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100+ Free CMSA Higher Diploma in Orthopaedics Practice Questions

Pass your Higher Diploma in Orthopaedics of the College of Orthopaedic Surgeons of South Africa [H Dip Orth(SA)] exam on the first try — instant access, no signup required.

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2026 Statistics

Key Facts: CMSA Higher Diploma in Orthopaedics Exam

100

Practice Questions

Adapted to official CMSA 5-domain blueprint

50%

Passing Mark

Criterion-referenced standard set by CMSA

24 Months

Accredited Training

Full-time orthopaedic department requirement

R 22,500

CMSA Exam Fee

Official 2026 fee schedule

30%

Trauma Weighting

Largest domain on H Dip Orth(SA) blueprint

Annual

Exam Schedule

Administered during Second Semester (SS) diet

The H Dip Orth(SA) examination assesses postgraduate orthopaedic knowledge across five major domains: Musculoskeletal Trauma & Fracture Management (30%), Basic Sciences & Bone Biology (25%), Paediatric & Adult Orthopaedics (20%), Joint Reconstruction & Sports (15%), and Musculoskeletal Infections, Tumours & Radiographs (10%). Eligible candidates require an MBChB/MBBS degree, HPCSA registration, 24 months of accredited training, a signed logbook, and an ATLS certificate. Passing standard is 50%.

Sample CMSA Higher Diploma in Orthopaedics Practice Questions

Try these sample questions to test your CMSA Higher Diploma in Orthopaedics exam readiness. Each question includes a detailed explanation. Start the interactive quiz above for the full 100+ question experience with AI tutoring.

1A 24-year-old male sustains an open right tibial shaft fracture following a motorcycle collision. Clinical examination reveals a 6 cm anterior skin wound with moderate muscle contusion, minimal periosteal stripping, and intact neurovascular status. According to the Gustilo-Anderson classification, how is this injury graded?
A.Type I
B.Type II
C.Type IIIA
D.Type IIIB
Explanation: Gustilo-Anderson Type II open fractures feature a skin wound between 1 cm and 10 cm in length with moderate soft-tissue damage, minimal periosteal stripping, and no extensive contamination. Type I open fractures have a wound <1 cm and are clean; Type III fractures feature wounds >10 cm or extensive soft-tissue destruction regardless of wound size.
2A 30-year-old trauma patient with a closed tibial shaft fracture develops severe leg pain out of proportion to physical findings, exacerbated by passive stretch of the great toe. Diastolic blood pressure is 75 mmHg and intracompartmental pressure of the anterior compartment is measured at 50 mmHg. What is the delta pressure (ΔP) and what action is indicated?
A.ΔP is 25 mmHg; immediate emergency two-incision four-compartment fasciotomy
B.ΔP is 125 mmHg; non-operative observation with limb elevation
C.ΔP is 25 mmHg; high-dose intravenous steroids and hyperbaric oxygen
D.ΔP is 50 mmHg; immediate closed reduction and tight cast immobilization
Explanation: Delta pressure (ΔP) is calculated as Diastolic Blood Pressure minus Intracompartmental Pressure (75 - 50 = 25 mmHg). A ΔP <30 mmHg is diagnostic of acute compartment syndrome and mandates urgent emergency surgical decompression via a two-incision four-compartment fasciotomy of the leg.
3A 40-year-old farm worker sustains a severe Gustilo-Anderson Type IIIB open femoral shaft fracture after a tractor rollover, with extensive soil contamination. According to established open fracture antimicrobial guidelines, which intravenous antibiotic regimen should be initiated immediately in the resuscitation bay?
A.First-generation cephalosporin (Cefazolin) monotherapy only
B.First-generation cephalosporin (Cefazolin) plus an aminoglycoside (Gentamicin) plus Benzylpenicillin
C.Oral Ciprofloxacin monotherapy
D.Intravenous Vancomycin monotherapy
Explanation: Gustilo-Anderson Type III open fractures require broad-spectrum coverage: Cefazolin for Gram-positive coverage, Gentamicin (or an aminoglycoside/3rd generation cephalosporin) for Gram-negative coverage, and high-dose Benzylpenicillin added specifically for soil or agricultural contamination to prevent Clostridium infection.
4A 28-year-old polytrauma patient arrives in shock with a core temperature of 33.8°C, arterial pH of 7.15, and an INR of 2.1. Radiographs show a displaced pelvic ring injury and bilateral open femoral shaft fractures. What is the most appropriate initial orthopaedic management strategy?
A.Immediate bilateral total femur ORIF with long anatomical plates
B.Damage Control Orthopaedics (DCO) with rapid external fixation and pelvic binder application
C.Definitive reamed intramedullary nailing of both femora taking 6 hours
D.Conservative non-operative skeletal traction in the trauma bay
Explanation: The patient presents with the lethal triad of trauma (hypothermia, metabolic acidosis, and coagulopathy), marking them as 'in extremis' or 'unstable'. Under Damage Control Orthopaedics (DCO) principles, definitive early total care is contraindicated; treatment focuses on rapid external fixation, hemorrhage control, and transfer to ICU for resuscitation.
5During the emergency room management of an Anteroposterior Compression (APC II) 'open-book' pelvic ring disruption, where should a commercial pelvic binder or wrapped sheet be centered anatomical to achieve optimal pelvic volume reduction?
A.Across the iliac crests
B.Centred directly over the greater trochanters
C.Around the mid-lumbar spine
D.Across the mid-femoral shafts
Explanation: To effectively reduce an open-book pelvic disruption and tamponade retroperitoneal venous bleeding, a pelvic binder or sheet must be centered directly over the greater trochanters. Placing it higher over the iliac crests can actually flare the pelvis open further.
6A active 25-year-old female sustains a completely displaced (Garden IV) intracapsular femoral neck fracture in a high-speed car crash. What is the surgical treatment of choice to preserve her native hip joint?
A.Emergent anatomical reduction and rigid internal fixation with cannulated screws or a sliding hip screw
B.Primary cemented hemiarthroplasty
C.Uncemented total hip arthroplasty
D.Non-operative bed rest with skin traction for 8 weeks
Explanation: In young patients (<60 years) with displaced intracapsular femoral neck fractures, joint preservation is paramount. Emergent open or closed anatomical reduction and internal fixation (using cannulated screws or a dynamic hip screw with a side plate) should be performed urgently to restore blood flow and mitigate avascular necrosis (AVN) risk.
7An 82-year-old female presents with an unstable intertrochanteric hip fracture featuring posteromedial comminution and loss of the lateral femoral wall. Which internal fixation device is mechanical gold standard for this fracture pattern?
A.Single cannulated 6.5 mm compression screw
B.Cephalomedullary nail (intramedullary hip nail)
C.Standard two-hole side-plate dynamic hip screw (DHS) without lateral wall support
D.Volar locking plate
Explanation: Unstable intertrochanteric fractures with loss of posteromedial support and lateral femoral wall compromise (AO/OTA 31-A2 and A3) have high failure rates when treated with a standard sliding hip screw due to lateral wall blowout. An intramedullary cephalomedullary nail provides superior biomechanical load-sharing and prevents excessive collapse.
8A 32-year-old male sustains an isolated closed mid-shaft femoral fracture. What is the definitive treatment of choice associated with the highest union rate (>95%) and lowest complication rate?
A.Reamed locked intramedullary nailing
B.Plaster of Paris hip spica casting
C.Bridging external fixation as definitive care
D.Open reduction and 3.5 mm dynamic compression plating
Explanation: Reamed interlocking intramedullary nailing is the gold standard definitive treatment for diaphyseal femoral fractures in adults. It provides biomechanical load-sharing, preserves periosteal blood supply, and yields union rates exceeding 95-98%.
9A coronal plane intra-articular fracture of the femoral condyle visible on lateral radiographs of the knee is specifically designated as a:
A.Hoffa fracture
B.Patterson fracture
C.Segond fracture
D.Tillaux fracture
Explanation: A Hoffa fracture is a unicondylar coronal plane intra-articular fracture of the distal femur (usually lateral femoral condyle). Because it is an intra-articular injury, anatomic reduction and rigid internal fixation with countersunk lag screws (often anterior-to-posterior or posterior-to-anterior) is required.
10Under the Schatzker classification of tibial plateau fractures, which type describes a high-energy split fracture of the medial tibial plateau that carries a high risk of peroneal nerve or popliteal neurovascular injury?
A.Schatzker Type I
B.Schatzker Type II
C.Schatzker Type IV
D.Schatzker Type V
Explanation: Schatzker Type IV represents an isolated fracture of the medial tibial plateau (split or depressed). Medial plateau fractures result from high-energy varus forces, frequently involve subluxation of the knee joint, and carry a high incidence of neurovascular (popliteal artery / peroneal nerve) injury.

About the CMSA Higher Diploma in Orthopaedics Exam

The Higher Diploma in Orthopaedics [H Dip Orth(SA)] is a postgraduate clinical qualification awarded by the College of Orthopaedic Surgeons of South Africa (CMSA). Designed to upgrade the standard of orthopaedic trauma and non-specialist surgical care across South African public and private healthcare facilities, the diploma validates competence in managing acute trauma, open fractures, bone and joint infections (including skeletal tuberculosis and osteomyelitis), paediatric orthopaedic emergencies, basic sports medicine, and radiographic diagnostic interpretation. This 100-question practice bank serves as an English-language study adaptation to prepare candidates for the official written and clinical assessment.

Questions

100 scored questions

Time Limit

3 hours

Passing Score

50%

Exam Fee

R 22,500 (College of Orthopaedic Surgeons of South Africa (CMSA))

CMSA Higher Diploma in Orthopaedics Exam Content Outline

30%

Musculoskeletal Trauma & Fracture Management

Resuscitation of poly-trauma patients (ATLS), damage control orthopaedics (DCO vs early total care), open fracture classification (Gustilo-Anderson) and antibiotic/surgical protocols, acute compartment syndrome diagnosis (delta pressure <30 mmHg), pelvic ring instability (Tile & Young-Burgess), acetabular fractures, hip fractures (Garden, Pauwels, Evans), femoral shaft and distal femur fractures, tibial plateau (Schatzker) and pilon fractures, ankle fractures (Weber and Lauge-Hansen mechanisms), Lisfranc joint disruptions, calcaneal fractures, upper extremity trauma (distal radius, scaphoid nonunion risk, humerus shaft radial nerve injury, shoulder dislocation/instability), and surgical fixation options.

25%

Orthopaedic Basic Sciences, Bone Biology & Pathology

Haematomatous, cartilaginous callus, and bony remodeling phases of fracture healing, primary (direct) vs secondary (indirect) healing, mechanical strain theory (Perren), Wolff's Law, osteoblast, osteocyte and osteoclast signalling (RANKL/OPG system), articular cartilage histology (superficial, middle, deep, calcified zones), tendon/ligament micro-architecture and repair stages, bone graft properties (osteogenesis, osteoinduction, osteoconduction), autograft vs allograft vs synthetic substitutes, metabolic bone pathology (osteoporosis criteria, osteomalacia/rickets vitamin D pathways, Paget disease stages, hyperparathyroidism osteitis fibrosa cystica), tourniquet inflation thresholds and ischemic time limits, local anaesthetic systemic toxicity (LAST) rescue with lipid emulsion, and biostatistical principles (sensitivity, specificity, positive/negative predictive value).

20%

Paediatric & Adult Orthopaedic Conditions

Physeal fracture staging (Salter-Harris types I-V), Developmental Dysplasia of the Hip (Ortolani, Barlow, Galeazzi sign, ultrasound vs radiograph age thresholds), Legg-Calvé-Perthes disease (Catterall & Herring classification), Slipped Capital Femoral Epiphysis (SCFE; Southwick angle, Klein line, obligatory external rotation), paediatric supracondylar humerus fractures (Gartland classification, anterior humeral line, Baumann angle, neurovascular monitoring of anterior interosseous nerve), clubfoot (Ponseti serial casting and Achilles tenotomy), Kocher criteria differentiating septic arthritis from transient synovitis, scoliosis evaluation (Cobb angle, Risser sign, bracing vs surgical indications), cervical spondylotic myelopathy (Hoffmann sign, Lhermitte sign, sagittal MRI), lumbar disc herniation vs spinal stenosis, cauda equina syndrome red flags, and compressive peripheral neuropathies (carpal tunnel, cubital tunnel).

15%

Joint Reconstruction, Arthroscopy & Sports Injuries

Radiographic classification of hip and knee osteoarthritis (Kellgren-Lawrence), total joint arthroplasty indications, implant fixation modes (cemented vs uncemented), knee ligamentous instability (anterior cruciate ligament pivot-shift and Lachman tests, posterior cruciate ligament posterior drawer test, posterolateral corner injuries), meniscal tear patterns (bucket-handle, vascular zone repair potential), shoulder rotator cuff tears (full-thickness vs partial, supraspinatus testing), glenohumeral anterior dislocation (Bankart labral tear and Hill-Sachs compression fracture), adhesive capsulitis clinical phases, Achilles tendon rupture (Thompson test, non-operative vs operative protocols), plantar fasciitis, and periprosthetic joint infection diagnostic workup (MSIS criteria, synovial fluid aspirate, CRP/ESR).

10%

Musculoskeletal Infections, Tumours & Radiographic Imaging

Acute haematogenous osteomyelitis etiology (Staphylococcus aureus, Salmonella in sickle cell disease), chronic osteomyelitis (sequestrum, involucrum, cloaca), skeletal tuberculosis (Pott's disease of spine, gibbus deformity, cold abscess, TB arthritis), septic arthritis emergency management, benign bone lesions (osteoid osteoma nidus with nocturnal pain relieved by NSAIDs, giant cell tumour soap-bubble epiphyseal lesion, osteochondroma cartilage cap, enchondroma), malignant primary bone tumours (osteosarcoma Codman triangle and sunburst pattern, Ewing sarcoma onion-skin periosteal reaction), metastatic bone disease (breast, prostate, lung, kidney, thyroid; Mirels scoring for prophylactic fixation), and radiographic alignment lines.

How to Pass the CMSA Higher Diploma in Orthopaedics Exam

What You Need to Know

  • Passing score: 50%
  • Exam length: 100 questions
  • Time limit: 3 hours
  • Exam fee: R 22,500

Keys to Passing

  • Complete 500+ practice questions
  • Score 80%+ consistently before scheduling
  • Focus on highest-weighted sections
  • Use our AI tutor for tough concepts

CMSA Higher Diploma in Orthopaedics Study Tips from Top Performers

1Master compartment syndrome criteria: A delta pressure (diastolic blood pressure minus measured compartment pressure) of less than 30 mmHg or an absolute pressure greater than 30 mmHg in a symptomatic patient mandates emergency surgical double-incision four-compartment fasciotomy of the leg.
2Know open fracture antibiotic protocols: Cefazolin for Gustilo-Anderson Type I and II open fractures; add an aminoglycoside (e.g. gentamicin) for Type III fractures; add high-dose benzylpenicillin for soil, farmyard, or anaerobic contamination.
3Understand paediatric hip red flags: Differentiate Septic Arthritis from Transient Synovitis using Kocher criteria (fever >38.5°C, non-weight bearing, ESR >40 mm/h, WBC >12,000/mm³). The presence of 4 criteria gives a >99% probability of septic arthritis.
4Memorize physeal fracture staging: Salter-Harris Type I (S = slipped physis), Type II (A = above physis through metaphysis, most common), Type III (L = lower through epiphysis into joint), Type IV (T = through metaphysis, physis, and epiphysis), Type V (R = rammed/crushed physis).
5Recognize skeletal tuberculosis features: Pott's disease characteristically spares the posterior elements early while involving anterior adjacent vertebral bodies and intervening disc space, forming a cold abscess and angular gibbus deformity.

Frequently Asked Questions

What is the CMSA Higher Diploma in Orthopaedics [H Dip Orth(SA)]?

The H Dip Orth(SA) is a postgraduate diploma administered by the College of Orthopaedic Surgeons of South Africa (CMSA). It is designed to validate advanced competence in managing orthopaedic trauma, acute musculoskeletal infections, paediatric orthopaedic emergencies, and basic orthopaedic conditions for medical officers and doctors working in district, regional, and tertiary hospitals in South Africa.

Are these practice questions an official CMSA exam paper?

No. This practice module is an independent, English-language study adaptation designed to help candidates prepare for the official CMSA Higher Diploma in Orthopaedics written examination. It is structured according to the official CMSA content blueprint and weightings but is not an official past paper or endorsed by the CMSA.

What are the eligibility requirements for the H Dip Orth(SA) examination?

Candidates must hold a recognized medical degree (MBChB / MBBS), maintain active registration with the HPCSA (or equivalent medical council), complete 24 months of full-time training in a CMSA-accredited orthopaedic surgical post, submit a completed and signed CMSA H Dip Orth(SA) logbook, and hold a valid Advanced Trauma Life Support (ATLS) certificate.

How is the H Dip Orth(SA) examination structured?

The official CMSA assessment consists of a written multiple-choice examination diet offered annually in the Second Semester (SS), followed by a clinical / OSCE / viva evaluation. Candidates must achieve an overall passing mark of 50% across the assessment components.

What is the fee for taking the H Dip Orth(SA) examination?

The CMSA examination fee is approximately R 22,500 as per the 2026 fee schedule published by the Colleges of Medicine of South Africa. Candidates are also responsible for enrolling in and covering the cost of their independent ATLS certification course.

What topics are covered on the H Dip Orth(SA) blueprint?

The blueprint allocates 30% to Musculoskeletal Trauma & Fracture Management, 25% to Basic Sciences & Bone Pathology, 20% to Paediatric & Adult Orthopaedics, 15% to Joint Reconstruction & Sports Injuries, and 10% to Musculoskeletal Infections, Tumours & Radiographic Imaging.

Why are skeletal tuberculosis and acute osteomyelitis heavily emphasized?

In South African clinical practice, skeletal tuberculosis (Pott's disease, TB arthritis) and acute haematogenous or chronic osteomyelitis represent major public health burdens. Medical officers taking the H Dip Orth(SA) must demonstrate high clinical competency in diagnosing cold abscesses, sequestra, and septic joints.