Intercollegiate Specialty Examination in Trauma & Orthopaedic Surgery
Navigation-focused study syllabus for thinKbox FRCS, arranged from the official JCIE Trauma & Orthopaedic Surgery Syllabus Blueprint 2023 (V2.0; last reviewed July 2023).
How to use this syllabus
The JCIE blueprint is organised around:
- Knowledge — assessed principally in the Intercollegiate Specialty Board (ISB) Section 1 and Section 2 examinations, with workplace-based assessment during training.
- Clinical skills — history, examination, interpretation, judgement and management.
- Critical conditions — conditions requiring prompt recognition and safe initial management.
- Technical skills — general and region-specific operative skills.
- Professional capabilities — professional behaviour, communication, leadership, patient safety, quality improvement, teaching and scholarship.
This page is arranged as an FRCS revision map rather than reproducing the JCIE assessment matrix column-by-column.
Professional capabilities
Capabilities in Practice
The JCIE blueprint maps assessment to high-level surgical practice, including the ability to:
- manage an outpatient clinic
- manage the unselected emergency take
- manage ward rounds and continuing inpatient care
- manage an operating list
- work effectively in multidisciplinary teams
Generic Professional Capabilities
Candidates are expected to demonstrate:
- professional values and behaviours
- professional skills
- professional knowledge
- health promotion and illness prevention
- leadership and team working
- patient safety and quality improvement
- safeguarding of vulnerable groups
- education and training
- research and scholarship
1. Applied Clinical (Basic) Science
Anatomy and development
- clinically relevant and functional musculoskeletal anatomy
- operative anatomy and surgical approaches to the limbs and axial skeleton
- embryology and development of the musculoskeletal system
- structure and function of:
- bone
- articular cartilage and meniscus
- muscle and tendon
- synovium
- ligaments
- peripheral nerves
- intervertebral discs
Pathology and healing
- venous thromboembolism and prophylaxis
- fracture healing
- wound healing
- tendon and ligament injury and healing
- nerve injury and regeneration
- shock: types, physiology, recognition and treatment
- metabolic and hormonal regulation
- metabolic and immunological response to trauma
- blood loss, fluid balance and transfusion
- osteoarthritis
- osteoporosis
- metabolic bone disease
- rheumatoid arthritis and other inflammatory/crystal arthropathies
- haemophilia
- inherited musculoskeletal disorders
- inherited and acquired neuromuscular disease
- failure mechanisms of joint replacement
- periprosthetic fracture
- osteonecrosis
- osteochondritides
- heterotopic ossification
- infection of bone, joints and soft tissue, including tuberculosis
- prosthetic joint infection
- surgery in high-risk and immunocompromised patients
Prostheses and orthoses
- principles of prosthetic design
- prescription and fitting of standard prostheses
- principles of orthotic bracing for disease, deformity and instability
Pain
- principles of local, regional and general anaesthesia relevant to orthopaedic practice
- pain mechanisms and pain relief
- pain management programmes
- complex regional pain
- behavioural dysfunction and somatisation
Musculoskeletal oncology
- presentation, imaging, pathology, treatment and outcome of common benign and malignant bone tumours
- metastatic bone disease
- prophylactic and definitive fixation of pathological fractures
- principles of oncological management
- assessment and management of soft-tissue masses and sarcomas
Biomechanics and biomaterials
- bone grafts, bone banking and tissue transplantation
- biomechanics of musculoskeletal tissues
- biomechanics of fracture fixation
- tribology of natural and artificial joints
- implant design
- implant failure, wear and loosening
- biomaterials used in orthopaedic surgery
Genetics and cell biology
- clinical relevance of genetics to orthopaedic disease
- molecular genetics and molecular biology in trauma and orthopaedics
- cell biology
- cellular and molecular basis of wound healing
Diagnostics
- plain radiography and contrast studies
- CT
- MRI
- ultrasound
- radioisotope imaging
- bone mass and fracture-risk assessment
- effects of ionising radiation
- blood tests used in musculoskeletal disease
- gait and kinematic analysis
- electrophysiological investigations
Clinical environment
- operating-theatre design
- ventilation, temperature, humidity and lighting
- tourniquets
- diathermy
- sterilisation
- infection prevention and control
- patient warming
- skin preparation and surgical scrubbing
Ethics, evidence and quality
- duty of care
- informed consent
- data analysis and statistics
- epidemiology
- design and conduct of clinical trials
- quality-improvement methodology and reporting
- audit
- clinical governance
2. Foot & Ankle
Basic science and regional anatomy
- foot and ankle anatomy and related structures
- surgical approaches to:
- ankle
- subtalar joint
- mid-tarsal region
- forefoot
- arthroscopic portals
- ankle fractures
- peripheral nerve function around the foot and ankle
Pathology and biomechanics
- inflammatory, degenerative and infective conditions
- instability
- neuropathic foot
- acquired and developmental deformity
- causes of foot pain
- foot and ankle biomechanics
- biomechanics of tendon transfer
- ankle and first-ray prostheses
- orthotic biomechanics
Investigation and assessment
- radiological investigation
- diagnostic and image-guided injections
- examination under anaesthesia
- diagnostic arthroscopy
- neurophysiology
- structured history and examination
- special clinical tests
Treatment
- ankle and foot arthroplasty
- arthroscopy
- amputation
- arthrodesis
- excision arthroplasty
- first-ray surgery
- lesser-toe surgery
- ligament reconstruction
- rheumatoid foot and ankle
- neuropathic foot
- tendon, ligament and nerve injury
- tendon transfer
- footwear modification
- orthoses
- total-contact casting
- rehabilitation
- management of failed arthroplasty and failed soft-tissue surgery
Critical condition
- Compartment syndrome
3. Knee
Basic science
- anatomy of the knee and related structures
- surgical and arthroscopic approaches
- nerve function around the knee
Pathology
- inflammatory, degenerative and infective disease
- instability, including patellofemoral instability
- acquired and developmental deformity
- painful knee
- benign and malignant tumours around the knee
Biomechanics
- native-knee biomechanics
- biomechanics of knee arthroplasty
Investigation and assessment
- radiological investigation
- diagnostic and therapeutic injections
- examination under anaesthesia
- arthroscopy
- neurophysiology
- history and examination
- special clinical tests
Treatment
- knee arthroplasty
- knee arthroscopy
- ligament instability in adults and children
- patellofemoral disorders
- meniscal pathology
- degenerative and inflammatory arthritis
- revision arthroplasty principles
- articular-cartilage and osteochondral restoration
- tendon, ligament and nerve injuries
- orthoses
- rehabilitation
- failed arthroplasty and failed soft-tissue surgery
Critical conditions
- Neurovascular injury
- Dislocated knee
4. Hip
Basic science
- anatomy of the hip and pelvis
- surgical and arthroscopic approaches
- relevant peripheral nerve physiology
Pathology
- inflammatory, degenerative and infective disease
- impingement disorders
- primary and secondary tumours around the hip
- acquired and developmental deformity
- painful hip
Biomechanics
- native-hip biomechanics
- biomechanics of hip arthroplasty
Investigation and assessment
- radiological investigation
- diagnostic and guided injections
- hip arthroscopy
- neurophysiology
- history and examination
- special clinical tests
Treatment
- hip arthroplasty
- hip arthroscopy
- soft-tissue surgery
- osteotomy
- osteoplasty
- arthrodesis
- tendon, ligament and nerve injuries
- orthoses
- rehabilitation
- failed arthroplasty and failed soft-tissue surgery
5. Spine
Basic science
- development of the spine, spinal cord and nerve roots
- anterior, posterior and endoscopic approaches
- nerve and spinal-cord physiology
- spinal shock and secondary problems
Pathology
- ageing and degenerative disease
- acute and chronic spinal infection
- metabolic disease
- neurological disease
- thoracic outlet syndrome
- congenital and acquired deformity:
- scoliosis
- kyphosis
- acute painful back and referred pain
- prolapsed intervertebral disc
- primary and secondary spinal tumours
Biomechanics
- cervical and lumbar biomechanics
- spinal instability in:
- trauma
- tumour
- infection
- spondylolysis/spondylolisthesis
- deformity biomechanics
- instrumentation and fixation
- spinal bracing
Investigation
- interpretation of spine imaging
- diagnostic and therapeutic injections
- biopsy routes and complications
- blood tests
- electrophysiological studies
- spinal-cord monitoring
Assessment
- painful and injured spine
- neurological examination
- special clinical tests
- referred pain from non-spinal causes
- recognition of somatisation
- assessment after failed deformity/reconstructive surgery
Treatment
- decompression
- management of spinal instability
- principles of tumour surgery
- deformity correction
- spinal bracing
- non-operative management of low-back pain and sciatica
- spinal fracture management
- interventional radiology
- initial and ward care of the paralysed patient
- failed spinal surgery
- consequences of delayed surgery
Critical conditions
- Cauda equina syndrome
- Spinal trauma
- Spinal infection, including tuberculosis
- Major complications of inflammatory spinal disease
- Metastatic spinal cord compression
- Painful spine in a child
6. Hand & Wrist
Basic science
- anatomy of the hand, wrist and related structures
- operative and arthroscopic approaches
- nerve physiology
Pathology
- inflammatory, degenerative and infective conditions
- Dupuytren disease
- acquired and developmental deformity
- painful hand and wrist
Biomechanics
- hand and wrist biomechanics
- arthroplasty biomechanics
Investigation and assessment
- radiology
- neurophysiology
- diagnostic and guided injections
- examination under anaesthesia
- arthroscopy
- history and examination
- special clinical tests
Treatment
- prosthetic replacement
- excision arthroplasty
- arthroscopy
- arthrodesis
- entrapment neuropathies
- rheumatoid hand and wrist
- congenital hand conditions
- Dupuytren disease
- tendon transfer
- rehabilitation
- orthoses
- failed arthroplasty and soft-tissue surgery
Critical condition
- Compartment syndrome
7. Elbow
Basic science
- anatomy and related structures
- surgical and arthroscopic approaches
- nerve physiology
Pathology
- compressive neuropathy
- instability
- inflammatory, degenerative and infective disease
- elbow stiffness
- acquired and developmental deformity
- painful elbow
Biomechanics
- elbow biomechanics
- elbow arthroplasty biomechanics
Investigation and assessment
- radiology
- diagnostic and guided injections
- examination under anaesthesia
- arthroscopy
- neurophysiology
- history, examination and special tests
Treatment
- elbow arthroplasty
- arthroscopy
- ligamentous instability
- entrapment neuropathy
- degenerative and inflammatory arthritis
- soft-tissue conditions
- rheumatoid elbow
- rehabilitation
- orthoses
- failed arthroplasty and soft-tissue surgery
8. Shoulder
Basic science
- shoulder-girdle anatomy
- open and arthroscopic approaches
- nerve physiology
Pathology
- impingement and rotator-cuff disease
- instability and labral pathology
- inflammatory, degenerative and infective disease
- shoulder stiffness
- acquired and developmental deformity
- painful shoulder
Biomechanics
- shoulder-girdle biomechanics
- shoulder arthroplasty biomechanics
Investigation and assessment
- radiological investigation
- diagnostic and guided injections
- examination under anaesthesia
- arthroscopy
- neurophysiology
- shoulder examination and special tests
- brachial-plexus examination
Treatment
- arthroplasty
- arthroscopy
- soft-tissue reconstruction
- arthrodesis
- osteotomy
- excision arthroplasty
- reconstruction for brachial-plexus and other neurological disorders
- rehabilitation
- orthoses
- failed arthroplasty and soft-tissue surgery
9. Trauma
Principles
- regional anatomy relevant to trauma
- surgical approaches for bone and soft-tissue injury
- physiological response to trauma
- delayed union and non-union
- fractures in abnormal bone
- malunion
- analgesia in trauma
Fracture biomechanics and immobilisation
- principles of open reduction and internal fixation
- external fixation
- splintage
- traction
- casting
Assessment and investigation
- imaging of the injured patient
- primary clinical assessment
- prioritisation of treatment
- recognition of life-threatening and limb-threatening injury
- trauma-team working
Treatment
- closed and open fracture management
- pathological fracture management
- soft-tissue management
- amputation
- non-operative fracture management
- rehabilitation
- reconstruction of non-union and malunion
Regional trauma
Spine
- acute fractures and dislocations
- spinal shock
- cord syndromes
Pelvis and acetabulum
- fracture stabilisation
- associated visceral and neurovascular injury
Shoulder and humerus
- clavicle fractures
- proximal humeral fractures
- shoulder dislocation
- brachial-plexus and peripheral nerve injury
- humeral-shaft fractures
Elbow and forearm
- proximal-ulnar injuries
- distal-humeral fractures
- proximal-radial injuries
- radius and ulna shaft fractures
Wrist and hand
- distal-radius fractures
- scaphoid fractures
- carpal injuries
- metacarpal and digital trauma
- mangled hand
Femur
- proximal femoral fractures
- femoral-shaft fractures
Knee and leg
- periarticular knee fractures
- tibial-shaft fractures
Ankle and foot
- periarticular ankle fractures
- common unstable ankle-fracture patterns
- hindfoot trauma
- midfoot trauma
- forefoot trauma
- crushed foot
Periprosthetic trauma
- fractures around joint replacements and other implants
Critical conditions
- Compartment syndrome
- Neurovascular injury
- Major physiological response to trauma / haemodynamic compromise
10. Paediatric Orthopaedic Surgery
Basic science
- growth of bone
- physeal anatomy
- growth-plate injury
- anatomy of bones and joints in the growing child
- mechanisms of growth and deformity
- neurological causes of deformity, including:
- spina bifida
- cerebral palsy
- muscular dystrophy
Clinical assessment
- history and examination of the child
- communication with and involvement of parents/carers
- assessment of the disabled child
- normal developmental and rotational variants
Investigation
- plain radiographs
- arthrography
- CT
- MRI
- ultrasound
- nuclear imaging
- limitations and interpretation of investigations in children
Treatment and core conditions
- fractures, including non-accidental injury
- physeal injuries and sequelae
- bone and joint infection
- irritable hip and other common childhood orthopaedic presentations
- slipped upper femoral epiphysis
- Perthes disease
- developmental dysplasia of the hip
- talipes / clubfoot
- scoliosis
- forefoot deformity
- congenital hand abnormalities
- osteogenesis imperfecta
- skeletal dysplasia
- tarsal coalition
- torticollis
- leg-length discrepancy
- normal variants:
- genu valgum
- flexible flatfoot
- femoral anteversion
- orthoses
- rehabilitation
- assessment of physical disability
- screening for congenital abnormality
- Ponseti technique
Critical condition
- Painful hip in a child
Applied clinical skills
The JCIE blueprint separately lists technical and procedural skills. For revision, they can be navigated in the following groups.
General
- compartment-pressure measurement and fasciotomy
- correction of malunion/deformity
- haematoma evacuation
- bone-graft harvesting
- abscess drainage
- irrigation and debridement for native-joint infection
- external fixation and circular frames
- skeletal traction
- removal of frames, wires and implants
- arterial and nerve repair
- tendon repair
- wound debridement and closure
- skin grafts and local/free flaps
- aspiration and injection of major joints
- bone and soft-tissue biopsy
- benign and malignant tumour procedures
- osteomyelitis surgery
- tendon procedures
- amputations at appropriate upper- and lower-limb levels
Spine
- trauma stabilisation and decompression
- cervical, thoracic and lumbar reconstruction
- spinal fusion and fixation
- decompression and discectomy
- spinal injections and biopsy
- deformity correction
- scoliosis surgery
- vertebral augmentation
- disc replacement
- revision procedures
Shoulder
- fracture fixation
- reduction of shoulder dislocation
- treatment of clavicular and scapular trauma
- arthroscopy
- instability surgery
- rotator-cuff repair
- biceps procedures
- arthrodesis
- shoulder arthroplasty and revision
Elbow
- fracture and dislocation management
- fixation of periarticular injury
- arthroscopy
- ligament reconstruction
- contracture release
- ulnar-nerve decompression/transposition
- elbow arthroplasty and revision
Hand & Wrist
- distal-radius and carpal trauma
- metacarpal and phalangeal injuries
- tendon and ligament repair
- nerve and arterial repair
- revascularisation and replantation
- fingertip reconstruction
- infection surgery
- wrist arthroscopy
- carpal tunnel and other nerve decompressions
- TFCC surgery
- arthrodesis
- proximal-row carpectomy
- ulnar/radial shortening
- Dupuytren surgery
- congenital hand procedures
- tendon grafting, transfer and tenolysis
Hip
- pelvic and acetabular trauma
- proximal-femoral fracture surgery
- femoral-shaft fracture fixation
- hip infection surgery
- periprosthetic fracture management
- hip arthroscopy
- arthrodesis
- excision arthroplasty
- treatment of osteonecrosis
- osteotomy
- primary total hip replacement
- revision total hip replacement
Knee
- distal-femoral and tibial-plateau trauma
- patellar fracture/dislocation
- quadriceps and patellar-tendon repair
- knee arthroscopy
- ligament reconstruction
- meniscal surgery
- osteotomy
- primary knee arthroplasty
- revision knee arthroplasty
- periprosthetic fracture management
Foot & Ankle
- ankle fracture/dislocation management
- external fixation
- hindfoot and midfoot fracture surgery
- tendon and ligament repair
- arthroscopy
- arthrodesis
- first-ray and lesser-toe surgery
- tendon transfer
- ankle replacement
- revision procedures
Children's Trauma & Orthopaedics
- supracondylar humeral fracture management
- paediatric forearm fracture manipulation/fixation
- elastic nailing of paediatric long bones
- paediatric fracture and physeal-injury management
- core reconstructive procedures for common paediatric orthopaedic conditions
Critical conditions at a glance
These are the high-priority conditions explicitly highlighted within the JCIE knowledge blueprint or requiring immediate recognition and management:
- shock and major physiological response to trauma
- significant blood loss and transfusion-related management
- musculoskeletal infection
- compartment syndrome
- neurovascular injury
- dislocated knee
- cauda equina syndrome
- acute spinal trauma
- spinal infection
- instability/major complications in inflammatory spinal disease
- metastatic spinal cord compression
- painful spine in a child
- painful hip in a child
Examination perspective
The official blueprint maps syllabus items to several assessment methods. For FRCS preparation, the two examination components are:
- ISB Section 1 — written examination
- ISB Section 2 — clinical and oral examination
The blueprint also maps training outcomes to workplace-based tools such as CEX, CBD, DOPS, PBA, MSF and MCR. These mappings indicate how competence may be assessed during training and should not be interpreted as meaning that a topic belongs only to one examination component.
Source
Primary source
Joint Committee on Intercollegiate Examinations (JCIE).
Intercollegiate Specialty Examination in Trauma & Orthopaedic Surgery — Syllabus Blueprint 2023.
Version 2.0. Last review: July 2023.
Official JCIE Trauma & Orthopaedic Surgery page:
https://www.jcie.org.uk/content/content.aspx?ID=20
Official JCIE syllabus blueprint PDF:
https://www.jcie.org.uk/Utils/DocumentGenerator.aspx?Type=CMS&docID=a00f232c-4cee-4d28-94f8-466f24372472
Accessed: 19 September 2026.
This thinKbox FRCS page is a professionally reorganised study-navigation version of the official JCIE blueprint. The official JCIE document remains the definitive source for the examination syllabus and assessment mapping.