The Complete Guide to the FC Orth(SA) Examination 2025

The Fellowship of the College of Orthopaedic Surgeons of South Africa—FC Orth(SA)—is one of the most clinically demanding orthopaedic qualifications in the world. Administered by the Colleges of Medicine of South Africa (CMSA), it is the gold standard for specialist registration with the Health Professions Council of South Africa (HPCSA). This guide provides a detailed breakdown of the grueling three-part examination pathway, specifically tailored for registrars navigating the South African public health context.

Visual Element: A timeline graphic illustrating the 4-5 year registrar journey: Primary Exams (Year 1) -> Intermediate Exams (Year 2) -> Research/MMed -> Final Exams (Year 4/5).

What is FC Orth(SA)?

The FC Orth(SA) is not just an exam; it is a rite of passage. South African orthopaedic training is renowned for its high trauma volume ("The Knife and Gun Club" of the world), and the examination reflects this. It demands not only theoretical brilliance but also the practical ability to manage complex polytrauma, advanced pathology (TB spine, chronic osteomyelitis), and resource-constrained scenarios.

Key Facts at a Glance

Examination Pathway

The road to fellowship is divided into three major hurdles.

graph TD
    A[Medical Officer / Junior Registrar] --> B(FCS(SA) Primary)
    B -->|Pass| C[Registrar Rotation Year 1-2]
    C --> D(FC Orth(SA) Intermediate)
    D -->|Pass| E[Registrar Rotation Year 3-4]
    E --> F[Case Logbook & Portfolio]
    F --> G(FC Orth(SA) Final)
    G -->|Pass| H[Specialist Orthopaedic Surgeon]

Part 1: FCS(SA) Primary Examination

This exam is shared with general surgery and plastic surgery trainees. It filters candidates based on basic surgical sciences.

Format

• Papers: 2 MCQ Papers (Online).
• Content: Anatomy, Physiology, Pathology, Microbiology.
• Difficulty: High. The anatomy paper is notorious for detailed questions on neuroanatomy and embryology.

Trap: Don't underestimate the Physiology/Pathology paper. Many orthopaedic aspirants focus solely on limb anatomy and fail because they didn't study acid-base balance, shock physiology, or tumor markers.

Part 2: FC Orth(SA) Intermediate Examination

Once you are a registrar, this is your first specialty-specific hurdle. It usually takes place in the second year of training.

Eligibility

• Surgical Training: Minimum 18 months total.
• Orthopaedics: Minimum 12 months in a numbered registrar post.
• ICU: 3 months (Critical for trauma management).
• General Surgery/Trauma: 3 months.

Content: "Principles"

The Intermediate exam tests "Principles of Orthopaedics." This includes:

• Pathology: Bone healing, infection, tumors.
• Biomechanics: Implants, gait, tribology.
• Trauma Principles: ATLS, damage control, open fractures.
• Basic Sciences: Histology, genetics.

Clinical Pearl: The Intermediate exam often asks about "The Basics." You might be asked to classify plate functions (neutralization, compression, buttress, bridging) or explain the corrosion of implants. Master the AO Principles of Fracture Management book.

Part 3: FC Orth(SA) Final Examination

The "Finals" are the ultimate test. It is a comprehensive assessment of your readiness to be a consultant.

Eligibility

• Passed Primary and Intermediate.
• Completed 48 months of training (excluding community service).
• Logbook: A verified consolidated logbook showing sufficient surgical volume.
• ATLS: Current certification.
• WBA: Completion of Work-Based Assessments (since 2023).

Examination Structure

The Final is a tripartite beast. You must pass the written component to proceed to the orals (usually, though rules can vary by college regulations).

1. Written Component (33.3%)

• Paper 1: Pathology and General Principles.
• Paper 2: Trauma (Adult & Paediatric).
• Paper 3: Reconstructive / Elective Orthopaedics.
• Format: Short Answer Questions (SAQs). These require concise, bullet-point answers.

2. Clinical Based Scenarios (33.3%)

This replaces the old "Long Case" in some formats or supplements it. It involves paper-based or tablet-based scenarios with imaging.

• Focus: Diagnosis, classification, and detailed management planning.
• Example: "60M, 3 weeks post-THR, draining sinus. Outline management."

3. Oral Examination (33.3%)

• Format: Multiple stations (typically 3-4).
• Examiners: 2 per station.
• Content:
  • Trauma: X-rays on lightboxes. Complex fractures.
  • Pathology: Tumors, infection (TB, chronic osteo).
  • Paediatrics: Clubfoot, CP, DDH.
  • General: Arthroplasty, Hands, Spine.

The "South African" Context

You must know local pathology.

• TB Spine: Know the classification, medical management (drug regimens), and indications for surgery (Hong Kong operation).
• HIV in Orthopaedics: Management of fractures in HIV+ patients, risk of infection, IRIS.
• Gunshot Wounds: Low velocity vs. High velocity, debridement protocols, fracture fixation in GSWs.
• Chronic Osteomyelitis: Cierny-Mader classification and staged management (Masquelet technique).

Evidence Corner: South African literature is heavily tested. Read the SA Orthopaedic Journal (SAOJ). Knowing local papers (e.g., studies by Dunn on spine, or regarding local trauma burdens) gains immense respect from examiners.

Portfolio & Work-Based Assessment (WBA)

The CMSA has modernized. It's no longer just about the exam day; it's about the journey.

• WBA: You must have regular assessments signed off by consultants in your unit (e.g., Case-Based Discussions, Direct Observation of Procedural Skills).
• Logbook: The numbers matter. You need to show you are a "safe pair of hands." If you haven't done enough hips or nails, you may be flagged.

Preparation Strategies

1. The "Big Three" Books

• Solomon (Apley's): For general reading and flow.
• Campbell's: For operative details. You will be asked "How do you do it?"
• Rockwood & Green: For trauma. The bible of fractures.

2. Study Groups

Isolation is fatal. Form a group with registrars from different universities (UCT, Wits, Stellies, UP, UKZN). This cross-pollination is vital because examiners come from all these centers, and each center has its "favorite" topics/approaches.

3. Mock Exams

Simulate the stress. Do timed written papers. Practice vivas with consultants who are known to be "hawks" (tough examiners).

4. The "Golden Minute"

In the oral exam, your first minute dictates the station.

• Look: "This is an AP radiograph of the pelvis..."
• Describe: "...showing a disruption of the pelvic ring with..."
• Classify: "...consistent with a Young-Burgess APC II injury."
• Plan: "This is a surgical emergency requiring binder application and hemodynamic resuscitation."

Reciprocity and Global Standing

The FC Orth(SA) is highly respected.

• Fellowships: SA graduates are sought after in Canada, Australia, and the UK for trauma fellowships because of their superior surgical hands-on experience.
• GMC Registration: It facilitates registration in the UK (though PLAB/FRCS may still be required depending on current GMC rules).

How OrthoVellum Helps

OrthoVellum recognizes the unique challenges of the SA exam:

• Local Pathology: We have specific modules on TB Spine, GSWs, and Neglected Trauma.
• SAQ Practice: Our question bank includes "Short Answer" style questions to train you for the written papers.
• Visual Pathology: High-quality images of chronic osteomyelitis, Mycetoma, and advanced TB tailored for the Pathology station.

Key Takeaways

1. Trauma is King: You cannot pass FC Orth(SA) without mastering trauma.
2. Local Context: Know TB, HIV, and GSW management inside out.
3. Endurance: It’s a 4-year marathon. Pace yourself.
4. Portfolio: Keep your WBA and logbook updated in real-time. Do not backlog.
5. Viva Skills: Speak clearly, confidently, and safely. Conservative management is often a valid (and safe) answer in the SA context.

Start your FC Orth(SA) preparation today with OrthoVellum.

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