100+ Free FC Orth(SA) Final Practice Questions

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Key Facts: FC Orth(SA) Final Exam

100 Qs

MCQ Study Adaptation

OpenExamPrep Practice Bank

R21 500

Exam Fee

CMSA Fee Structure 2026

50%

Passing Score

CMSA College of Orthopaedic Surgeons Regulations

verified

Metadata Status

CMSA Official Blueprint

The CMSA FC Orth(SA) Final is the specialist exit examination for orthopaedic surgeons in South Africa. This practice bank provides 100 high-yield, clinically sophisticated MCQs tailored to the official South African orthopaedic fellowship syllabus.

Sample FC Orth(SA) Final Practice Questions

Try these sample questions to test your FC Orth(SA) Final exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 28-year-old male motor vehicle accident victim presents with a Gustilo-Anderson Grade IIIB open tibial shaft fracture with a 6 cm anterior skin defect and periosteal stripping. Following emergency surgical debridement and joint-spanning external fixation within 6 hours of injury, what is the optimal timeframe for definitive soft tissue coverage to minimize post-operative infection rates?

A.Within 72 hours of injury

B.At 14 to 21 days after initial granulation formation

C.Within 48 to 72 hours of injury

D.Delayed until 6 weeks post-injury after fracture callus formation

Explanation: Definitive soft tissue flap coverage for Gustilo Grade IIIB open tibial fractures should ideally be achieved within 48 to 72 hours (and certainly within 7 days per BOA/BAPRAS guidelines) of the initial injury. Early reconstruction significantly decreases deep infection rates, osteomyelitis, and flap failures compared to delayed coverage beyond 7 days.

2A 35-year-old female sustains a high-energy pelvic ring injury after a fall from height. AP pelvic radiography reveals a Lateral Compression Type 1 (LC-1) fracture with complete sacral fracture displacement and persistent hemodynamic instability despite pelvic binder placement and fluid resuscitation. What is the most appropriate next step in acute resuscitation?

A.Immediate pelvic angiography and transcatheter arterial embolization

B.Urgent open reduction and internal fixation of the anterior pelvic ring

C.Immediate placement of a distal femoral traction pin

D.Bilateral internal iliac artery surgical ligation

Explanation: In lateral compression pelvic injuries with sacral disruption and persistent hemodynamic instability unresponsive to pelvic binding, the primary bleeding source is arterial (such as branches of the internal iliac artery like the superior gluteal or internal pudendal arteries). Immediate pelvic angiography and selective transcatheter embolization is the gold standard intervention.

3A 32-year-old male polytrauma patient sustains a displaced femoral neck fracture (Pauwels Type III, Garden Grade IV). He is hemodynamically stable. What is the definitive operative management of choice to minimize femoral head osteonecrosis?

A.Emergency open reduction and anatomical internal fixation with a sliding hip screw and anti-rotation screw within 6 hours

B.Primary cemented bipolar hemiarthroplasty

C.Primary uncemented total hip arthroplasty

D.Closed reduction and percutaneous fixation with 3 cannulated screws in 48 hours

Explanation: In young adults (<50 years) with displaced high-energy femoral neck fractures, joint preservation via urgent, anatomical open reduction and internal fixation (using a sliding hip screw with anti-rotation screw or parallel cannulated screws) within 6 hours is essential to decompress capsular hematoma and preserve the medial femoral circumflex arterial supply.

4A 45-year-old male sustains a Schatzker Grade VI comminuted bicondylar tibial plateau fracture with severe soft tissue compromise and skin blistering. What is the safest surgical strategy?

A.Immediate open reduction and internal fixation with dual locking plates

B.Joint-spanning knee external fixation and delayed definitive ORIF once soft tissue wrinkling occurs

C.Primary total knee arthroplasty with long modular stems

D.Non-operative treatment in a above-knee plaster cast for 8 weeks

Explanation: High-energy bicondylar tibial plateau fractures (Schatzker VI) with severe soft tissue compromise are best treated with a staged protocol: immediate knee-spanning external fixation to restore length and alignment, followed by delayed definitive ORIF (typically 10 to 14 days later) once soft tissue swelling subsides and the positive wrinkle sign appears.

5A 40-year-old woman presents with a displaced volar Barton fracture-dislocation of the distal radius. What is the definitive surgical treatment of choice?

A.Closed reduction and sugar-tong splint immobilization

B.Open reduction and internal fixation via a Henry approach using a volar locking plate

C.Dorsal bridge plating spanning the radiocarpal joint

D.Percutaneous K-wire fixation and cast immobilization

Explanation: Volar Barton fractures are volar marginal intra-articular fracture-dislocations of the distal radius. They are inherently unstable shear injuries that require anatomical open reduction and buttress fixation via a volar (Henry) approach using a anatomical volar locking plate.

6A 68-year-old female on long-term alendronate therapy presents with prodromal thigh pain followed by an atypical subtrochanteric femoral fracture showing lateral cortical thickening and a transverse fracture line. What is the most appropriate implant for surgical stabilization?

A.Dynamic hip screw (DHS) with a side plate

B.Long cephalomedullary intramedullary nail

C.Volar locking distal femoral plate placed inverted

D.External fixation construct

Explanation: Atypical femoral fractures (AFF) associated with long-term bisphosphonate use are tension-side subtrochanteric or shaft fractures characterized by lateral cortical beaking and transverse orientation. A long cephalomedullary nail spanning the entire length of the femur is the implant of choice to protect the entire femoral shaft from secondary stress fractures.

7A 38-year-old male construction worker falls 4 meters and sustains a displaced intra-articular calcaneal fracture (Sanders Type III). Soft tissue swelling has resolved. What surgical approach provides optimal visualization of the subtalar joint and lateral wall?

A.Extensile lateral L-shaped approach

B.Medial McReynolds approach

C.Direct posterior longitudinal approach

D.Anteromedial approach over the sustentaculum tali

Explanation: The extensile lateral approach (or modified sinus tarsi approach) provides comprehensive visualization of the posterior facet of the subtalar joint, calcaneocuboid joint, lateral calcaneal wall, and anterior process, enabling anatomical reduction and plate fixation in Sanders III fractures.

8A 24-year-old male sustains a closed mid-shaft humeral fracture following a fall. Physical examination reveals complete wrist drop, thumb extension loss, and sensory loss over the first dorsal web space. X-rays show a simple transverse mid-diaphyseal fracture. What is the correct initial management of the nerve deficit?

A.Observation and clinical re-evaluation with EMG/NCS at 3 to 4 months

B.Immediate open exploration of the radial nerve and fracture ORIF

C.Emergency exploration of the brachial plexus

D.Immediate nerve graft harvest and transfer

Explanation: Acute radial nerve palsy following closed mid-shaft humeral fractures is typically a neuropraxia or axonotmesis in over 85% of cases. Initial non-operative management with splinting, observation, and electrodiagnostic studies at 3-4 months is recommended before considering surgical exploration.

9A 22-year-old male polytrauma patient presents with severe bilateral pulmonary contusions, ARDS (PaO2/FiO2 < 150), and a displaced bilateral femoral shaft fracture. What is the most appropriate acute stabilization technique for the lower extremities?

A.Damage control orthopaedics: immediate temporary knee-spanning external fixation

B.Immediate bilateral reamed intramedullary femoral nailing

C.Immediate bilateral unreamed femoral nailing

D.Bilateral plate and screw fixation

Explanation: In border-zone or unstable polytrauma patients with respiratory failure/ARDS, performing prolonged definitive reamed intramedullary nailing induces a secondary inflammatory insult ('second hit'). Damage Control Orthopaedics (DCO) using rapid temporary external fixation is indicated to minimize physiological stress.

10A 30-year-old male presents 8 hours after a high-energy closed tibial shaft fracture with excruciating pain out of proportion to injury, pain on passive extension of the toes, and tense leg swelling. Passive stretch pain is severe. What is the definitive treatment?

A.Emergency four-compartment double-incision leg fasciotomy

B.Closed reduction of fracture and tight cast application

C.Immediate hyperbaric oxygen therapy

D.Intravenous mannitol and elevation above heart level

Explanation: Acute compartment syndrome of the lower leg is a surgical emergency requiring immediate four-compartment decompression via two double incisions (anterolateral and posteromedial) to prevent irreversible muscular necrosis and nerve ischemia.

About the FC Orth(SA) Final Exam

The FC Orth(SA) Final is the exit qualification for orthopaedic surgeons in South Africa, conferring specialist registration with the Health Professions Council of South Africa (HPCSA). The examination tests comprehensive knowledge in adult trauma, total joint replacement, paediatric orthopaedics, spine surgery, musculoskeletal oncology, hand/upper limb, foot & ankle, and sports medicine.

Assessment

Written Paper 1 (Principles of Orthopaedic Surgery), Written Paper 2 (Specialised & Regional Orthopaedic Surgery), clinical case examinations, and viva voce.

Time Limit

Two 3-hour written papers plus clinical and oral examinations

Passing Score

Overall 50% with written subminimum

Exam Fee

R24 650 (College of Orthopaedic Surgeons of South Africa (Colleges of Medicine of South Africa))

FC Orth(SA) Final Exam Content Outline

25%

Complex Trauma & Fracture Fixation

Adult periarticular fractures, pelvic/acetabular disruption, open fracture protocols, nonunion, malunion, compartment syndrome, damage control orthopaedics, and polytrauma.

20%

Adult Reconstruction & Joint Arthroplasty

Primary and revision total hip and knee arthroplasty, periprosthetic joint infection (PJI), periprosthetic fractures, bearing surfaces, biomechanics, and osteotomy.

15%

Paediatric Orthopaedics

Developmental dysplasia of the hip (DDH), Perthes disease, slipped capital femoral epiphysis (SCFE), clubfoot (TEV), limb deformities, neuromuscular conditions, and physeal trauma.

10%

Spine Surgery

Subaxial and suboccipital cervical spine trauma, thoracolumbar burst fractures, spinal tuberculosis (Pott's disease), spondylolisthesis, lumbar spinal stenosis, and spinal deformity.

10%

Hand & Upper Limb Surgery

Brachial plexus injury, flexor/extensor tendon repairs, perilunate dislocations, scaphoid nonunion, rotator cuff disease, complex elbow instability, and peripheral nerve compression.

Foot & Ankle Surgery

Complex ankle trauma, Lisfranc fracture-dislocation, calcaneal fractures, hallux valgus, flatfoot deformity (PTTD), Achilles tendon rupture, and Charcot neuroarthropathy.

Orthopaedic Oncology & Pathology

Benign and malignant bone and soft tissue tumours (osteosarcoma, Ewing sarcoma, chondrosarcoma, giant cell tumour), metastatic bone disease, Enneking staging, and biopsy principles.

Sports Medicine & Arthroscopy

Multiligament knee injuries, ACL/PCL reconstruction, shoulder instability (Bankart, Hill-Sachs, Latarjet), rotator cuff tear arthropathy, and hip impaction (FAI).

How to Pass the FC Orth(SA) Final Exam

What You Need to Know

Passing score: Overall 50% with written subminimum
Assessment: Written Paper 1 (Principles of Orthopaedic Surgery), Written Paper 2 (Specialised & Regional Orthopaedic Surgery), clinical case examinations, and viva voce.
Time limit: Two 3-hour written papers plus clinical and oral examinations
Exam fee: R24 650

Keys to Passing

Work through all 100 available questions
Review every answer and explanation
Track weak areas and revisit them
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FC Orth(SA) Final Study Tips from Top Performers

1Master AO/OTA fracture classifications, surgical approaches (Hoppenfeld), and mechanical principles of internal and external fixation.

2Review the MSIS/EBJIS consensus definitions for Periprosthetic Joint Infection (PJI) and Paprosky classifications for acetabular/femoral bone loss in revision THA.

3Understand the clinical presentation and surgical management of endemic conditions such as spinal tuberculosis (Pott's disease) and late-presenting paediatric hip dysplasias.

Frequently Asked Questions

What is the format of the CMSA FC Orth(SA) Final examination?

The examination comprises two 3-hour written papers (Principles and Specialised Orthopaedic Surgery), followed by clinical patient examinations (long and short cases) and viva voce oral examinations.

What is the pass mark for the FC Orth(SA) Final?

The overall passing score is 50% with a mandatory subminimum score across the written component to qualify for the clinical and viva examinations.

What is the examination fee for the FC Orth(SA) Final?

The examination fee is R21 500 as listed on the Colleges of Medicine of South Africa (CMSA) portal.

What are the entry prerequisites for the FC Orth(SA) Final examination?

Candidates must have passed the FC Orth(SA) Part I and Intermediate examinations, completed a minimum of 48 months in an accredited registrar post, submitted an approved research component/MMed dissertation, and presented a certified logbook.

100+ Free FC Orth(SA) Final Practice Questions

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