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SBAs for the FRCS (Tr&Orth)
Examination
A Companion to the Postgraduate
Orthopaedics Candidate’s Guide
Second Edition
Written by highly experienced clinicians and examiners, this thoroughly
revised and expanded second edition is an essential text for orthopaedic
trainees preparing for FRCS (Tr&Orth) examination. Highly illustrated and
containing over 1,000 single best answer questions (SBAs), it is a highquality, useful revision tool. Rather than prom oting simple recall like most
orthopaedic MCQ texts, SBAs encourage higher order thinking and
judgement which will support more comprehensive revision and
understanding for trainees.
This edition builds on key features from the first, containing new and
updated exam questions that cover the spectrum of the orthopaedic syllabus.
This includes difficult subject areas such as biomechanics, prosthetics/
orthotics, anatomy and statistics. The text also contains two new chapters
covering the imp act of ethics and diseases on orthopaedic surgery. Crucially,
this edition is tailored to post-pandemic examination and deals with the
more difficult esoteric ambiguous types of SBA questions that often appear
in the real test.
SBAs for the FRCS (Tr&Orth)
Examination
A Companion to the Postgraduate Orthopaedics
Candidate’s Guide
Second Edition
Edited by
Paul A. Banaszkiewicz
Consultant Orthopaedic Surgeon, Queen Elizabeth Hospital, Gateshead NHS Foundation Trust
Visiting Professor, Northumbria University, Newcastle-upon-Tyne
Trustee Council Member, British Orthopaedic Association (BOA)
Editor, Journal of Trauma and Orthopaedics
Chair, Education and Careers Committee, BOA
Kiran Singisetti
Consultant Orthopaedic Surgeon, Queen Elizabeth Hospital, Gateshead Health NHS Foundation
Trust
Shaftesbury Road, Cambridge CB2 8EA, United Kingdom
One Liberty Plaza, 20th Floor, New York, NY 10006, USA
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Cambridge University Press is part of Cambridge University Press & Assessment,
a department of the University of Cambridge.
We share the University ’s mission to contribute to society through the pursuit of
education, learning and research at the highest international levels of excellence.
www.cambridge.org
Information on this title: www.cambridge.org/9781009287920
DOI: 10.1017/9781009287883
First edition © Cambridge University Press 2021
Second edition © Cambridge University Press & Assessment 2025
This publication is in copyright. Subject to statutory exception and to the provisions
of relevant collective licensing agreements, no reproduction of any part may take
place without the written permission of Cambridge University Press & Assessment.
When citing this work, please include a reference to the DOI 10.1017/9781009287883
First published 2021
Reprinted 2022
Second edition 2025
Printed in the United Kingdom by TJ Books Limited, Padstow Cornwall
A catalogue record for this publication is available from the British Library.
A Cataloging-in-Publication data record for this book is available from the Library of Congress.
ISBN 978-1-009-28792-0 Paperback
Cambridge University Press & Assessment has no responsibility for the persistence
or accuracy of URLs for external or third-party internet websites referred to in this
publication and does not guarantee that any content on such websites is, or will
remain, accurate or appropriate.
..........................................................................................................................................
Every effort has been made in preparing this book to provide accurate and up-to-date information that is in accord with
accepted standards and practice at the time of publication. Although case histories are drawn from actual cases, every effort
has been made to disguise the identities of the individuals involved. Nevertheless, the authors, editors, and publishers can
make no warranties that the information contained herein is totally free from error, not least because clinical standards are
constantly changing through research and regulation. The authors, editors, and publishers therefore disclaim all liability for
direct or consequential damages resulting from the use of material contained in this book. Readers are strongly advised to pay
careful attention to information provided by the manufacturer of any drugs or equipment that they plan to use.
Contents
List of Contributors vii
Foreword ix
Preface xi
Acknowledgements xiii
Section 1 General Advice for the FRCS
(Tr&Orth) Oral Examination
1 Candidate Guidance for the Section 1 Written
SBA Paper 1
Hussein Noureddine and Matthew Brown
2 SBA Writing Process 9
Paul Banaszkiewicz
Section 2 Adult Elective Orthopaedics
and Spine
3 Hip I Structured SBA 29
Edward Holloway
4 Hip II Struc tured SBA 43
James Gill and Majeed Shakokani
5 Hip III Structured SBA 71
Nicholas Wei and Paul Banaszkiewicz
6 Knee I Structured SBA 108
Oliver Bailey and Pradyumna Raval
7 Knee II Structured SBA 137
David Deehan, Philip Dobson and Daniel
Hipps
8 Knee III Structured SBA 154
Kiran Singisetti
9 Foot and Ankle I Structured SBA 178
Gavin Heyes and Lyndon Mason
10 Foot and Ankle II Structured SBA 205
Andrea Nicolas and Simon Chambers
11 Spine I Structured SBA 222
Paul Rushton and Niall Eames
12 Spine II Structured SBA 257
Prasad Karpe
13 Shoulder/Elbow I Structured SBA 279
Razvan Taranu and Shantanu Shahane
14 Shoulder/Elbow II Structured SBA 293
Jonny Kent and Faizan Jabbar
Section 3 Trauma
15 Trauma I Structured SBA 313
Tim Brock and Rishi Dhir
16 Trauma II Structured SBA 346
Nayef Aslam-Pervez
17 Trauma III Structured SBA 365
Yusuf Omran Hasan
Section 4 Hand and Upper Limb/
Children’s Orthopaedics
18 Hand I Structured SBA 381
Emma Reay
19 Hand II Structured SBA 407
Matthew Brown and David Yeoh
20 Children’s Orthopaedics I Structured
SBA 443
Hussein Noureddine and Sattar Alshryda
21 Children’s Orthopaedics II Structured SBA 469
Rebecca Critchley and James Fernandes
22 Children’s Orthopaedics III Structured
SBA 495
Maire-Clare Killen and Ling Hong
v
Contents
Section 5 Applied Basic Sciences
23 Anatomy and Surgical Approaches Structured
SBA 513
Christopher George Ghazala
24 Structure and Function of Connective Tissue
Structured SBA 547
Paul Banaszkiewicz
25 Pathology I Structured SBA 566
Nicholas Wei and Adam Farrier
26 Pathology II Structured SBA 589
Rory Morrison and Rajesh Kakwani
27 Pathology III Structured SBA 611
Jonathan Lenihan and Alexander Durst
28 Orthopaedic Oncology Structured SBA 623
Heledd Havard, Walid A. Elnahal, Ossama
Al-Obaedi, Muthana Abdelhalim and Craig H.
Gerrand
29 Prosthetics and Orthotics Structured
SBA 647
Emerson Budhoo
30 Biomechanics Structured SBA 659
Edward Jeans and Richard Hutchinson
31 Evidence Management: Data Analysis and
Clinical Trials Structured SBA 682
Munier Hossain
32 Conditions Impacting on Orthopaedic Surgery
Structured SBA 701
Sheba Basheer
33 Ethics, Professional Behaviour and Leadership
Structured SBA 716
Hussam Elamin-Ahmed and Hussein
Noureddine
Index 736
vi
Contributors
Muthana Abdelhalim MBBS MRCS
King Hussein Cancer Foundation and Center,
Jordan
Ossama Al-Obaedi MBChB FRCS (Tr&Orth) PGCert
Med Ed
The Royal London Hospital, London
Sattar Alshryda MBChB MRCP (UK) MRCS SICOT
EBOT FRCS (Tr&Orth) MSc PhD
Al Jalila Children’s Specialty Hospital, Dubai
Nayef Aslam-Pervez MBChB FRCS (Tr&Orth) Dip
Med CAOS
Hull University Teaching Hospitals NHS Trust
Oliver Bailey MBChB BSc Hons MSc Sports Med
FRCS (Tr&Orth)
NHS Lanarkshire - Trauma and Acute Knee Service
Paul A. Banaszkiewicz FRCS (Glas) FRCS (Ed)
FRCS (Eng) FRCS (Tr&Orth) MClinEd FAcadMEd
FHEA
Queen Elizabeth Hospital Gateshead; Faculty of
Health and Life Sciences, Northumbria University
Sheba Basheer FRCS (Tr&Orth)
Sheffield Children’s NHS Foundation Trust
Tim Brock MBChB BSc FRCS (Tr&Orth) MSc MRES
James Cook University Hospital, Middlesbrough
Matthew Brown FRCS (Tr&Orth) Dip Hand Surg
(Br & Eur)
St John’s Hospital, Livingston, Midlothian
Emerson Budhoo MBBS DM (Ortho) FRCS
(Tr&Orth)
Caribbean Orthopaedic Foot and Ankle Institute,
St Clair Medical Centre; Medical Associates St Joseph,
Rampersad Medical Centre
Simon Chambers FRCS (Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Rebecca Critchley FRCS (Tr&Orth)
Leeds General Infirmary
David Deehan MB ChB, MSc, MD FRCS
(Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Rishi Dhir MBChB BSc (Hons) FRCS (Tr&Orth)
Princess Alexandra Hospital, Harlow
Philip Dobson MBBS PhD FRCS (Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Alexander Durst FRCS (Tr&Orth)
Welsh Centre for Spinal Surgery and Tr auma,
Cardiff
Niall Eames MD FRCS (Tr&Orth)
Royal Victoria Hospital, Belfast
Hussam Elamin-Ahmed MRCS
Queen Elizabeth Hospital, Gateshead
Walid A. Elnahal MD FRCS (Eng) FEBOT MSc
Royal National Orthopaedic Hospital Stanmore;
Orthopaedics, Cairo University
Adam Farrier FRCS (Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
James Fernandes FRCS (Tr&Orth)
Sheffield Childrens Hospital
Craig H. Gerrand FRCSEd (Tr&Orth) MD
Royal National Orthopaedic Hospital, Stanmore
vii
List of Contributors
Christopher George Ghazala BSc Hons (Dunelm)
MB BS MRes (N’cle) MSc (Edin) FRCS (Tr&Orth)
FHEA
South Tyneside and Sunderland NHS Foundation Trust
James Gill MB BChir BSc FRCS (Tr&Orth)
West Suffolk Hospital, Bury St Edmunds
Daniel Hipps MBBS FRCS (Tr&Orth) PhD
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Yusuf Omran Hasan MD FRCS (Tr&Orth)
Salmaniya Medical Complex, Kingdom of Bahrain;
Royal National Orthopaedic Hospital, Stanmore
Heledd Havard MSc FRCS (Tr&Orth)
Royal National Orthopaedic Hospital, Stanmore
Gavin Heyes MBChB Msc FRCS (Tr&Orth)
Liverpool University Hospitals NHS Foundation
Trust UK
Edward Holloway FRCS (Tr&Orth)
Chesterfield Royal Hospital
Munier Hossain MBBS PGCE MSc (Orth Eng) MSc
(Oxon) FRCS (Glas) FRCS (Tr&Orth) FHEA
United Lincolnshire Hospitals NHS Trust
Richard Hutchinson MSc (Hons) FRCS (Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Faizan Jabbar MBChB BSc MRCS
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Edward Jeans BMedSci BMBS MRCS MSc
School of Engineering, Cardiff University;
Wrightington, Wigan and Leigh Teaching Hospitals
Rajesh Kakwani MBBS MS (Orth) FRCS (Tr&Ort h)
Northumbria Healthcare NHS Foundation Trust
Prasad Karpe MBBS MS (Orth) FRCS (Tr&Orth)
James Cook University Hospital, Middlesbrough
Jonny Kent FRCS (Tr&Orth) MB BS MD
North Cumbria Integrated Care NHS Trust
Maire-Clare Killen FRCS (Tr&Orth)
South Tyneside and Sunderland NHS Foundation Trust
Ling Hong Lee MD MCh PGCert Genomic Med
South Tyneside and Sunderland NHS Foundation Trust
Jonathan Lenihan BSc MBBS FRCS (Tr&Orth)
Addenbrooke’s Hospital Cambridge
Lyndon Mason MB BCh FRCS (Tr&Orth)
Liverpool University Hospitals NHS Foundation
Trust UK
Rory Morrison BMSc MBChb FRCS (Tr&Orth) PhD
Northumbria Healthcare NHS Foundation Trust
Andrea Nicolas FRCS (Tr&Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Hussein Noureddine BSc CHM (Tr&Orth) FRCSEd
(Tr&Orth)
University Hospitals of Leicester NHS Trust
Pradyumna Raval MBBS MCh(Orth) FEBOT FRCS
(Tr&Orth)
East of Englan d Deanery
Emma Reay MBBS FRCSEd (Tr&Orth)
James Cook University Hospital, Middlesbrough
Paul Rushton BMedSci BMBS MSc FRCS (Tr& Orth)
The Newcastle upon Tyne Hospitals NHS Foundation
Trust
Shantanu Shahane Ms (Orth) Mch (Orth) FRCS
(Tr&Orth)
Chesterfield Royal Hospital
Majeed Shakokani MBBS FRCS (Tr&Orth)
Cambridge University Hospitals NHS Foundation
Trust
Kiran Singisetti MBBS MS Fellow EBOT FRCS Ed
(Tr&Orth)
Queen Elizabeth Hospital, Gateshead
Razvan Taranu MSc FRCSEd (Tr&Orth)
Arcadia Hospital, Iasi, Romania
Nicholas Wei MBBS MRCS PGCert
Queen Elizabeth Hospital, Gateshead
David Yeoh MBBS Msc FRCS (Tr&Orth)
Norfolk and Norwich University Hospital, Norwich,
Norfolk
viii
Foreword
Any fool can know. The point is to understand.
Albert Einstein
The Postgraduate Orthopaedics team have significantly updated the content in the second edition for
what is the foremost guide to the written section of
the FRCS (Trauma and Orthopaedics) examination.
The sections relating to understanding the purpose
and standard setting of the SBA section give the
readers clarity on why it is a proven method of testing
higher-order thinki ng. For most orthopaedic trainees,
the exam represents the pinnacle of their training and
passing it is a validation that they are able to perform
at a level expected of a day one consultant. The
authors have captured the essence of the exam, which
is to demonstrate a deep understanding of the art and
science of our specialty and not simply to recite
memorised knowledge.
The expanded sections include Ethics, Professional
Behaviour and Leadership which are increasingly relevant in our clinical practice and therefore reflected in
the exam. The questions are supported by up-to-date
evidence and also identify areas of controversy. The
book has been beautifully illustrated and the number
of clinical photographs has been increased, which
improves the reader’s ability to retain information.
This edition not only is a guide for preparation
for the exam but serves as a high-quality textbook of
clinical knowledge for surgeons of all levels.
The Editor, Paul Banaskiewicz, is internationally
recognised for his courses, books, publications and
passion for training. He is a serving member of the
Council of the British Orthopaedic Association and has
been instrumental in improving the quality of education and training on behalf of the association. He has
assembled and led an exceptional team of authors.
Hiro Tanaka
Consultant Orthopaedic Surgeon
Honorary Secretary of the British Orthopaedic
Association
ix
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