FRCS Experience Chesterfield Feb 2015 – HC


Intermediate case

12 yr old girl with mother. GP letter just says b/l hip pain.

Difficult history, congenital hip deformity, multiple surgeries. Pt states “chromosomal bone disease?!”

Has problems with feet, knees, forearms.

Mum reports the legs were bent and the hip not in joint when born, she then had surgery.

Examination showed pes planus, hallux valgus, no knee creases with flexed left knee. Trendenburg –ve, Walking with a waddling gait.

Lying down I fumbled around with galeazzi and offered a tap measure but they moved me on. Hip movements were stiff and I didn’t even get to thomas’ test. Knee flexion was intact.


I said it sounded like pffd. The lack of creases on the knees looked like arthrogyposis but not with the range of movement.

Xrays showed dysplastic acetabulum and absent femoral heads

Asked about classification pffd – I said Aitken etc femoral head vs no head with or without socket. They asked about associations, talked about absent acl, hypoplastic lat condyle, fibula hemimelia

Asked about upper limb, I said lack of pronation/supination sounds like radioulnar synostosis. They asked what else –the bell rang.

1st CMCJ OA (B/L) and recent right wrist replacement.

Nice case, history of OA etc. Examination all the usual movements etc. some altered sensation over middle finger ?cause. APB intact and medial ok. Altered sensation over superficial radial nerve.

Discussion about xrays, treatment options, asked to describe sling and tendon interposition.

Short cases:

Hallux valgus, other side has had corrective osteotomy. Nothing complicated. Discussion on treatment options

Young girl with multiple scars over both legs. Fell on glass when 8 years old. Subsequent surgeries to treat the injury. I went for deep peroneal nerve, explained Tib ant loss. Then led to back of legs – sural nerve grafts – asked to quote a success rate (I guessed at 50% – examiner didn’t look impressed). Asked about tendon transfers in the foot. Failed miserably. Asked about principles of tendon transfer – managed to scrap a little back with that.

Walked with high stepping gait. Asked about management, I started talking about orthosis, bell rang. Not a great case

Man with “old knee injury” discuss. Weird gait, failing to extend knee – I said it looked like quads weakness, they asked about compensatory mechanisms. I muttered about bring centre of gravity over knee to compensate, they wanted something else.

They asked my differential I said old quads rupture. So they said fine examine the quads.

Sitting down I couldn’t palpate a patella. And the patient couldn’t straighten leg from bent position. I said the tendon was subluxed “how common is that”, not common. The examiner demonstrated the leg extends passively and then could be held by patient. I finally cottoned onto the laterally dislocated patella. Discussed treatment options then bell rang.

Upper limb:

Cubital valgus in a young child following previous elbow injury

Brachial plexus injury – C5 spared

Functional assessment in the hand of an elderly lady with multiple scars



40 year old i/c hip fracture, management options, timing etc

Supracondylar fracture in a child – pink pulseless, how to manage, when to operate. 8pm, child ate 1 hour ago. Evidence behind

Pipkin head fracture in 55 yr old with ipsilateral tibial fracture

Dislocated knee, external fixator application on a prone pt etc

Segmental ulnar fracture with radial shaft fracture and head dislocation, how to fix and order to fix

Distal humeral fracture – low comminuted, management plan


Club foot in newborn management and then late presentation, medial release

Child with scoliosis secondary to leg length discrepancy, discussion on LLD, Anterolateral tibial bowing, neurofibromatosis diagnostic criteria etc

SUFE usual questions, severe slip a few days old – discussed uglow and clark paper. Gift of a question!


Dissection of APB, discussion about recurrent motor branch, tendon transfers,

Flexor sheath infection, management

Radial nerve palsy, tendon transfers, how nerve conduction studies work, seddon and sunderland etc

Basic Science

Lag screw, diagram of a screw, discussion on cannulated screws, second moment area

Polyethylene acetabular component, wear, fatigue failure,

Foot prosection discussion on anatomy, tendon transfer, approaches

Tibia, medioanterior wear ?why – ACL intact, discussion on mechanical axis

Cross section tibia – anatomy, compartment release, pressure monitoring

Biomaterials, titanium vs stainless steel

Adult pathology

Humeral lesion, enchondroma, management, olliers/mafuccis, Ca risk etc.

AVN bilateral hips, ficat, management options, how to do a core decompression, type of hip replacement and why

Clinical picture of a erythematous ankle in a kid, short history etc. differientals, got to MRI which was a terrible picture showing osteomyelitis with subperiosteal abscess. Management options discussed. Common organisms in different age groups and appropriate antibiotics.

Told history of patient with back pain, asked a few questions, young man with stiffness, sounded like Ankylosing sponditlitis, HLA B27 xray showing spine with syndesmophytes. Absent SI joints, discussed new york classification. Treatment options, referral to rheum etc. Orthopaedic complications, problems with surgery anaesthetics etc. Draw an osteophyte vs a syndesmophyte! (my picture was embarrassingly poor)

Patient with sciatica, MRI, draw spine, where do roots go, which bits are compressed depending on disc types, MRI Sequestered disc L3/4. Treatment options conservative vs injections vs surgery

Prosection of a brain!!! Lots of little red dots, finally got to fat embolism in brain. Causes, symptoms, ways of reducing risk, pressurising cement. Risks of surgery. Management of post op surgical patient.