosed joints. In 1834, Barton wired a fractured patella. In 1835, he described “Barton’s fracture” a wrist injury with subluxation in association with a marginal fracture of the articular surface of the radius.

Bennett, Edward [1837-1907]
Professor of surgery, Trinity College, Dublin, Republic of Ireland.He described Bennett’s fracture [fracture-dislocation of the first metacarpophalangeal joint].
Bennett is said to have introduced antisepsis to Dublin and to have performed many osteotomies for rickets. He became President of the Royal College of Surgeons of Ireland

Bigelow, Henry Jacob [1818-1890]
Professor of Surgery at Harvard University from 1849 to 1882.
He described the importance of the Y shaped ligament at the front of the hip in a 1869 book on hip dislocation and was awarded by having his name attached to it.

Brodie, Sir Benjamin Collins [1783-1862]
Famous surgeon at St. George’s Hospital, London and a friend of the Thomas family (that of Hugh Owen Thomas). He first published his book, “On the Diseases of Joints” in 1819, which proved to be a popular reference for many years. In 1832, he described the chronic bone abscess that has been named after him. The patient was a man of 24 who had recurring symptoms in the lower extremity of his right tibia. On examination, Brodie found a pus filled cavity, for which he believed that amputation could be avoided by trephination of that cavity. He recognised the association of arthritis with gonorrhoea and that all children’s hip disorders were associated with infection. He also described the Trendelenburg test for saphinofemoral incompetence in varicose veins.
He was chosen to be the first president of the general medical council…In 1843; he introduced the Fellowship examination of the Royal College of Surgeons in order to improve the education and standing of surgeons.

Brown-Sequard, Charles E [1818-1894]
Professor of Medicine at Harvard, Massachusetts, USA and Paris France.He described the Brown Sequard syndrome in spinal cord hemisection leading to distal loss of motor power on the side of the lesion and loss of pain on the contralateral side.

Browne, Sir Dennis [1892-1967]
He was an Austrian born in 1892 and qualified in Sidney before coming to England with the Australian Armed Forces in the First World War.He became a consultant surgeon at the Hospital for Sick Children, Great Ormond Street, London. He described the Denis Browne splint for clubfoot and the Dennis Browne operation for hypospadias. He had a colourful personality, was 6 feet, 6 inches tall and was a renowned inventor of a bicycle seat, an inflatable corset and a new grip for a tennis racket with which he played at Wimbledon.

Calve Jacques [1875-1954]
Jacques Calve of Berck, France, Arthur T. Legg of Boston, U.S.A. and George Perthes of Tubingen, Germany, are all said to have described Perthes’ disease in 1910. Hence this disease is sometimes referred to as Calve-Legg-Perthes disease. With the help of radiography, Calve realised that some cases of “tuberculous” hips in children were actually cases of coxa plana. He saw that these rare cases of hip irritability had X-ray evidence of coxa vara, hypertrophy of the femoral head, increased density, fragmentation and flattening of the epiphysis. He noted that the disease was of short clinical duration, had good recovery, did not relapse and was not associated with adenopathy or abscess. Calve also described vertebral osteochondritis with collapse, which he attributed to vascular changes subsequent to trauma (although we now know that eosinophil granuloma is the common cause).

Charnley Sir John [1911-1982]
In 1950, the great Sir John Charnley of Manchester wrote a classic book on the non-operative approach to fractures, “The Closed Treatment of Common Fractures”. Charnley is however renown as the effective innovator of the total hip replacement. Among other principal contributions was the development of a self-curing acrylic cement to anchor both the femoral replacement and the acetabular cup. Charnley was also interested in joint friction, replacing the Teflon with the use of high-density polyethylene.

Codman, Ernest A. [1869-1940]
Surgeon Massachusetts General Hospital, Boston, USA.He described Codmans triangle, the radiological appearance seen in osteosarcoma. He also described Codmans method of shoulder joint examination.

Colles, Abraham [1773-1843]
Irish surgeon born in Kilkenny, Ireland, of humble origins. Trained at Dublin and then went to Edinburgh for post-graduate studies obtaining the degree of MD in 1797.
On returning to Dublin he became a leading surgeon and professor of anatomy and surgery at the Royal College of Surgeons Ireland
He was elected president of the Royal College of Surgeons of Ireland at the young age of 29
He was the first to tie the subclavian artery, but is best known for his description of Colles’ fracture, in 1814 (the same year as Monteggia).

Charcot, Jean-Martin [1825-1893]
Charcot was from Salpetriere in Paris and is known worldwide as the first professor of Neurology. He wrote a thesis distinguishing gout, rheumatoid arthritis and osteoarthritis. Charcot also first described the arthropathy that bears his name. Charcot’s joints. He was first to write about amyotrophic lateral sclerosis, intermittent claudication, disseminated sclerosis, intermittent hepatic fever and herpes zoster

De Morgan, Campbell [1811-1876]
Surgeon Middlesex Hospital London, UK.He described de Morgans spots, raspberry –red tiny capillary angiomas, which do not show the sign of emptying [they do not blanche when compressed]. Thet are of no clinical significance.

Moore, Austin T [1890-1963]
In 1942 Moore performed the first metallic hip replacement. He had replaced, for the first time, the entire upper portion of the femur with a vitallium prosthesis a foot long. It had a round head, loops for muscle attachments, and a lower end, which slipped over the cut shaft and bolted to it. Over the years, the design of the prosthesis and the procedure improved. Consequently, there is one type of prosthesis called the Austin-Moore, which is still used today.

De Quervain, Fritz [1868-1940]
Professor of surgery, Berne, Switzerland. In 1895, de Quervain described de Quervain’s disease [or stenosing tenosynovitis], which affects the common tendon sheath of abductor pollicis longus and extensor pollicis brevis.
Like Kocher, he studied thyroid disease describing acute de Quervians thyroiditis and is responsible for the introduction of iodised table salt.

Doppler, Christian J [1803-1853]
Austrian physicist who inverted Doppler ultrasonic blood velocity detector

Dupuytren, Baron Guillaume [1777-835]
Born in the hamlet of Le Puytren near Limoges in central France.The son of a poor lawyer; he was kidnapped as a young boy by a rich lady him on account of his good looks. Rescued, he was taken to Paris and educated by a rich cavalry officer. As a medical student he endured poverty, allegedly reading books by the light of oil prepared from dissected cadavers. He became surgeon-in-chief at the Hotel Dieu at the age of 36 and worked extremely hard starting at dawn or earlier each day.
He became a fashionable and expensive physician to the wealthy aristocracy.
Regarded as a tyrant who reined as an absolute monarch for over 20 years with a harsh and over bearing manner to both patients and colleagueship became known as “the first of surgeons and the least of men” He was described as an unpleasant person to met, yet his work was delightful to read
He was an accurate clinical observer with a great interest in pathology. Dupuytren’s name is most associated with the contracture of palmar fascia. He also described Dupuytrens fracture sustained by failing onto the feet; the talus being driven upwards with the ligaments supporting it producing inferior tibiotalar diastasis. He wrote on many other subjects, including congenital dislocation of the hip, the nature of callus formation, subungal exostosis and the Trendelenburg sign.
He was the first surgeon to excise the lower jaw in 1812 and the first to treat torticollis by subcutaneous section of the sternoclidomastoid in a 12-year-old girl in 1822.

Esmarch, Fredrich Von [1823-1908]
German military surgeon of Kiel.Wrote treatises on first aid treatment and in 1861 organised a scheme for the proper siting of field hospitals and bandaging stations in relation to the battle line. Esmarch’s bandage or tourniquet, a long rubber strip to produce a bloodless limb by compression was introduced in 1873.

Erb, Wilhelm Heinrich [1840-1921]
The son of a woodsman in the black forest

Ewing, James [1866-1943]
Professor of Oncology, Cornell University Medical College, New York, USA.He described Ewing’s sarcoma of the long bones in males.

Galeazzi, Riccardo [1866-1952]
Director of the Milan Istituto dei Rachitici for 35 years building up the unit into a famed European centre of excellence. Well known for his enormous experience with congenital dislocation of the hip and for his work with structural scoliosis.
In 1934,he complemented the description by another Milanese, Monteggia, of his eponymous forearm fracture by reporting on ulnar shaft fractures accompanied by disruption of the inferior radio-ulnar joint, analogous to Montegia’s fracture but much more common.

Halstred, William Stewart [1852-1922]
Surgeon, John Hopkins Hospital, USA.Introduced the use of rubber gloves for the first time [used initially for protection of his theatre nurse, Caroline Hampton, who had contact rash with antiseptics; Halsted later married her]
He taught the modern doctrine that surgical safety lies in the avoidance of blood loss, meticulous care and gentle handling of tissues.
He was the pioneer of radical mastectomy and Halsteds repair of hernia [closure of external oblique posterior to the cord]. He invented the Halsteds needle holder and fine mosquito artery forceps.
He also discovered the local anaesthetic properties of cocaine and was the first surgeon to use regional anaesthetic. Unfortunately he became addicted to narcotic drugs up until he died.

Harrison, Edwin [1779-1849]
Physician, St Marylebone Infirmary, London, UK.He described Harrison’s sulcus or groove at the costochondral junction in the rachitic chest.

Heberden, William [1710-1801]
Heberden was born in London were he also built up a busy practice. He is known for initiating the Medical Transactions in 1766, but even more so for his description of Heberden’s nodes.

Henry, Arnold [1794-1962]
He entered Trinity College, Dublin and graduated M.B., B.Ch. in 1911.He became a Fellow of the Royal College of Surgeons of Ireland in 1914.In the early part of the 1914-1918 war he went to Serbia as a surgeon with the Serbian army. His wife, who was also a surgeon, accompanied him and acted as his assistant. When the country was over-run by the German Army in 1916 he managed to escape to England.The Serbian government later awarded him the Order of St.Sava for his distinguished services in the field. He later joined the French Army where he served as a surgeon from 1917-1919.He was honoured by the French government and made a Chevalier de la Legion d’Honneur. On his return from war service he went back to Dublin where he established himself as a highly respected surgeon. When he resigned to go to Cairo as Professor of Surgery in 1925 it was considered a great loss to Dublin.He wrote his book “Henry’s Extensile Exposure” on operative approaches for which he became very famous. He then worked at Hammersmith Hospital London before returning to Dublin, as Professor of Anatomy.He is also famous for his master knot seen during clubfoot surgery.

Hey, William [1736-1819]
William Hey was born in Pudsey near Leeds. At the age of 14 he was apprenticed to a surgeon and apothecary and nearly died of an overdose of opium whilst studying its effects. He was the founder of Surgery at Leeds and trained at St. George’s Hospital. Hey wrote a book on Surgery, which contained several chapters on Orthopaedics. Subacute Osteomyelitis of the tibia was described and he advocated deroofing of the lesion. In 1773, Hey banged his knee getting out of the bath, and many attribute his subsequent interest in the knee to this. He coned the phrase “internal derangement of the knee”, and described meniscal injuries. Hey described loose bodies and introduced tarso-metatarsal amputation.

Homans, John [1877-1954]
Professor of Clinical Surgery, Harvrd University, Boston, USAHe described Homans sign [passive dorsiflexion of the foot causes calf pain in deep venous thrombosis].

Horner, Johann F. [1831-1886]
Professor of Opthalmology, Zurich, Switzerland.He described Horner’s Syndrome [myosis, ptosis, enophthalmus and anhidrosis] in injury of the cervical sympathetic chain

Hunter, John [1728-1793]
Hunter worked on a Lowland farm until he was 20 years of age. Until he was 32, he was a pupil and house surgeon at St. George’s Hospital in London and also worked in his brother’s dissecting room in Covent Garden. In the Seven Years’ War, he served as a military surgeon. He set up a research centre in London’s Golden Square and taught and lectured at Leicester Square until angina eventually lead to his death. Hunter’s contribution was immense and even stemmed through the pupils he taught (e.g. Abernethy, Chessher, Jenner and Philip Syng Physick). Hunter himself was a pupil of Percival Pott. Although he received little formal education (unlike his brother William, an obstetrician in London) Hunter put the practice of surgery on a scientific foundation and laid the framework for the twentieth century developments. His saying “Don’t Think, try the experiment” has inspired generations of modern surgeons. Much of Hunter’s knowledge may be attributed to his military experience and his experiments on animals.

Jones Sir Robert [1855-1933]
Probably the most important figure at the turn of the century. Indeed many would argue that he was the greatest orthopaedic surgeon that the world had ever seen. It was said that when Jones operated, “Time stood still”. Jones was a nephew of the great Hugh Owen Thomas and became one of his apprentices in Liverpool. In 1896, Jones published the first report of the clinical use of an X-ray to locate a bullet in a wrist. He founded several associations and Orthopaedic hospitals. Jones wrote several important books such as “Injuries of Joints” in 1915 and “Notes on Military Orthopaedics” in 1917. His textbook “Orthopaedic Surgery” is said to be the first to have dealt systematically with the diagnosis and treatment of fresh fractures. In World War I, Jones headed the orthopaedic section of the British Forces. Jones was an advocate of tendon transplantation, bone grafting, and other conservative, restorative procedures

Kienbock ,Robert[1871-1953]
An Austrian radiologist who graduate from the University of Vienna.He developed the use of X-rays diagnostically and therapeutically with a particular interest in bone.He wrote about characteristic radiological changes seen in the lunate bone which he considered to be traumatic in origin. In 1910 he feel off his horse and fractured his skull,following which he became very quite,withdrawen and a severely depressed man.

Kirshner Martin [1879-1942]
Martin Kirschner was from Greifswald, Germany and was also known for his methods of fixation, in particular for the Kirschner or K-wire. He also performed the first successful pulmonary embolectomy

Kocher, Theodor [1841-1917]
Kocher was born in Berne and studied in Berlin, London, Paris and Vienna. In 1872, he became Professor of Clinical Surgery, University of Berne, Switzerland. Kocher had a great interest in anatomy and in 1870 he described his eponymous method of reducing a dislocated shoulder.
A pupil of Langenbeck and Billroth he developed the surgical technique of thyroidectomy and described Kochers collar incision and subcostal incision for biliary operation. In 1878 he drained a gall bladder at operation for the first time. His main interest was in thyroid disease performing over 2000 thyroidectomies He also decribed Kocher’s maneuvre in mobilisation of the second part of the duodenum. He also developed several surgical instruments
He received the Nobel Prize in 1909[the first time it was awarded to a surgeon].

Kuntsher, Gerhard [1900-1972]
Gerhard Kuntscher served in the German army during the Second World War and published his revolutionary procedure in the opening months of the war. His work was concerned with the intramedullary nailing of fractures of the shafts of long bones and his name is associated with the nail, the Kuntsher was prejudiced academically. He was never offered a chair.

Lane, Sir William Arbuthnot [1856-1938]
Lane was a Scot from Inverness who trained and later worked at Guy’s Hospital in London. Lane is known for his attempts at improving alignment of fractures by using internal fixation. He started off using silver wire, then he used steel screws and this was followed by the use of plates and screws. Lane was said to have been eccentric, regarding humans as machines and performed total colectomies as a cure for “auto-intoxication”. He also initiated the programmes of health education that are present today. Lane wrote columns in the newspapers, held public lectures and improved the distribution of fruit and vegetables.

Legg, Arthur T. [1874-1939]
Arthur T. Legg (1874-1939) of Boston, U.S.A. described Perthes’ disease in 1910. Legg had wide interests, but is best known for the eight papers that he published on coxa plana.

Little William John [1810-1894]
Little was educated at the Jesuit seminary at St. Omer. He himself had a paralytic clubfoot. The treatment in London was amputation, however, he found a cure in Germany by tenotomy. Little was a founder of the Royal Orthopaedic Hospital. He published a detail report, in 1862, of the then ill-understood group of deformed and partly retarded children and young adults. This type of spastic paralysis with paraplegia of the lower limbs was then called Little’s disease for many years.

Lister Joseph [1827-1912]
Professor of Surgery, Glasgow, Edinburgh and Kings College Hospital, London, UK.
Lister is known as the leader of modern aseptic surgery, applying the discoveries of Pasteur to surgery. He developed antiseptics that reduced postoperative wound infection .He first applied carbolic acid to a compound fracture in 1865. It was soon clear that his practices had a dramatic effect in reducing the incidence of abscesses, pyaemia, hospital gangrene, erysipelas and amputation mortality. Lister was made a baronet in 1883, and later in his life was thought to have trialed the application of the Penicillium mould directly to wounds.

Madelung,Otto [1846-1926]
Studied medicine in Bonn,Berlin and Tuingen.He worked in a mental hospital in Siegburg and then served in the Franco-Prussian war of 1871.When he was appointed Professor of Surgery at Strasbourg in 1894 he was the youngest member of the medical faculty.At the end of the First World War,he was kicked out by the French and put unde house arrest before moving to Gottingen.His discription of a wrist deformity was not original and was little more than that previously described by both Dupuytren and Smith.He was apparently an unforgiving individual and said every clinical lession must be prepared and conducted in such a way that every student who contemplates missing the class must feel that he would miss something important

Marie, Pierre [1853-1940]
Marie was born in Paris, he worked for Charcot and eventually succeeded him as Professor of Neurology at Salpetriere. Marie described peroneal muscular trophy (Charot-Marie-Tooth disease). He was the first to associate acromegaly with a pituitary tumour in 1886. In 1980, he described hypertrophic pulmonary osteoarthropathy. In 1898, he gave the first account of cranio-cleidal dystosis and noted the partial aplasia of the clavicles, the increased skull diameter, the disordered dentition and the failure of ossification at the fontanelles. Also in 1898, he published a classic paper on ankylosing spondylitis, which he refereed to as “spondylosis rhizomelique”. Marie believed that poliomyelitis was infectious

Marjolin [1780-1850]
Surgeon, Paris, France.He described Marjolins carcinomatous ulcer in burn scars.

Mathysen, Antonius [1805-1878]
Mathysen was a Dutch military surgeon who in 1851 invented the plaster of Paris (POP) bandage that was to become so important to orthopaedic practice. To this day, a POP cast is the mainstay of fracture immobilisation

Monteggia, Giovanni B. [1762-1815]
Monteggia was born at Lake Maggiore and was a Milanese pathologist who acquired syphilis by cutting himself at autopsy. He became a surgeon and Professor of Surgery at Milan, Italy.
He is particularly remembered for his description in 1814 of the fracture that bears his name, Monteggia’s fracture [fracture of the ulna with dislocation of the upper radioulnar joint].

McMurray, Thomas Porter [1888-1949]
In the chain of great surgeons that followed Hugh Owen Thomas, came Thomas Porter McMurray who worked for Robert Jones. McMurray was born in Belfast, but worked in Liverpool. His operative dexterity was renown, for he could remove an entire meniscus in five minutes and disarticulate a hip in ten minutes! In 1928, McMurray published a paper on internal derangements of the knee. Here he introduced his sign for a torn meniscus, McMurray’s sign. An operation was also named after him as McMurray was the first to perform a displacement osteotomy for un-united fractures of the femoral neck and arthrosis of the hip.

Ollier, Louis Xavier Edouard Leopold [1830-1900]
Ollier was born in Vans in Ardeche and studied at Lyons and ontpellier. Ollier, like Macewen, performed pioneering bone grafts. Although both were successful, their methods and the theory behind them were in fierce opposition. In 1877, Ollier suggested that bone growth might be inhibited in order to correct certain deformities by resecting the epiphyeal plate. In 1899, Ollier first described dyschondroplasia or “Ollier’s Disease”. Ollier researched bone growth to an enormous extent and believed that it might be possible one day to treat patients by stimulating their cartilage to ossify.

Paget, Sir James [1814-1899]
He was born in Great Yarmouth, England, the son of a brewer and ship owner. After an apprenticeship to a local surgeon he went to St. Bartholomew’s Hospital in London as a student, where he remained for the rest of his career. It was in 1877 that Paget gave the first description of what he called “osteitis deformans”, but what is now commonly called Paget’s disease. He noted the increased incidence of osteosarcoma, the increasing head size and deformities. Paget was also a remarkable lecturer with a great interest in bone pathology. His name is also associated with Paget’s disease of the penis and Paget’s disease of the nipple.
He became curator of the Anatomy Museum in the Royal College of Surgeons of England and then without any previous surgical posts, was elected Professor of Surgery at the Royal Colleage of Surgeons and a Consultant Surgeon.
He had a huge private practice and is said to have earned 10,000 pounds a year from it.
He almost died from sepsis following a cut sustained accidentally when he carried out a post-mortem.

Pancoast, Henry K [1875-1939]
Professor of Roentgenology, University of Pennylvania, Philadelphia, USA.He described Pancoasts syndrome due to apical pulmonary cancer, swollen congested face due to pressure on the superior vena cava, Horners syndrome [pressure on the sympathetic chain] and shooting pains down the arm [pressure on the brachial plexus]. The first rib is usually eroded on Chest radiograph

Pare, Ambroise [1510-1590]
He was born in France in 1510,the son of a valet and barber. Regarded as the most famous surgical figure of the l6th century and “the father of French Surgery”. In 1532 he became an apprentice to a Parisian barber-surgeon, then worked for four years at Hotel Dieu in Paris. In 1541, he became a master barber-surgeon and did some work as an army surgeon. In 1564, he published a monumental work on Surgery, the “Dix Livres de la Chirurgie”. The first part contained Anatomy and Physiology and the second, Surgery. In this, many surgical techniques were described, one of the most significant being the use of ligature for large vessels in amputations. He also used a tourniquet in his amputations, to hold the muscles retracted with the skin, prohibit the flux of blood and to dull the senses. He designed a wide variety of forceps, instruments and braces of all kinds. With the help of armourers, he made a variety of artificial limbs from iron. The majority were cosmetic, although Pare did design a scoliosis corset and a clubfoot boot.
He developed an ointment for the treatment of gunshot wounds as a non-operative alternative to cauterisation with boiling oil. He was a surgeon to four French Kings.He was one of the few Huguenots spared at the massacre of St.Bartholomew.
In 1561,he sustained a compound fracture of his own tibia. He told his surgeon to put his foot in a straight line and if the wound wasn’t big enough to increase it so as to reduce the fracture and take out any fragments of blood and expressed blood

Perthes, George [1869-1927]
Professor of Surgery, Tubingen Germany.He described Perthes disease. He also described Perthes test [walking with a tourniquet placed below the saphenous opening to diagnose deep venous thrombosis in cases of pain and venous congestion of the leg.

Peyronie, Francois de La [1678-1747]
Surgeon to Louis XV and founder of the Royal Academy of Surgery, Paris, and France.Mainly due to him, Paris became a great surgical centre in the eighteenth century. He described Peyronies disease of the penis [a localised painless induration of one or both corpora cavernosa leading to lateral curvature of the erect penis]

Pott, Percival [1714-1788]
Surgeon, St Bartholomews Hospital London from were he received the diploma of the Barber-Surgeons’, Company in 1763. He is best known for the ankle fracture that bears his name “Pott’s fracture”. In 1756, he received a fracture of his own. It was an oblique compound fracture of the lower third of the tibia, which was acquired after falling from his horse. He refused to be moved until he had purchased a door to be carried on, as he believed that the jolting of a carriage would have exacerbated the injury. Immediate amputation was usually conducted on such injuries, but at the last moment amputation was stopped and the limb was saved. Pott’s most famous work is on the paraplegia of spinal tuberculosis. He also described Potts Puffy Tumour, a localised oedema over osteomylitis of the skull.

Raynauld, Maurice [1834-1881]
Physician, Hospital Lariboisiere, Paris, France.He described Raynauld’s disease in females in which arterial spasm occurs in cold weather with colour changes from white to blue to red.

Roentgen, Wilhelm C .Von [1845-1923]
Although Rontgen was a professor of Physics at Wurzburg, his discovery of X-rays (Rontgen rays) and their use has provided an enormous contribution to Orthopaedics and is still of great value to Orthopaedic practice. The first radiography that Rontgen took was of his wife’s hand on the 22nd of December 1895. This was allegedly her Christmas present. Rontgen received the Nobel Prize for his discovery in 1901.

Schmorl,George Christian[1861-1926]
He became Professor of Pathology in Dresden.He had a photographic memory and is best known for his work on bone.He attracted students from all over the world and always examined the spine at autopsy ..He died of septicaemia after scratching his finger on a band saw whilst ctting a specimen.He described intra-vertebral disc protrusions

Smith-Petersen, Marius [1886-1953]
He was born in Grimstead, Norway but left for the United States when he was 17 and graduated from Harvard Medical School in 1914.He joined the orthopaedic teaching staff in Harvard in 1920 and was Clinical Professor and Chief of the Orthopaedic Service at the Massachusetts General Hospital until 1946.As a resident he devised his own anterior approach to the hip joint to reduce blood loss. He pioneered cup arthroplasty, osteotomy of the spine for ankylosing spondylitis and a new device to fix femoral neck fractures. He never retired.

Smith, Robert William [1807-1873]
Smith was born in Dublin; he studied and worked there. He became Professor of Surgery at Trinity College in Dublin. Smith founded the Dublin Pathological Society with Colles, Graves, Corrigan and Stokes. In 1847, Smith wrote a classic book called “A Treatise on Fractures in the Vicinity of Joints, and on certain forms of Accidents and Congenital Dislocations.” Here he describes the eponymous “Smith’s fracture”, and Madelung’s deformity before Madelung described it. In 1849, he published “A Treatise on the Pathology, Diagnosis and Treatment of Neuroma”. This book was said to be so large that it was larger than an ordinary sized dinning-room table when opened up. Smith wrote on neurofibromatosis in great detail, much before von Recklinghausen did.

Still,Sir George[1868-1941]
He was born in Hollway ,London,the son of a Surveyor of Customs.Aftertaking a First in Classics at Cambridge he trained at Guys Hospital before going onto Great Ormond Street.He was one of Britains first full time paediatricians.He is most famous piece of work resulted in 1896 in a Cambridge MD for a thesis entitled “A special form of joint disease meet in children”.
He was an extremely good looking bachelor who lived with his mother until she died,taking her to church every unday.He was one of the most popularpaediatricians in London so that almost every sick child of well to do parents had seen him at one time or another.

Struthers, Sir John [1823-1899]
Professor of Anatomy in Aberdeen from 1863-1889.Fibrous band of the supratrochlear spur of the humerus

Sydneham, Thomas [1624-1689]
Sydneham is likened to Hippocrates because his writings cover a large field and are characterised by good observation. Likewise, he is also known as “the father of English medicine”. He was born at Winford Eagle, and studied at Oxford and Montpellier. He himself suffered from gout and wrote an excellent description of the disease, detailing the attack, the changes in urine and the link with renal stones. He described acute rheumatism, chorea, and the articular manifestations of scurvy and dysentery

Syme, James [1799-1870]
Syme was born in Edinburgh. As a student at Edinburgh University he found a way of dissolving rubber. Syme opened a school of Anatomy and later opened a very successful private clinic. In 1833, he became Professor of Surgery in Edinburgh and held that position until his death, (he had actually made an agreement with his predecessor to pay him a pension if he resigned). Syme is known for introducing conservative alternatives to the major amputations that were carried out at the time. In 1831, he released a booklet, which detailed cases where joint excision could be used instead of amputation for grossly diseased joint, as in tuberculosis, and injured joints. In 1842, Syme described an amputation at the ankle. This amputation bears his name, as it replaced a portion of below knee amputations, which were ordinary practice at that time.

Thomas, Hugh Owen [1834-1891]
Hugh Owen Thomas is regarded as “the father of British Orthopaedics”. He was the eldest of five sons born to a family of well-known bonesetter at that time. All studied Medicine.Thomas was a thin and nervous child who was somewhat delicate. His peculiar temperament in adulthood led many to ignore him and his immense contributions to Orthopaedic Surgery during his lifetime. Hugh Owen Thomas could not even work with his father and never held a hospital appointment. He treated all his patients at his home. His practice was so busy that he started his rounds at five or six in the morning and never left his home for other than professional purposes. Thomas would designate Sunday as his “free day” and hundreds of patients from the country would surround his house in order to be treated. The people of Liverpool knew Thomas as a short and quick man. A man who always wore a black coat buttoned up to the neck and a sailors cap pulled over a damaged eye.A cigarette was seen constantly in his mouth.
He believed in enforced,prolonged and uninterrupted rest for the treatment of tuberculous joints.Thomas developed  a great number of splints in order to achieve this.His long splint for the knee was adapted for treatment of femoral fractures during the First World War and drastically reduced the mortality rate of open fractures from 60% to 25%.He was the first to demonstrate concealed flexion of the hip joint and a way of unmasking this by performing the Thomas Test”

Tinel, Jules [1879-1952]
Jules Tinel, of Rouen and Paris, was a neurologist in the First World War and first described “Tinel’s sign” in 1917. This related to nerve injuries, and on percussion of the nerve below the site of nerve injury, “formication” was elicited if nerve fibres were degenerating. If this was absent, there was a bad prognosis.

Trendelenburg, Fredrich [1844-1924]
Trendelenburg was born in Berlin where his father was a professor of philosophy. His mother was a teather and he was educated at home by his parents. He did his national service as a military surgeon before returning to Berlin where he trained under Langenbeck.He spent some time as a surgeon in Berlin before being appointed at Professor at Rostock in Germany.He later succeeded to the chairs of surgery in Bonn and Leipzig.
In 1895 he described observations on the gait of congenitally dislocated hip patients. Later he went on to describe the pelvic inclination on single leg weight bearing, which became known as the Trendeleburg sign. He also described Trendeleburg’s position [head down and legs up], Trendelenburgs test [for saphenofemoral imcompetence], Trendelenburgs operation [midthigh high ligation of the great saphenous vein and the Trendelenburg gait which occurs in bilateral congenital dislocation of the hips

Venel, Jean-Andre [1740-1791]
Jean-Andre Venel was a Genevese physician who studied dissection at Montpellier at the age of 39, and in 1780, established the first orthopaedic institute in the world at Orbe, in Canton Waadt. This was the first true hospital that dealt specifically with the treatment for crippled children’s skeletal deformities. Venel recorded and published all his methods and for this was known as the first true orthopaedist. He is also regarded as the father of orthopaedics, as his institute acted as a model for hospitals throughout Europe. Venel stressed the importance of sunlight and made various braces and appliances at the workshops within the institute.

Virchow, Rudolf [1821-1902]
German physiologist and anatomist of Wurzburg and Berlin.The founder of the science of cellular pathology.
He designed the sewage system of Berlin’organised the Prussian ambulance corps in 1870 and served as a member of the German Reichstag.
He founded Virchow’s archives [medical journal] in 1847.Well known for Virchow’s triad of thrombosis [endothelial injury, viscosity change and platelet aggregation] and for Virchow’s supraclavicular lymph nodes, enlargement of which produces Troisiers sign in advanced gastric carcinoma

Volkmann, Richard Von [1830-1889]
Born in Leipzig ,the son of a German Professor of Physiology at Halle.He became Professor of Surgery at Halle in 1867,was a Consulting surgeon in the Franco Prussian war and one of Lister’s major champions.He was mainly interested in the surgery of bones and joints, but also claimed to be the first surgeon to excise the rectum for cancer in 1878. In 1881, Volkmann published his famous paper on ischaemic contractures following brachial artery trauma in supracondylar fractures.He described the claw hand that resulted from muscle death and fibrosis
It is interesting to note that Volkmann wrote popular poems and fairy stories for his children during the Franco-Prussian war of 1870-1871. and also founded a surgical journal.

Von Recklinghausen, Friedrich D. [1833-1910]
Professor of Pathology, Stasburg, Germany.He was the first to point to the blood-borne skeletal metastases in cancer. He described the diffuse neurofiromatosis with cutaneous pigmentation and multiple tumours [Von Reckinghausens disease]. He also described bone cyst formation in hyperthyroidism.

Wallace, Alexander B [1906-1974]
Plastic surgeon, Royal Hospital for Sick Children, Edinburgh, and Scotland.He introduced the Rule of Nines in burns.

Willis, Thomas [1621-1675]
Physician, Oxford, UK. He described the circle of Willis at the base of the brain, first noticed the sweet taste of diabetic urine and described myasthenia gravis.

Chapter 1 How to pass the FRCS (Tr&Orth) while avoiding divorce

How to pass the FRCS (Tr&Orth) while avoiding divorce

William Thomas and Koye Odutola

BON Issue 49 Autumn 2011

This is an informative overview of the FRCS (Tr &Orth) exam from 2 trainees who have recently passed the exam. There is considerable emphasis of the disruption the exam causes to family life and the need to have the family on board during the exam. Various all round revision tactics are discussed. The new computer based exam is touched on and the different skills required to pass section 1 and section 2 analyzed.

It is an extremely well written and thought out article that offers that bit extra guidance and detail than the usual exam advice stuff you may come across.

I can’t really find any fault with the article and congratulations to the authors on a very well written piece of work.


Chapter 1 The Mechanical Properties of the FRCS (Tr & Orth) exam

The Mechanical Properties of the FRCS (Tr & Orth) exam

The FRCS exam is, to many trainees, an evil, distant great aunt, easily ignored and kept at arms-length for many years. Unfortunately, at some point we must all confront her if we wish to complete our training. This article will give a brief overview of how to approach one of the biggest hurdles in your professional career.

During the course of the exam, you will come to know the mechanical properties of many different materials, to the extent that you dream of them at night. May I suggest that you consider the effect that the exam has upon your own personal stress/strain curve (with strain proportional to lack of knowledge) and how this may adversely affect your preparation and performance. Poor knowledge will result in increased stress, high levels of stress makes knowledge acquisition difficult, resulting in lack of knowledge.

Applying too much stress will lead to you rapidly reaching your yield strength, moving into the plastic region and ultimately to potential fracture and failure. Managing the application of stresses is vital to ensure ideal performance and success. The development of some visco-elastic properties is possible but dependent on ideal preparation.

When asked about how long to prepare for the exam, trainees and consultants who have taken and passed it will give varying answers. Some will look smug and tell you they managed it with 3 weeks revision with a few late nights and gallons of coffee. Others will affect a haunted look and tell you it took them 4 years of preparation, reading Miller “356 times”.

IGNORE what everyone says. The amount of preparation you require is very personal and dependent on how much you already know and how you assimilate and retain information.

Before embarking on the exam, you should have a pretty good idea of how you learn and therefore how long you will need. Learning throughout the course of training with regular reading, attending teaching and courses will give you an excellent base to work from.

In the months before you start revising, finish off any projects and papers and ensure that everyone is aware of the immanent exam – you need to rid yourself of any distractions so that you can focus fully on the exam.

At the start of your preparation, if you do not know the standard you are at, take the UKITE exams and online MCQs to see how you score. This will help guide you in the amount of work required and your areas of weakness.

Revision initially follows the toe region of the curve with a slow building up of time, commitment and work intensity. Because of this, you must give yourself enough time to prepare or at a point nearer the exam, you will increase your stress hugely. If you manage your time correctly, you may even exhibit “stress-relaxation” as the exam nears because you are so confident with the time and preparation that you have put in – do not let this completely take over or it may adversely affect your revision.

Devise a reading list and revision timetable and attempt to stick to it as much as possible. However, do not be too rigid and allow for breaks and time off. Proper time away from revision is very important. Your relationships with family and friends will suffer unless you commit to regular breaks and revision-free periods and it is worth scheduling these into your plan. If you work solidly without a break for too long, you will reach your fatigue limit and run the risk of failing.

Books and courses
There are a number of good books available, none of which are perfect but all offer different things. Practice MCQs and EMQs are available both as books and online. Whichever texts you choose, utilize modern technology and your time carefully – online MCQs can be used during bus journeys, text books read on trains and electronic texts read in between patients in clinic.

There are increasing numbers of FRCS courses – some didactic teaching whilst others offer viva and clinical examination practice. The key is identifying where your weaknesses lie and attending courses that will specifically target these. Book early as many are hugely over subscribed. Courses may reduce stress by increasing knowledge but ensure you select them according to your areas of weakness or you may feel you are wasting your time and money.

Study groups
The study group provides you not only with people to practice viva’s and examinations with but more importantly, a vital support network. Choose your group early and start with evenings of easy quizzing and presentations. When the exam gets nearer, the viva’s get more aggressive and realistic providing a yard-stick for your progression, motivation to keep working but also a group of people experiencing similar emotional turmoil to moan and whinge at!

Some groups prepare formal teaching sessions with powerpoint slides while others keep things very informal. However your group decides to progress, plan regular meetings, push each other but try not to fight! Team work will help to decrease stress by sharing the load, allowing a vent for your anger and frustrations and if planned well, your group will include people with other interests and areas of knowledge, aiding your preparation.

This is now taken in driving test centres around the country. Arrive early to familiarize yourself with the building (and get a locker!). Some centres segregate FRCS candidates from driving test candidates but others do not so take ear plugs if you are easily distracted. Most people come out feeling they have performed poorly but the exam is highly scrutinized and moderated by the examiners, making it very fair.

The Viva and Clinical
After sitting the written exam, take a week to relax and do no work. Once you get your results, you will be refreshed for the final push. Change your approach, increasing study group meetings and attending clinics to practice examination and viva skills in front of Consultants and senior trainees. Put yourself forward to be quizzed and tested by colleagues – practicing in a similar stressful environment to the exam is vital to help you feel calm during the real thing.

Book yourself into a quiet but comfortable hotel near to the exam location. Try to avoid a hotel where a large crowd of candidates might stay – there can be nothing worse than sharing breakfast with others who look like they are on “death row”. Sleep prior to the exam is vital but very difficult – do whatever you can to ensure a few hours of rest.

Wear a suit and look the part – the examiners must feel they are with a colleague, not a junior. If one section of the exam goes badly (as it almost invariably will), take a deep breath, pause and stop digging yourself a hole. You can recover from one or two errors but do not compound an error by falling to pieces.

After the exam you will be surprised by the basic level of knowledge that you are tested on. It has a huge breadth but only when you are doing well are you pushed beyond what should be “every-day knowledge”.

The FRCS exam period is an extremely stressful time not only because of the effort required to pass but also the added pressures of family life and non-work commitments that most trainees will have accumulated in the years preceding it.

Preparation is the key not only to success but also reducing the stress of the exam. Bare in mind the stress/strain curve when planning your revision, work hard over an adequate time period but with regular breaks, do not cram and work in a team to increase knowledge and decrease stress.

Article originally published in Journal of British Orthopaedic Trainees Association 2013
Author Francois Tudor