01 Dec 2017

Volume 5 Issue 4


From the Editor

As we approach the end of 2017 we face a world of uncertainty. The Christmas break is a time for reflection and also a time for looking forward. I hope that the articles we publish give some reasons for optimism.

The BOA Annual Congress in Liverpool reflected the breadth and diversity of our profession. Our reporters clearly took inspiration from their positive experiences and I hope that Congress 2018 in Birmingham is even bigger and better.

Two of the greatest challenges to a career in our specialty are selection and the Intercollegiate Examination. Applicants for ST3 posts should be reassured by the transparency of the process outlined by Lawrence Moulton. The examination is a particular challenge to those who are not working in a recognised training scheme. Kebba Marenah gives some sound advice on how to overcome this hurdle.

The orthopaedic curriculum has been criticised for being too centred on process and ticking boxes. We hope that the new version due for publication in August 2018 will correct this by focusing on a trainee’s capabilities and the expert trainer’s judgment on progression. Lisa Hadfield-Law explains the changes.

Our clinical articles look at two areas of concern and controversy. Spinal surgery is under the microscope as never before. Lee Breakwell and Michael Foy explain the particular problems this specialty is facing. The anxiety of dealing with potential malignant disease is never far away from our minds whatever our subspecialty interest. Paul Cool as our guest editor covers soft tissue sarcoma, metastatic bone disease and primary bone tumours in a way that is relevant to all of our readership.

In this issue we publish the obituaries of two of the giants of contemporary arthroplasty practice. Whilst it is sad to report the passing of Robin Ling and Michael Freeman, we should take heart and inspiration from their drive, innovation and leadership.

Finally, we have the distraction of our Christmas quiz to test you and your family.

I also take this opportunity to thank Fred Robinson for his enthusiasm, skill, knowledge and support as our co-editor over the last two years.

With very best wishes for the New Year from me, Fred and the JTO Team.


Phil Turner - BOA Vice President


Reference Lists


How I Do ... Whither (wither?) Spinal Surgery

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5. The 'three-legged stool': a system for spinal informed consent.  Powell JM, Rai A, Foy M, Casey A, Dabke H, Gibson A, Hutton M. Bone Joint J. 2016 Nov; 98-B (11):1427-1430. 

The Evolution of Trauma Courses in European Practice

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The Implementation of Rota Changes to Optimise Training Opprtunities in the East of Scotland

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4. Black J. 2009. EWTD: maintaining the pressure. Ann R Coll Surg Engl. 91: 258–259

5. Kara N, Patil PV,  Shimi, SM. 2008. Changes in working patterns hit emergency general surgical training. Ann R Coll Surg Engl. 90: 60–63

6. Stephens MR, Pellard S, Boyce J, Blackshaw, GRJC, Williams DH, Lewis WG. 2004. Influence of EWTD compliant rotas on SHO operative experience. Ann R Coll Surg Engl. 86: 120–121

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8. Marron CD, Byrnes CK, Kirk SJ. 2005. An EWTD compliant shift rota decreases SHO training opportunities Ann R Coll Surg Engl. 87: 246–248

9. Bates T, Cecil E, Greene I. 2007. The effect of the EWTD on training in general surgery: an analysis of electronic logbook records. Ann R Coll Surg Engl. 89: 106–109

10. Temple J. 2010. Time for training: a review of the EWTD on the quality of training. Department of Health, London  

11. Fitzgerald JEF, Caeser BC. 2012. The European Working Time Directive: A Practical review for surgical trainees. Volume 10, Issue 8, Pages 399–403  

12. Fitzgerald JEF, Caeser BC. 2012. The European Working Time Directive: A Practical review for surgical trainees. Volume 10, Issue 8, Pages 399–403 

An Alternative Route to Passing the FRCS: a Non-Trainee's Perspective

1. Davies J, Hadfield-Law, L. FRCS (T&O): a trainee’s and educationalist’s perspective on exam preparation. Journal of Trauma and Orthopaedics. 2017; 5(2):26-27

2. The Joint Committee on Intercollegiate Examinations - FRCS (Specialty) Examination Results. (Accessed Sept 2017) (Available from: https://www.jcie.org.uk/content/content.aspx?ID=9)

3. Joint Committee on Surgical Training - Waypoint assessment for ST6 Trainees in Trauma & Orthopaedics. (Accessed Sept 2017) (Available from: https://www.jcst.org/-/media/files/jcst/certification-guidelines-andchecklists/st6-checklist--to-2017-final.docx?la=en)

4. Joint Committee on Surgical Training - Penultimate year assessment checklist for Trauma & Orthopaedics. (Accessed Sept 2017) (Available from: https://www.jcst.org/-/media/files/jcst/certification-guidelines-andchecklists/penultimate-year-checklist--to-2017-final-(1).docx?la=en) 

Loss of Malpractice Insurance for Spinal Surgeons: Why You Need to Know About the Discount Rate

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2. Ministry of Justice (2017) The Personal Injury Discount Rate: how it should be set in the future 7th September 2017.

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4. Stride R (2017) MDU blasted for ditching back surgery.  Independent Practitioner Today July-Aug p8.