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  • What is this and how does it work?
  • What considerations do you have when using a tourniquet?
  • What considerations should you give regarding antibiotics?
  • How would you exsanguinate the limb and what pressure would you set the tourniquet for an arm and for a leg.
  • How long would you leave the tourniquet inflated for?
  • When is a tourniquet contraindicated?
  • What complications are associated with tourniquet use?

 

This is a pneumatic tourniquet. It is commonly used in orthopaedic surgery to reduce blood loss, and improve visualisation of he operative field

Goal is minimum pressure for the minimum length of time

Considerations

  • Widest tourniquets possible should be used and it should be atleast half the diameter of the limb to avoid local pressure complications.
  • Overlap by at least 3inches (7.6cm) for sufficient hold, but no more than 6inch to avoid skin wrinkling under tourniquet and possible local pressure complications
  • Located away from operative field
  • 2 layers padding (more reduces pressure transfer to vessels, therefore less effective)
  • Contoured useful in obese to improve contact area
  • Antibiotics should be administered atleast 5 minutes before the inflation of the tourniquet.

Pressure

Limb exanguinated either with elevation or device.
The pressure should be set to 100 mmHg above systolic BP in lower limb, 50mmHg in upper limb

How long?

The tourniquet should not be inflated for more than 120 minutes in the lower limb, and 90 minutes in the upper limb. If you need the tourniquet for longer then deflate for 10 minutes and then reinflate.

Contraindications

  • High risk thromboembolic complications
  • Peripheral vascular disease
  • Diabetes
  • Sickle cell disease (ischaemia may provoke crisis) Sickle trait is a relative contraindication.
  • AV fistula
  • Local anaesthetic cases – patient discomfort so relative contraindication
  • Local sepsis not a contraindication but elevation not mechanical exanguination.

Complications
Local

  • Skin injury (pressure necrosis or chemical burn by prep
  • Neurapraxias
  • Arterial injury / thrombosis
  • Distal
  • Ischaemic injury
  • Thrombosis
  • Post tourniquet syndrome – ischaemia and reperfusion injury leading to oedema, pallor, stiffness, weakness without paralysis and subjective numbness
  • Haemorrhage – venous tourniquet, or post op in unrecognised vessel injury
  • Compartment syndrome

Systemic

  • Haemodynamic effects – elevated BP with inflation, decreased BP deflation
  • Metabolic effects – hypoxia, hypercarbia, acidosis, hyperkalaemia, rhabdomyolysis and myoglobinuria after deflation (prolonged use)
  • Hypercoagulability
  • Pulmonary embolus

If bilateral tourniquets stagger deflation by 30-45mins ideally.


Answers to this weeks case of the week can be found within the viva questions bank here.

Welcome to the FRCSOrtho site. Frequently we release a case from our question bank to help you prepare for your FRCS Tr and Orth exam.  The question bank continues to grow and we now have over 350 questions.  Please also look at our sample questions.

We hope you have enjoyed this question. Please register to FRCS Tr & Orth Viva Question Bank Access to discover the answer to these questions, and many more questions.  We hope you enjoy the largest FRCS Tr & Orth question bank and we wish you every success in your FRCS Orth exam!

Good Luck!

FRCS Ortho Team

Question of the week – Statistics

This table shows study results where MRI results where confirmed by arthroscopy:

In terms of this table (A,B,Cand D) please:

  1. Define sensitivity
  2. Define specificity
  3. Define PPV
  4. DefineNPV

Answer:

Be able to draw this table and talk examiner through it as you go. Ensure you leave no room for confusing double negatives.

Sensitivity = True Positive/ True Positive + False Negative

Specificity = True Negative/ True negative + False Positive

Positive Predictive Value = True Positives / True Positives + False Positives

Negative Preditive Value = True Negatives / True Negatives + False Negatives

Note: NPV = C/C+D – error on image

Answer


Answers to this weeks case of the week can be found within the viva questions bank here.

Welcome to the FRCSOrtho site. Each week we release a case from our question bank to help you prepare for your FRCS Tr and Orth exam.  The question bank continues to grow and we now have over 350 questions.  Please also look at our sample questions.

We hope you have enjoyed this question. Please register to FRCS Tr & Orth Viva Question Bank Access to discover the answer to these questions, and many more questions.  We hope you enjoy the largest FRCS Tr & Orth question bank and we wish you every success in your FRCS Orth exam!

Good Luck!

FRCS Ortho Team

OXFORD FRCS REVIEW COURSE ONLY

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  • 4-day lecture/seminar series
  • Intense and comprehensive review of Orthopaedics
  • Course materials, lunch and refreshments throughout each day

OXFORD ADVANCED CLINICAL EXAMINATION & VIVA COURSE

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11th-12th January 2020

  • £155 off RRP!
  • 2 day course focusing on practical aspects of the FRCS examination
  • Examine REAL patients with pathology
  • Course materials, lunch and refreshments throughout each day

https://millerfrcsorthopaedicrevisioncourse.co.uk/book-courses

Orthopaedic Network T&O FRCS Revision Course 20th October 2019

Orthopaedic Network T&O FRCS Course

Sunday 20th October 2019

Intensive one day viva specific course with a high faculty to trainee ratio

Early bird fee: £125before8/9/19

Course Fee: £149

www.orthopaedicnetwork.org.uk

Paediatric Spine – Case of the week – March 2019 FRCS Tr&Orth

A 3 year old patient was brought in by ambulance following a road traffic collision.  He was placed on spine board and the neck was immobilised.

Describe what you see?

If a paediatric spine board was not available, how else would suggest the child could be positioned?

8 year old boy presenting with an acute torticollis after an injury to the neck sustained whilst play fighting with siblings.

X-rays and CT scan were performed. Tell me what you see.

Which anatomical structures provide atlantoaxial stability?

Are you aware of any classifications for this type of injury?

What are your management options?


Answers to this weeks case of the week can be found within the viva questions bank here.

Welcome to the FRCSOrtho site. Each week we release a case from our question bank to help you prepare for your FRCS Tr and Orth exam.  The question bank continues to grow and we now have over 350 questions.  Please also look at our sample questions.

We hope you have enjoyed this question. Please register to FRCS Tr & Orth Viva Question Bank Access to discover the answer to these questions, and many more questions.  We hope you enjoy the largest FRCS Tr & Orth question bank and we wish you every success in your FRCS Orth exam!

Good Luck!

FRCS Ortho Team

Case of the week – Bone Tumour

This is a radiograph of an 11 year old following twisting her ankle. Describe what you see

She twisted her ankle whilst playing football and has pain on the distal lateral aspect of her fibula. How do you proceed?

In which patients is the fracture risk high?

Would you perform an MRI on this lesion?

 


Answers to this weeks case of the week can be found within the viva questions bank here.

Welcome to the FRCSOrtho site. Each week we release a case from our question bank to help you prepare for your FRCS Tr and Orth exam.  The question bank continues to grow and we now have over 350 questions.  Please also look at our sample questions.

We hope you have enjoyed this question. Please register to FRCS Tr & Orth Viva Question Bank Access to discover the answer to these questions, and many more questions.  We hope you enjoy the largest FRCS Tr & Orth question bank and we wish you every success in your FRCS Orth exam!

Good Luck!

FRCS Ortho Team

Recent Part 1 Experience – MCQ / EMQ – FRCS Tr & Orth

Dear All,

I am writing to give you all a heads up about the FRCS (Tr & Ortho) Exam. I am sure you would be aware of what is required but felt it may be useful to give you my own account of the whole process leading up to Part 1 (can’t speak about Part 2 yet).

Having a study buddy greatly helps with the preparation to motivate each other to revise and not to loose focus (helps for Part 1 as well from my own experience).

The Part 1 exam is very much different to all the available resources. UKITE come closest but I personally felt the exam was more difficult and vague compared to UKITE.

During the actual exam time is very critical. You need to complete the exam in the allocated time, which sometimes can be demanding. Hence the more you practise the better you get.

Feb 2019 Sitting.

  • The MCQs were a bit tough but manageable.
  • However the EMQs were a different ball game. Majority of the EMQs were very vague with minimal clinical information requiring one to make a reasonable judgement of the answer – which basically relies very much of background clinical knowledge.
  • The exam itself is taxing (in spite of all the practise you have done) – half way through the EMQs I was feeling very tired and definitely exhausted after the exam – few others who sat the exam in Feb felt the same.
  • Anatomy was the key for the Feb 2019 Part 1 sitting. Not sure if this was the case previously. These were all applied anatomy questions assessing anatomical relations etc – all the questions required to go through at least 2 hurdles to get to the answer.

General advice

  • Know you anatomy well – read a good book. Miller’s textbook has a good synopsis of anatomy but I know it is difficult to read.
  • Millers audio lectures / podcast are good to listen whilst driving – 40hrs of lectures covers the whole breadth of orthopaedics. It’s a bit dated (2006-7) but still good place to start off.
  • Orthobullets is good resource for background knowledge but my feeling is that it didn’t help much for the exam, as the questioning style for FRCS is very different. It give you the background knowledge but you still need to practise FRCS style questions.
  • The exam tests your background knowledge, which you would have gained from different clinical situations with a majority of questions testing applied clinical knowledge. So learn and take in as much information as you go along through training.

Resources: the below are the resources which I felt are good for Part 1.

The exam requires a significant amount of preparation so please don’t take the exam lightly. You may have heard some previous trainees say they prepared for 1-2 month before the exam and still passed – I would suggest don’t leave this to luck unless you are already well prepared.

It is better to be over prepared than under prepared for the exam. The Doctors mess at Oswestry has this quote – ‘FAIL TO PREPARE = PREPARE TO FAIL’ which sums up everything I wanted to say (The Oswestry training programme has been talked about as having the best teaching programme).

I understand that some of you may be considering sitting the Part 1 in Nov 2019 so plan your preparation.  Hopefully I have been able to give you my thoughts about the Part 1. I will give you all an update following my Part 2 exam. If you have any questions please don’t hesitate to contact me.

Best wishes

K H Sunil Kumar MBBS  MRCSEd MCh Ortho DipSEM (UK&I) FEBOT
ST7 Trauma & Orthopaedics
East of England T&O Training Programme

BOTA Members Receive 50% Discount!

We are pleased to announce that we have teamed up with the British Orthopaedic Trainees Association (BOTA) to provide members with a 50% discount to the website.

FRCS Ortho It is a one-stop shop to help you pass the FRCS Ortho Viva Exam.

It has the largest online resource of FRCS Ortho viva questions and also includes relevant FRCS courses.

Plus information on how to apply for the exam and a letter to help you claim the tax back from your exam afterwards.

BOTA members will be given a 50% discount.

Once you access the site there are a huge range of VIVA questions to help you practice and learn for part 2. These are separated by sub-specialty and basic science.

There is also a section on surgical approaches and a section to mix up your learning with videos that successful candidates found useful in their preparation.

If you are having difficulty redeeming the discount please contact us with your BOTA membership number via email.

Yours sincerely,

FRCS Ortho

Question of the Week – Trauma – 3rd March 2019

12 year old boy with ongoing lower leg pain

Describe what you see

How would you manage this patient?

This is a stress fracture of the tibia. How would you treat it?

This is a 22 year old man, who has been treated nonoperatively with protected weighbearing for 8 weeks. How would you manage him? He is otherwise fit and well and a non smoker.

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Answers to this weeks case of the week can be found within the viva questions bank here. Welcome to the FRCSOrtho site. Each week we release a case from our question bank to help you prepare for your FRCS Tr and Orth exam.  The question bank continues to grow and we now have over 350 questions.  Please also look at our sample questions. We hope you have enjoyed this question. Please register to FRCS Tr & Orth Viva Question Bank Access to discover the answer to these questions, and many more questions.  We hope you enjoy the largest FRCS Tr & Orth question bank and we wish you every success in your FRCS Orth exam! Good Luck! FRCS Ortho Team