KURIKULUM PENDIDIKAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA

KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA

PERHIMPUNAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI INDONESIA

JAKARTA, JUNI 2012

KURIKULUM

PENDIDIKAN DOKTER SPESIALIS

ORTHOPAEDI DAN TRAUMATOLOGI

Penanggung Jawab : Prof. dr. Errol U Hutagalung, SpB, SpOT(K)

- (Ketua Kolegium Orthopaedi dan Traumatologi Indonesia )

Prof Dr. dr. Moh. Hidayat, SpB, SpOT(K) - (Wakil Ketua)

Ketua Komisi Kurikulum: Prof. Dr. dr. Putu Astawa, MKes. SpB, SpOT (K) Sekretaris Komisi : Dr. dr. Nucki N Hidajat, MKes, SpOT(K) Anggota : Prof. Dr. dr. Moh Hidajat, SpB, SpOT(K)

- Staf Pengajar PPDS Orthopaedi dan Traumatologi FKUB

dr. Ifran Saleh, SpOT(K)

- KPS PPDS Orthopaedi dan Traumatologi FKUI Dr. dr. Ismail, SPOT ( K )

- SPS PPDS Orthopaedi dan Traumatologi FKUI Dr. dr. Ferdiansyah, SpOT(K)

- Ka Dept. Orthopaedi & Traumatologi FK UNAIR /RSU Dr.Soetomo

Dr. dr. Dwikora Novembri Utomo, SpOT(K) - - KPS PPDS Orthopaed dan Traumatologi FUNAIR

dr. Mouli Edward, SpOT(K)

- - KPS PPDS Orthopaed dan Traumatologi FKUNAIR Dr. dr. Hermawan Nagar Rasyid, SpOT(K), MT(BME), PhD

- KPS PPDS Orthopaedi dan Traumatologi FK UNPAD dr. Yoyos Dias Ismiarto, SpOT(K)

- SPS PPDS Orthopaedi dan Traumatologi FK UNPAD Prof. Dr. dr. H.R. Agung Saifullah, SpB,SpOT(K) - KPS PPDS Orthopaedi dan Traumatolohi FK UNHAS dr. M. Ruksal Saleh, SpOT(K), PhD

- SPS PPDS Orthopaedi danTraumatologi FK UNHAS dr. Ismail Mariyanto, SpOT(K)

dr. Mujaddid Idulhaq, M.Kes, SpOT

- SPS PPDS Orthopaedi dan Traumatologi FK UNS Dr. dr. Rahadyan Magetsari, SpOT(K)

- KPS PPDS Orthopaedi dan Traumatologi FKUGM Dr. dr. Puntodewo, M.Kes, SpOT(K)

- SPS PPDS Orthopaedi dan Traumatologi FKUGM Prof. Dr. dr. I Ketut Siki Kawiyana, SpB, SpOT(K) - KPS PPDS Orthopaedi dan Traumatologi FK UNUD dr. I Ketut Suyasa, SpB, SpOT (K)

- SPS PPDS Orthopaedi dan Traumatologi FK UNUD Dr. dr. Edi Mustamsir, SpOT (K)

- KPS/Ka. SMF Orthopaedi dan Traumatologi FKUB dr. Istan Irmansyah, SpOT (K)

- SPS PPDS Orthopaedi dan Traumatologi FKUB

Editor : Prof. Dr. dr. Putu Astawa, MKes, SpOT(K)

- Staf Pengajar PPDS Orthopaedi dan Traumatologi FK UNUD

Dr. dr. Nucki N Hidajat, MKes, SpOT(K)

- Kepala Dept. Orthopaedi dan Traumatologi FK UNPAD /RS Dr. Hasan Sadikin

Syukur Alhamdulillah kita panjatkan ke hadirat Allah SWT, bahwa telah bisa diterbitkan buku kurikulum Progam Pendidikan Dokter Spesialis (PPDS) Orthopaedi dan Traumatologi oleh Kolegium Orthopadi dan Traumatologi edisi tahun 2012 ini, Buku ini merupakan revisi dan perubahan format serta penambahan di beberapa bagian dari edisi 2007, hal ini dilakukan atas dasar bahwa ilmu Orthopaedi dan Traumatologi merupakan cabang ilmu kesehatan yang terus bergerak secara dinamis sesuai dengan kebutuhan masyarakat maupun perkembangan ilmu teknologi kedokteran sendiri.

Penambahan yang paling signifikan adalah dalam aspek kompetensi afektif serta bidang sport injury, yang menjadi sumber rujukan adalah Kurikulum pendidikan dari British Orthopaedic Assossiation (BOA) yang disesuaikan dengan kondisi situasional local dan tingkatan kompetensi dari KKI (Konsil Kedokteran Indonesia).

Kami sangatlah menyadari buku kurikulum ini jauh dari kesempurnaan sehingga merupakan keniscayaan adanya asupan dan kritikan yang dapat membuat buku ini menjadi lebih baik.

Wassalam. Editor.

Ketua Kolegium Orthopaedi dan Traumatologi

Indonesia

Dokter Spesialis Orthopaedi dan Traumatologi adalah dokter yang telah mencapai kemampuan tertentu dan secara professional mengkhususkan diri dalam pelayanan bidang Orthopaedi dan trauma muskuloskeletal dan mempunyai kemampuan menyerap, mengembangkan serta mentransformasikan keilmuannya.

Penerbitan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi edisi tahun 2012 merupakan hasil penyempurnaan cetakan sebelumnya, Pada edisi ini dimasukan berbagai informasi baru yang merupakan hasil pengembangan dan pendalaman serta penyelarasan dari berbagai sumber.

Buku kurikulum ini disusun oleh Kolegium dan menjadi paduan bagi seluruh pimpinan, pendidik, tenaga kependidikan, dan paserta didik program dokter spesialis Orthopaedi dan Traumatologi di Indonesia, untuk dapat dilaksanakan secara konsisten. Disamping itu, untuk melengkapi buku ini diterbitkan pula buku Standar Penyelenggaraan Pendidikan Profesi Dokter spesialis Orthopaedi dan Traumatologi.

Kami mengucapkan terima kasih dan penghargaan setinggi-tingginya kepada Editor, Tim komisi Kurikulum kolegium Orthopaedi dan Traumatologi, dan anggota Kolegium lainya yang telah bekerja keras untuk menuangkan informasi yang relevan dan terkini serta melakukan kajian-kajian secara berkesinambungan dalam penyusunan buku ini.

Saran dan kritik untuk penyempurnaan buku kurikulum ini dapat ditujukan kepada Tim kurikulum kolegium Orthopaedi dan Traumatologi Indonesia.

Semoga Allah Subhanahu Wata’ala memberikan bimbingan, petunuk, dan kekuatan kepada kita. Aamiin.

Jakarta, Juni 2012 Ketua Kolegium Orthopaedi & Traumatologi Indonesia (Periode Nopember 2010 – Nopember 2012)

SURAT KEPUTUSAN Nomor : 013/Koleg-IOT/XII/2012

Kolegium Orthopaedi dan Traumatologi Indonesia Tentang

PELAKSANAAN PEMAKAIAN BUKU KURIKULUM

PENDIDIKAN DOKTER SPESIALIS ORTHOPAEDI DAN TRAUMATOLOGI KOLEGIUM ORTHOPAEDI DAN TRAUMATOLOGI

Menimbang : 1. Bahwa untuk menjalankan kegiatan Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi diperlukan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi.

2. AD / ART BAB 1. Pasal 13.2 Tentang Tugas Kolegium Orthopaedi dan Traumatologi Indonesia yaitu ayat 13.2.12 : Menyusun katalog pendidikan profesi dokter spesialis dan spesialis konsultan Orthopaedi dan Traumatologi Indonesia.

Mengingat : 1. SK Kolegium Orthopaedi dan Traumatologi Indonesia mengenai Koordinator Pelaksana Komisi Kurikulum Kolegium Orthopaedi dan Traumatologi Indonesia tanggal 23 Desember 2009 yaitu menugaskan Komisi Kurikulum untuk merevisi Kurikulum dan Standarisasi Seleksi Nasional Peserta Didik, yang diharapkan revisi Kurikulum sudah dapat digunakan pada Januari 2011.

2. Untuk menjalankan kegiatan Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi diperlukan Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi.

Memutuskan : 1. Bahwa hasil revisi Buku Kurikulum Pendidikan Dokter Spesialis Orthopaedi dan Traumatologi dapat mulai digunakan sebagai buku pegangan Program Studi Orthopaedi dan Traumatologi Indonesia. 2. Surat keputusan ini berlaku sejak tanggal ditetapkan.

3. Bila kemudian hari ada kekeliruan, SK ini dapat diperbaiki sebagaimana mestinya.

CARA PENGGUNAAN BUKU

Buku ini terdiri atas 4 Bab.

Bab I

, Pendahuluan mengambarkan filosofi yang mendasari

disusunnya Kurikulum dan beberapa pengertian tentang istilah yang

dipergunakan didalamnya.

Pada Bab II

, Menjelaskan tentang isi atau kontain yang terbagi

dalam bidang Kognitif, Psikomotor, dan Afektif.

Bidang kognitif dikelompokkan berdasarkan kombinasi antara region

anatomis (Spine, Hip, Knee, Ankle Foot, Shoulder Elbow, Hand),

Diseases

(Oncology, Paediatrik, Sport Injuri, dan Trauma), dan

Ilmu-ilmu Dasar (

Basic science, General Orthopaedi

).

Bidang Psikomotor dikelompokkan dalam Trauma Hard Tissue dan

Soft Tissue (General, Upper limb, Pelvic girdle, Lower limb, spine),

dan Non trauma dengan pembagian sesuai dengan regionya.

Bidang Afektif di bagi kedalam 6 kelompok, yaitu Perilaku

Profesional, Komunikator yang baik, mengajar dan melatih,

Keeping

Up to date

, Menjadi manajer yang baik,

Promoting Good Health

,

Etika.

Bab III

, Menjelaskan secara sistematika tahapan pencapaian

Kompetensi, dan ruang lingkup yang harus di bahas maupun

dikerjakan. Tingkat Kompetensi yan dipakai dalam buku ini adalah

sesuai dengan standar dari KKI, yang matrikulasi semua ini

dijabarkan di dalam lampiran 1, 2 dan 3.

Bab IV

, Dalam bab ini dijelaskan secara sistematis cara

melaksanakan Kurikulum dari ketiga aspek Pendidikan, Prasyarat,

serta Ketentuan-ketentuan yang harus dipenuhi, serta bagaimana cara

memonitor dan evaluasinya.

Tim Penyusun dan Editor………. i

Kata Pengantar ... iii

Kata Sambutan Ketua Kolegium ……….. iv

Surat Keputusan Penggunaan Buku Kurikulum... Vi Cara penggunaan buku ... Vii Daftar isi ... viii

BAB I PENDAHULUAN... 1

1.1 Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi Indonesia ………... 2

1.2 Model Kurikulum………. 2

BAB II ISI KURIKULUM... 3

2.1 Bidang Kognitif (Applied Clinical Knowledge Syllabu).... 6

2.2 Bidang Psikomotor (Applied Clin Procedures Syllabus. 25 2.3 Bidang Afektif (Professional & Management and Good Clinical Practice)………. 34 BAB III TINGKAT KOMPETENSI DAN LINGKUP BAHASAN………... 41

3.1. Tingkat Kompetensi………. 41

3.2 Tahapan Pencapaian Kompetensi………...…….. 43

BAB IV PELAKSANAAN KURIKULUM... 47

4.1 Cara Pelaksanaan ………. 47

4.2 Modul tambahan Kursus ………. 47

4.3 Karya Ilmiah Wajib……….. 48

4.4 Pelaksanaan Stase………. 48

4.5 Monitor dan Evaluasi ………... 50

4.6 Buku Acuan Wajib ……….. 52

DAFTAR PUSTAKA... 53

LAMPIRAN... 54

Lampiran 1 Tingkat Kompetensi Kognitif Peserta didik berdasarkan Topik dan Thapan Pendidikan……… 54

75

84 91 Lampiran 2 Tingkat Kompetensi Psikomotor Peserta Didik

berdasarkan Topik dan Tahapan………... Lampiran 3 Tingkat Kompetensi Afektif Berdsarkan Topik dan

Tahapan Pendidikan ………

BAB I

PENDAHULUAN

Pencapaian kesehatan yang optimal sebagai hak asasi

manusia masyarakat perlu mendapat perhatian. Pelayanan yang baik

dan bermutu merupakan dambaan masyarakat Indonesia. Untuk

mendapatkan itu perlu dihasilkan pelayan kesehatan yang baik

termasuk perawat, dokter umum dan juga dokter sepesialis. Dokter

sebagai salah satu komponen utama pemberi pelayanan kesehatan

masyarakat mempunyai peran yang sangat penting sehingga

Pendidikan Kedokteran akan menjadi penting.

Untuk memberikan perlindungan kepada pasien dan

mempertahankan mutu pelayanan kesehatan pemerintah dengan

Undang-undang RI No. 20 tahun 2003 tentang Sistem Pendidikan

Nasional dan Undang-Undang RI No. 29 tahun 2004 tentang

Praktik Kedokteran menekankan Standar Pendidikan Kedokteran

dam memberi kepastian hukum kepada masyarakat dan Dokter.

Asosiasi Institusi Pendidikan Kedokteran berkoordinasi

dengan Organisasi Profesi, Kolegium, Asosiasi Rumah Sakit

Pendidikan, Departemen Pendidikan Nasional dan Departemen

Kesehatan Kolegium kedokteran dalam menyusun standar

Pendidikan Profesi Dokter berkoordinasi dengan Organisasi Profesi,

Asosiasi Institusi Pendidikan, Departemen Pendidikan Nasional dan

Departemen Kesehatan

1.1.

Pengertian Kurikulum Ilmu Orthopaedi dan Traumatologi

Indonesia

Kurikulum merupakan seperangkat rencana dan pengaturan

pendidikan yang meliputi tujuan pendidikan, isi, bahan pelajaran,

cara pencapaian dan penilaian, yang digunakan sebagai pedoman

penyelenggaraan Pendidikan Ilmu Orthopaedi dan Traumatologi

1.2. Model Kurikulum

Model Kurikulum berbasis Kompetensi dilakukan dengan

pendekatan terintegrasi baik horizontal maupun vertikal, serta

berorientasi pada masalah kesehatan individu, keluarga dan

masyarakat dalam konteks pelayanan kesehatan paripurna

.

ISI KURIKULUM

Isi Kurikulum meliputi prinsip-prinsip metode ilmiah,

biomedik, ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi

dan Traumatologi, Ilmu humaniora yang disesuaikan dengan

Standar Kompetensi yang ditetapkan. Prinsip-prinsip metode

ilmiah meliputi metodologi penelitian, filsafat ilmu, berpikir kritis,

biostatistik dan

evidence-based medicine

.

Ilmu biomedik meliputi anatomi, biokimia, histologi,

biologi sel dan molekuler, fisiologi, mikrobiologi, imunologi,

parasitologi, patologi, dan farmakologi. Ilmu biomedik dijadikan

dasar ilmu kedokteran klinik dalam hal ini Ilmu Orthopaedi dan

Traumatologi sehingga anak didik mempunyai pengetahuan yang

cukup untuk memahami konsep dan praktik kedokteran klinik.

Ilmu-ilmu humaniora meliputi ilmu perilaku, psikologi

kedokteran, sosiologi kedokteran dan profesionalisme. Menurut Dr.

Victor Neufeldt, satu kunci konsep kurikulum baru adalah “…

that

it is not only the sum total of residents’ experience, planned or

unplanned. A broader view is needed, and the curriculum should be

seen as an

activity

where residents and faculty

learn

and

work

Kurikulum berdasarkan Kompetensi terdiri atas dua

komponen utama yaitu

Core

Kurikulum dan

Non Core

Kurikulum

(

miss program of special study, local content

.)

Core

Kurikulum

sangat penting yang harus dikuasai oleh semua residen dan terdiri

dari :

1. Bidang Kognitif (

Applied Clinical Knowledge Syllabus

)

2. Psikomotor (

Applied clinical Procedure Syllabus

)

3. Afektif (

Professional and Management and Good Clinical

Practice

)

Core Curriculum

dapat disederhanakan menjadi

General

Core Curriculum

kemudian komponen Kurikulum sehingga

memudahkan Peserta Didik untuk mengikuti proses belajar

mengajar.

Fostering conducive environment Curriculum renewal

Gambar 1.1. Skema Tujuan Komprehensif Kurikulum

Management of change Resident

& faculty support systems

Curriculum communication

resident What to learn (content) How to learn (Methods – strategies) Assessment Education competency

2.1. Bidang Kognitif

(Applied Clinical Knowledge Syllabus

)

1. BASIC SCIENCE

No. General Core

Curriculum

Komponen Curriculum

1A Anatomy:  Clinical and functional anatomy with pathological and operative relevance

 Anatomy (and embryology) of nervous and vascular systems

 Surgical approaches to the limbs and axial skeleton

 Anatomy (and embryology) of musculo-skeletal system

1B. Tissues:  Bone - Structure & Function

 Cartilage - articular, meniscal - Structure & Function

 Muscle and tendon - Structure & Function

 Synovium - Structure & Function

 Ligament - Structure & Function

 Nerve - Structure & Function

 Intervertebral disc - Structure & Function 1C Physiology,

Biochemistry & Genetics:

 Structure and function of connective tissues

 Application/relevance of modern genetics to orthopaedic disease and treatment

 Shock - types, physiology, recognition and treatment

 Metabolism and hormonal regulation

 Metabolic and immunological response to trauma

 Blood loss in trauma/surgery, fluid balance and blood transfusion

 Bone grafts, bone banking and tissue transplantation 1D. Biomechanics &

Bioengineering:

 Biomechanics of musculoskeletal tissues

 Biomechanics of fracture fixation

 Tribology of natural and artificial joints

 Design of implants and factors associated with implant failure(wear, loosening)

 Kinematics and gait analysis

2. BONE, JOINT DISEASE & GENERAL ORTHOPAEDIC

2A General: Osteoarthritis

Osteoporosis

Metabolic bone disease

Rheumatoid arthritis and other arthropathies (inflammatory, crystal, etc)

Haemophilia

Curriculum

2A General: (Cont.) Neuromuscular disorders - inherited and acquired

Osteonecrosis

Osteochondritides

Heterotopic ossification 2B Investigations: Blood tests

Musculoskeletal imaging: x-ray, contrast studies ( myelography, arthrography), CT, MR, ultrasound, radioisotope studies

Effects of radiation

Bone densitometry

Electrophysiological investigations 2C Operative Topics: Tourniquets

Principles of Sterilization

Design of theatres & Skin preparation

Anaesthesia - principles and practice of local and regional anaesthesia and principles of general anaesthesia

Principle treatment of musculoskeletal tumor

Principle surgery of musculoskeletal tumor

Infection, Thromboembolism & Pain:

Infection of bone, joint, soft tissue, including tuberculosis , and their prophylaxis

2D Miscellanous: Thromboembolism and prophylaxis

Behavioural dysfunction and somatization

AIDS and surgery in high-risk patients

Management of Pain and pain relief

Complex regional pain syndromes e.g. Reflex Sympathetic

Dystrophy and Causalgia 2E Prosthetics &

Orthotics:

 Principles of design

 Prescription and fitting of standard prostheses

 Principles of orthotic bracing for control of disease, deformity and instability

2E Research & Audit:  Design and conduct of clinical trials

 Data analysis and statistics - principles and applications

 Principles of Epidemiology

 Audit 2F Medical Ethics:  Duties of care

 Informed consent

 Medical negligence

3. HAND & MICRORECONSRUCTION

3A. Anatomy of: The wrist/MCP/PIP/DIP joints and CMC joint of the thumb

The flexor and extensor mechanism of the fingers including interaction between extrinsic and intrinsic mechanism

The posture of the thumb in pinch, power and key grip

The nerve supply to the hand

The closed compartments of forearm and hand

3B. Pathology: An understanding of the special circum-stances associated with swelling and the effects of rising pressure in a closed compartment secondary to infection and injury

An understanding of the special circum-stances in which oedema causes fibrosis and permanent stiffness

Tendon injury and healing

Nerve injury and healing

An appreciation of the imbalances and deformities associated with inflammatory arthritis

 A classification system for congenital hand disorders

 Langers lines

 Hand tumours (e.g. ganglion/enchondroma)

 Dupuytren's disease 3C. Clinical

Assessment:

History of examination of hand and wrist in the assessment of tendons, distal radioulnar and radiocarpal joints

Ability to elicit median, ulnar and radial nerve function and disorders

Recognition of patterns of presentation of common compressive neuropathies and brachial neuralgia

Assessment of intrinsic and extrinsic motors in digits and recognition of common deformities and deficiencies

Awareness of presentation of work-related hand disorders

Ability to examine and assess common rheumatoid hand deformities, e.g.: inferior radioulnar subluxation and carpal translo-cation; MCP subluxation and ulnar drift; digital Boutonniere and swan neck; thumb Boutonniere deformity and CMC disease

Curriculum

3D. Investigations: Interpretation of plain and stress x-rays of wrist.

A knowledge of other views

Awareness of role of MRI/bone scan/ arthrography/arthroscopy

Place and interpretation of nerve conduction studies 3E.

Treatment:

Knowledge of a strategy of management for the osteoarthritic rheumatoid hand.

Understanding of the place of soft tissue

reconstruction, joint fusion, interposition and excision arthroplasty in the treatment of the arthritic hand and wrist.

Knowledge of the management of stenosing

tenovaginitis

Knowledge of the principles of treatment for common flexor and extensor tendon injuries and of the common surgical approaches to the digital flexor and extensor compartments

Fractures of metacarpals and phalanges

Familiarity with the surgical treatment of

Dupuytren’s disease

Awareness of the principles of tendon transfer for the reconstruction of mediun, ulnar and radial nerve palsy and familiarity with simple transfers, e.g. indicis to EPL

Knowledge of splinting techniques and

rehabilitation principles

Ability to plan management for finger tip injuries and undertake

closed management

Knowledge of surgical approach to digits with particular regard to the restoration of function and prevention of stiffness

Knowledge of the levels for digital amputation

Injuries of ulnar collateral ligament of thumb

Dislocations of carpus and carpal instability

Knowledge of closed and operative options of treatment for fractures of distal radius and common carpal injuries including scaphoid non union.

Familiarity with the surgical treatment of common compressive neuropathy

Curriculum 4. KNEE

4A. Anatomy:  Knowledge of regional anatomy of the knee, including:

 Surface anatomy

 Neural and vascular structures and their relations with particular reference to standard anterior and posterior surgical approaches

 Knowledge of regional anatomy of the knee, including:

 Surface anatomy

 Neural and vascular structures and their relations with particular reference to standard anterior and posterior surgical approaches

 Bones and joints

 Functional anatomy of ligaments and supporting muscles

 Innervation of the knee including controlling musculature

 The extent and function of the synovium and bursae of the knee

 The structure and function of the menisci, and articular cartilage

4B. Biomechanics:  The mechanics of the patello-femoral mechanism

 The medial and lateral weight-bearing joints and their inter-relationship

 The cruciate and collateral ligaments and other ligamentous and muscular supports

 Menisci and articular cartilage

4C. Pathology:  The mechanism of ligamentous, bony and combined trauma to the knee and healing potential

 A complete knowledge of arthritides, including degenerate wear, ageing changes and traumatic damage

 Pathology of inflammatory disease and infection affecting the knee

 The response of synovium to debris

 Benign and malignant conditions in the knee and surrounding structures including recognised classification where appropriate

4D. Clinical Assessment:

 A sound knowledge and understanding of:

 History and examination of the knee to include relevant surrounding structures

The standard clinical signs of the knee and relevant adjacent structures and competent skill in describing these

Curriculum 4D. Clinical

Assessment: (Cont.)

A critical understanding of rating and outcome measures in common use

4E. Investigations: Indications for and interpretations of:

Radiographs – standard and specialised

Blood investigation

Aspiration

Special investigations including CT, MRI and radioisotope scanning

Arthroscopy

Biomechanical testing

4F. Treatment: A sound knowledge of conservative and surgical

management, including the indications for referral to a specialist of:

Paediatric disorders, including deformity, dislocations, epiphyseal disorders, osteochondritis and discoid meniscus

Adolescent disorders including patello femoral and meniscal dysfunction, osteochondritis dissecans

Young adult disorders including patello femoral and meniscal injuries, instability and ligament deficiency, synovial disorders, benign and malignant tumours

Degenerative and inflammatory arthritis, including a balanced understanding of conservative and surgical options,including osteotomy, arthrodesis and arthroplasty

Traumatic disorders including skin and soft tissue injuries, fractures and dislocations of patella, tibia and femoral components, ligament ruptures and internal derangement of the knee. Conservative and surgical indications and detailed .Methods of treatment. Outcomes of conservative and operative management

Infections, particularly infections and inflammations of the bursae, intra-articular sepsis, prevention and management of sepsis in implant surgery

A sound working knowledge of the range of arthroplasties for primary and revision surgery for patello femoral, unicompartmental and total replacement of the knee with particular reference to secure bone anchorage, alignment, ligament stability and optimising range of movement; a good knowledge of post-operative complications, their Sprophylaxis and management

Curriculum 4F. Treatment

(cont):

 A knowledge of the indications and techniques of revision surgery particularly for aseptic and septic loosening

 A knowledge of simple arthroscopic surgery including meniscectomy, trimming and shaving

 An appreciation of complex arthroscopic procedures

 An appreciation of medical and surgical techniques available to repair and replace articular cartilage 5. ANKLE & FOOT

5A. Anatomy: Bones and articulations

Ligamentous structures – ankle/hindfoot/ midfoot

Plantar fascia and MTP anatomy

Surface markings of neural and vascular structures

Tendon anatomy

Muscle compartments of the foot

5B. Biomechanics: Function of the lower limb and foot in gait

Ankle and subtalar joint

Plantar fascia mechanisms

Tendon function

Orthoses and footwear 5C. Pathology: Arthritides

Degenerative joint disease

Rheumatoid foot disease

Neuropathy

Neuropathic joint and skin changes

Tumours

E.g. osteoid osteoma and plantar fibroma

Clinical Assessment:

History and clinical examination of the foot and ankle in order to assess pain, joint function, deformity, nerve, muscle and tendon function

5D. Ability to recognise and assess the following diseases of the ankle and foot: 1) Neurological

disorders:

Charcot joint

Morton's neuroma

Nerve entrapment

Neurological foot deformity

2) Trauma: Evaluation of skin and soft tissue injury

Compartment syndrome

Recognition of all fractures and dislocations

Curriculum

2) Trauma: (Cont.) Hindfoot pain

Ankle instability

Heel pain

Degenerative disease of the ankle

Rheumatoid arthritis

Osteochondritis dissecans of talus 3) Forefoot

disorders:

Hallux valgus

Hallux rigidus

Lesser toe deformities

Metatarsalgia

Inflammatory arthritis

4) Tumours: Ability to recognise and assess local foot swellings

 Diabetic foot:

 Complex foot deformity

 Flatfoot deformity - mobile and rigid

 Cavus deformity

 Residual congenital foot deformity 5E. Investigations:

Radiograph:  _{Standard foot and ankle views} CT, MRI and

Scintigraphy:

 Knowledge of role of these ancillary investiga-tions in certain specific condiinvestiga-tions e.g. infection, tumour, tibialis posterior rupture, osteonecrosis

EMG:  Relevance to foot and ankle disorders

5F. Treatment Non-operative:

 Knowledge of rational basis for the use of footwear modifications, orthoses and total contact casting

Operative:  Detailed knowledge of closed and operative methods for management of fractures and dislocations of ankle, hindfoot and forefoot, including knowledge of common reconstructive surgical procedures for foot deformity including hallux valgus, lesser toe deformity, acquired flat-foot, to include arthrodesis, osteotomy and soft-tissue reconstruction

 Knowledge of common amputations through foot

and ankle

 Knowledge of common reconstructive surgical

procedures for degenerative and inflammatory disorders of ankle and foot including arthrodesis, arthroplasty, excision arthroplasty procedures to first ray both proximal and distally for management of hallux valgus and rigidus

Curriculum 6. HIP JOINT 6A. Anatomy: 6B. Basic knowledge of the regional anatomy of the hip including:

 Development of the hip joint

 Relationship of bony elements

 Blood supply of the femoral head

 Anatomical course of all major regional vessels and nerves

 The capsule, labrum and related ligaments

 An understanding of the action, anatomy and innervation of the regional musculature

 Detailed knowledge of the applied anatomy of common surgical approaches to the hip (medial, anterior, lateral and posterior)

6C. Biomechanics:  An understanding of the lever arms, muscles and body weight forces that produce the joint reaction force in both normal and abnormal hips

 An understanding of the application of these principles to the rationale of both pelvic and femoral osteotomies, and replacement arthroplasty

 Knowledge of the tribological properties of materials used for articulating surfaces

 Knowledge of the biocompatibility and mechanical properties of materials in common use in total hip arthroplasty

6D. Pathology:  Basic knowledge of the pathology of pyogenic and non-pyogenic arthritis, slipped upper femoral epiphysis [SUFE], Perthes' disease and hip dysplasia

 Mechanism and pattern of common fractures and fracture dislocations around the hip (intracapsular, extracapsular, acetabular and periacetabular, femoral head, etc)

 Knowledge of the pathology of osteoarthritis, rheumatoid arthritis and the seronegative arthritides at the hip and of osteonecrosis of the femoral head

 Familiarity with current theories of the aetiopathogenesis of osteoarthritis

 An understanding of the microbiological rationale for the prevention of sepsis in total hip arthroplasty 6E. Clinical

Assessment:

 A sound knowledge of clinical assessment of the hip, lumbosacral spine and knee. Particular reference should be paid to the gait, the Trendelenberg sign, limb length, loss of movement and deformity at the joint

Curriculum

6E. The trainee needs to be well informed of current opinion regarding aetiopathogenesis, clinical presentation and appropriate investigation of:

 Proximal femoral fractures (intracapsular, extracapsular) and simple fracture dislocations of the hip

 Osteoarthritis and the inflammatory arthropathies

 Perthes' disease

 Slipped upper femoral epiphysis

 Septic arthritis

 Osteonecrosis

 Soft tissue conditions around the hip (snapping hip, gluteus medius tendonitis, etc)

A working knowledge of the clinical presentations and investigations of:

 The sequelae of CDH and hip dysplasia

 The sequelae of SUFE

 Juvenile chronic arthritis

 Non pyogenic arthritis

 The painful total hip replacement

6F. Investigation:  A working knowledge of the interpretation of plain radiographs, dynamic arthrography, CT, bone scintigraphy and MRI of the hip region

 A working classification of proximal femoral and periacetabular fractures. Also, mechanisms and classification of failure of joint replacement and of periprosthetic fractures

6G. Treatment:  Non-operative

 An understanding of the principles of traction, bracing and spica immobilisation

 An understanding of the non operative aspects of the management of hip pathology

 Operative

 A thorough knowledge of soft tissue surgery, osteotomy, arthrodesis and arthroplasty (excision and replacement). A sound knowledge of anterior, anterolateral, lateral and posterior approaches to the hip and of the complications associated with each

A sound knowledge of: internal fixation of proximal femoral fractures, hemiarthroplasty for intracapsular fractures, primary total hip replacement for OA and inflammatory arthropathies in the elderly, simple proximal femoral osteotomies. Familiarity with potential complications (i.e. thromboembolism, sepsis, dislocation, etc) and be aware of current opinion on the prevention and management of these complications

A knowledge of the indications for, and principles of, complex proximal femoral osteotomies, hip arthroscopy, reconstruction of the hip in young adults (JCA and hip dysplasia, etc), complex hip revision surgery

Curriculum

6G. Treatment (Cont.)  An appreciation of complex acetabular and pelvic fractures, complex periacetabular osteotomies

 An understanding of the place of modern technologies such as, joint resurfacing procedures minimally invasive hip replacements and computer assisted implantation in the management of hip pathology and the attendant risks and complications

7. THE SPINE

7A. Anatomy:  Development of the spine, spinal cord and nerve roots

 Surgical anatomy of the cervical, dorsal and lumbosacral spine

 Anterior and posterior surgical approaches to the spine at each level

7B. Biomechanics:  Basic knowledge of the biomechanics of the cervical and lumbosacral spines

 An understanding of the biomechanics of spinal instability as applied to trauma, tumour, infection and spondylolysis/listhesis

 Biomechanics of spinal deformity

 A knowledge of the basic mechanics of spinal instrumentation

7C. Pathology:  _{Pathophysiology of the ageing spine and} degenerative disc disease

 Acute and chronic infections of the spine

 Pathology of spinal deformity

 Pathology of the acutely prolapsed cervical and lumbar disc

 Recognition of patterns of spinal injury and associated cord and nerve root damage

 Tumours of the spine 7D. Clinical

Assessment:

 A thorough knowledge of general and orthopaedic history-taking and examination

 A knowledge of the assessment of spinal deformity

 An understanding of the assessment of thoracic pain

 A sound knowledge of clinical assessment of the spine for low back pain, sciatica, spinal claudication, neck pain, radiating arm pain, spinal injury and incipient myelopathy

 A knowledge of the assessment of spinal tumour

 A basic knowledge of the assessment of a patient after failed spinal surgery

Curriculum

7E. Investigation:  A thorough knowledge of the basic investigations required in spinal surgery, specifically: blood tests, plain radiographs, bone scintigraphy, discography, electrophysiological studies [including cord monitoring], CT scanning, MRI scanning

 A thorough knowledge of how each of these investigations contributes to the diagnosis and management of each of the major areas of spinal disease

7F. Treatment:

Non-operative  A knowledge of the non-surgical methods available for the treatment of low back pain, sciatica, claudication, neck pain, spinal deformity, instability, tumour, infection and fracture to include:

 Analgesics and NSAIDs, physiotherapeutic regimes, pain clinic techniques, bracing, use of radiotherapy and chemotherapy, non-operative management of spinal injuries

Operative  A sound knowledge of the indications for and operative surgical management of the acute prolapsed lumbar intervertebral disc, spinal stenosis, lumbar spinal instability due to spondylolysis/listheses

 A knowledge of the indications for, and operative surgical management of the acutely

 prolapsed cervical disc, cervical stenosis, spinal injury and the surgery of spinal infection

 A basic knowledge of the surgery of spinal deformity and tumours of the spine

8. TRAUMA

8A. Anatomy:  Applied to diagnosis and surgical treatment of common bone, joint and soft tissue injuries

 Knowledge of those anatomical structures particularly at risk from common injuries or in surgical approaches

 Physeal anatomy and its application to injury

8B. Biomechanics:  Application to open reduction and internal fixation of fractures and external skeletal fixation

 Applied to fracture formation and fracture treatment both operative and non-operative

 Biomechanics of implants and fracture fixation systems, including their material properties

 Epidemiology and Research Methods:

 Research and audit methods including the design of clinical trials

Curriculum 8C. Pathophysiology

& Pathology:

 Applied to fracture and soft tissue healing, including skin, muscle, tendon and neurological structures

 Classification systems for fractures and dislocations

 Pathology of non-union of fractures

 Response of the body, and local musculoskeletal tissues to infection

 Systemic response of body to major injury

 Mechanisms underlying Acute Respiratory Distress Syndrome and similar life threatening conditions

 Science of fluid replacement therapy in the acutely injured including application to the treatment of burns

 Science of treatment of compartment syndrome

 Response of infants, children and the elderly to injury 8D. Clinical

Assessment:

 Initial clinical assessment of the patient with severe injury, including spinal cord injury, soft tissue injury, burns and head injury

 Assessment of all types of fracture and dislocation, their complications, early and late

 Identification of life threatening/ limb threatening injuries. Understanding priorities of treatment 8E. Investigations:  Knowledge of the principles, application and side effects

of commonly used investigations, including radiographs, CT and MRI scans, radio-isotope imaging, ultrasound scans and electrophysiological investigations

8F. Management:  Knowledge of different treatment options for musculoskeletal injury, both non-operative and operative. Ability to analyse the pros and cons for each method

 Ability to manage the overall care of the severely injured

 Ability to undertake the complete treatment of all types of common fracture and dislocation including the bone and soft tissue treatment of open fractures and the treatment of pathological fractures

 Where common injuries are normally treated by a sub specialist (e.g. spinal injury, arterial injury or intra cranial haemorrhage) there should be ability to manage the initial treatment of the patient and know the principles of the specialist treatment

 Principles of reconstructive surgery for the injured, including treatment of non-union and malunion of fractures, bone defects, chronic post-traumatic osteomyelitis and delayed treatment of nerve injury; principles of soft tissue reconstruction

 The principles of amputation in the injured and the rehabilitation of such patients

Curriculum

9. PAEDIATRIC ORTHOPAEDIC

9A Basic Science:  Detailed knowledge of the growth of bones, physeal anatomy and its application to fracture types and pathological processes and infection in particular

 Knowledge of the anatomy of bones and joints in the growing child and its application to growth and deformity

 Knowledge of the neurological processes involved in the production of deformity e.g. spina bifida, cerebral palsy and muscular dystrophy

9B Clinical Assessment:

 Core knowledge should be at least that of a general orthopaedic textbook

 'Expert' knowledge, i.e. the level of the speciality journal is required for those wishing to pursue a career in children's orthopaedics

 The trainee must be able to clinically examine a child competently and to relate effectively with the family

 The trainee must be able to make proper management decisions in paediatric practice and to refer appropriately for treatment

9C Investigations:  Knowledge of the indications for plain x-ray, arthrogram, CT, MRI and the ability to interpret the images

 Knowledge of the indications for the use of ultrasound and nuclear imaging

 Awareness of the limitations of certain investigations in paediatric practice

9D Treatment:  A sound knowledge of normal variants, e.g. knock knees, bow legs and flat feet

 A detailed knowledge of the treatment for:

o Fractures (including non-accidental injury) and growth plate injuries and recognise the sequelae

o Bone and joint infection

o Common childhood orthopaedic conditions, e.g. irritable hip, anterior knee pain

 A working knowledge of the treatment for:

o Slipped epiphysis

o Perthes' disease

o Developmental dysplasia of the hip

o Talipes

o Scoliosis

o Simple foot deformities (e.g. hallux valgus, metatarsus varus)

Curriculum

9D Treatment (Cont.): oSimple congenital hand abnormalities (e.g. trigger thumb)

oOsteogenesis imperfecta

oSkeletal dysplasias

oTarsal coalitions

oTorticollis

oLeg length discrepancy

9E A knowledge of:  Screening services for congenital abnormalities

 Assessment of physical disability 10. SHOULDER & ELBOW

10A. Anatomy:

Basic knowledge of the regional anatomy of the shoulder including:

 Detailed anatomy of the sternoclavicular, acromioclavicular, glenohumeral and elbow joints to include the connecting bones, muscles and tendons acting across them, neurovascular supply, bursae and relationships to local structures

 Surgical approaches: deltopectoral and posterior approaches to glenohumeral joint; superior (McKenzie) approach to rotator cuff; and surgical approaches to the acromioclavicular and sternoclavicular joints

 Structure and function of the above joints; a clear understanding of the static and dynamic stabilisers of the glenohumeral and elbow joints

10B. Biomechanics:  Biomechanics of the shoulder and elbow to the level of the currently published specialist journals

 Knowledge of the various types of shoulder and elbow prostheses including the factors influencing design, wear and loosening to the level of the currently published specialist journals

10C. Pathology:  Sound knowledge of all commonly encountered benign and malignant conditions affecting the shoulder girdle, elbow and surrounding soft tissues

 A basic understanding of the pathology of:

 Impingement and rotator cuff disorders

 Instability of the shoulder and the elbow

 Inflammatory and degenerative conditions affecting the articular cartilage and synovium

 Infection

 Adhesive capsulitis of the shoulder

 The pathology of the stiff elbow

 Disorders such as ulnar neuritis and tennis or golfer’s elbow

Curriculum 10D. Clinical

Assessment:

 Detailed history and examination of the painful, stiff or unstable shoulder or elbow

 Knowledge of clinical tests used specifically to assess instability of the shoulder and elbow, rotator cuff disorders, the stiff shoulder or elbow and the use of local anaesthetic in assessment. Examples are the apprehension tests for shoulder instability, impingement signs and tests, Gerber’s lift off test, Napoleon's sign, elbow instability tests, ulnar nerve assessment

 Knowledge of conditions causing referred symptoms to the shoulder and elbow (e.g. cervical spine diseases, entrapment neuropathies and thoracic outlet disorders)

 Knowledge to the level of a basic specialist shoulder textbook of common conditions affecting the shoulder including instability, impingement, rotator cuff tears, adhesive capsulitis, osteoarthritis, rheumatoid disease, avascular necrosis, biceps tendon disorders, fractures of the proximal humerus and clavicle, and disorders of the acromioclavicular and sternoclavicular joints and scapula

 Knowledge to the level of a basic specialist elbow textbook of common conditions affecting the elbow including instability, osteoarthritis, rheumatoid arthritis, causes of stiffness, soft tissue problems such as medial and lateral epicondylitis, neuropathies and fractures around the elbow

10E. Investigation:  Knowledge of plain radiographs as used to assess shoulder and elbow disorders. This should include a knowledge of those special views (e.g. Modified axial, Stryker notch, Supraspinatus Neer outlet and cubital tunnel views) required to assess adequately the conditions which commonly affect the shoulder and elbow. The ability to recognise correctly normal and abnormal abnormalities on plain radiographs

 Knowledge of the value of ultrasound, arthrography, CT and MRI as used to assess the shoulder and elbow. An ability to identify straightforward abnormalities on CT and MRI (e.g. full thickness and partial thickness rotator cuff tears on MRI and the pathological anatomy of fractures around the shoulder and elbow using CT)

 Knowledge of the use and abuse of arthroscopy of the shoulder and elbow including a knowledge of normal and abnormal arthroscopic findings

Curriculum 10F. Treatment:

1) Non-operative  An ability to supervise the non-operative management of fractures, dislocations and soft tissue injuries around the shoulder and elbow

 An in-depth knowledge of the management of straightforward fractures and dislocations of the shoulder girdle and elbow. Knowledge of the treatment options for more complex fractures with an understanding that these might more appropriately be referred to someone with a special interest; examples of these might include four part fractures of the proximal humerus and complex intraarticular fractures of the distal humerus. An ability to recognise upper limb injuries involving injuries to the brachial plexus and refer on as appropriate

 A knowledge of injection techniques for both the shoulder and the elbow

 Knowledge of both the non-operative and operative treatment of common disorders such as recurrent anterior traumatic instability of the shoulder, rotator cuff impingement and small rotator cuff tears, adhesive capsulitis, acromioclavicular joint pain

2) Operative  A knowledge of the management of soft tissue elbow disorders such as lateral and medial epicondylitis and ulnar neuropathy

 Knowledge of the indications, options and complications for prosthetic replacement of the shoulder and elbow. A detailed knowledge of the surgical techniques is not required

2) Operative (cont.)  Knowledge of the indications and benefits of arthroscopy of the shoulder and elbow. An ability to perform an arthroscopic assessment of the shoulder is expected but a knowledge of the techniques of arthroscopic surgery procedures is not required

 Understanding the principles of management of tumours around the shoulder and elbow

11. ORTHOPEDIC ONCOLOGY

11A Basic  Knowledge of the presentation, radiological features, pathological features, treatment and outcome for common benign and malignant bone tumours

 Knowledge of the presenting features, management and outcome of soft tissue swellings, including sarcomas benign and malignant

 Understanding of the principles of management of patients with metastatic bone disease in terms of investigation, prophylactic and definitive fixation of pathological fractures and oncological management

Curriculum 11B  Classification benign/malignant  Tissue of origin 11C Staging  Investigations  Enneking Classification  Biopsy techniques

 Basic Histopathologal Interpreatation 11D Treatment  Principles surgical treatment

 Incisional Excision  Marginal Excision  Wide Excision  Radical Excision  Radiotherapy  Chemotherapy-principles of action

 Treatment of pathological fracturres

 Palliative treatment 11E Specific Tumours

Bone  Primary

 Osteoid Osteoma

 Osteoblastoma

 Osteosarcoma

 Ewing sarcoma

 Giant cell sarcoma

 Chondrosarcoma

 MFH

 Fibrosarcoma

 Multiple myeloma Metastases  General Features Soft Tissues Tumor  General features

12. SPORT INJURY

12A Arthroscopy  Principles of Arthroscopy

 Common indication of arthroscopy

 Standard and additional portals for knee, shoulder arthroscopy

 Complication of arthroscopy

12B  Pathoanatomy of ACL/PCL injuries and their management

 Pathoanatomy of MCL/LCL injueris and their management

 Pathoanatomy of meniscal injuries and management

 Patella-femoral disorder and various causes of anterior knee pain

Curriculum

12B Cont.:  Types and synovials plicae and treatment

 Management of knee dislocation and multiple ligaments injury

12C Shoulder  Pathoanatomy of recurrent shoulder dislocation

and management

 Types of shoulder impingement syndrome and ita

management

 Rotator cuff arthropathy

 Types of AC joint dislocation

12D Ankle  Acute and chronic ankle ligaments injury

 Impingement syndrome and meniscoid lesion

NO. TOPIC PROCEDURE 1. TRAUMA

1A Trauma General

Free flap

Full thickness skin graft

Muscle flap

Nerve repair

Pedicle flap

Removal external fixator or frame

Removal foreign body from skin / subcutaneous tissue

Removal K wires or skeletal traction

Split skin graft

Transpositional flap

Wound closure, delayed primary or secondary

Wound Debridement

Internal Fixation of Long Bone

Internal fixation of complex fracture

External fixation

Periarticuler fracture

Tendon repair

Vascular repair

Casting and splinting

1B Axial Sceleton

1) Cervical Spine Anterior fixation fracture / dislocation cervical spine

Application halo / tong traction cervical spine

MUA fracture / dislocation cervical spine

Posterior fixation fracture / dislocation cervical spine 2) Thoraco-lumbal

Spine

Posterior decompression / fixation thoracic spine

Lumbar Spine

Anterior decompression / fixation lumbar spine

Posterior decompression / fixation lumbar spine 3) Pelvis  Simple acetabular fracture ORIF

 Complex acetabular fracture ORIF

 Pelvic fracture:

 Pelvic fracture external fixator application

 Simple pelvic fracture ORIF

1C Upper Limb

1) Brachial Plexus  Exploration / repair / grafting brachial plexus 2) Clavicle  ORIF clavicle fracture

 ORIF non-union clavicle fracture 3) Shoulder Joint  Anterior dislocation shoulder

 Anterior dislocation shoulder closed reduction

 Anterior dislocation shoulder open reduction +/- fixation

 Acromioclavicular joint dislocation acute ORIF

 Fracture proximal humerus ORIF

 Glenoid fracture ORIF

 Posterior dislocation shoulder closed reduction 4) Humerus  Fracture diaphysis humerus non-op:

 Non-union ORIF +/- bone grafting

 Fracture diaphysis humerus IM nailing

 Fracture diaphysis humerus MUA +/- POP

 Fracture diaphysis humerus ORIF plating 5) Elbow Joint  Dislocated elbow +/- fracture:

 Dislocated elbow +/- fracture closed reduction

 Dislocated elbow +/- fracture open reduction +/- fixation

 Intraarticular distal humerus fracture ORIF

 Lateral condyle fracture ORIF

 Medial condyle / epicondyle fracture MUA / K wire / ORIF

 Olecranon fracture ORIF

 Dislocated elbow +/- fracture:

 Radial head / neck fracture MUA +/- K wire

 Radial head / neck fracture ORIF

 Radial head replacement for fracture

 Supracondylar fracture:

 Supracondylar fracture MUA +/- K wires

 Supracondylar fracture ORIF

6) Forearm  Fasciotomy for compartment syndrome

 Fracture distal radius:

 Fracture distal radius – closed non-op

 Fracture distal radius external fixation

 Fracture distal radius MUA & percutaneous wires

 Fracture distal radius MUA & POP

 Fracture distal radius ORIF

 Fracture shaft radius / ulna:

 Fracture shaft radius / ulna IM nailing

 Fracture shaft radius / ulna MUA & percutaneous wires

 Fracture shaft radius / ulna MUA & POP

7) Wrist  Carpal fracture / dislocation:

 Carpal fracture / dislocation MUA & percutaneous wires

 Carpal fracture / dislocation MUA & POP

 Carpal fracture / dislocation ORIF

 Scaphoid fracture non-op

 Scaphoid fracture ORIF

 Scaphoid fracture MUA & percutaneous wires

 Scaphoid fracture non-union ORIF +/- graft

8) Hand:

 Carpal fracture / dislocation:

 5th metacarpal fracture / dislocation non-op

 5th metacarpal fracture / dislocation MUA & percutaneous wires

 5th metacarpal fracture / dislocation MUA & POP

 5th metacarpal fracture / dislocation ORIF

 Finger tip reconstruction

 Infection:

 Infection hand drainage (not tendon sheath)

 Infection tendon sheath drainage

 IPJ fracture / dislocation:

 IPJ fracture / dislocation MUA & percutaneous wires

 IPJ fracture / dislocation MUA +/- POP

 IPJ fracture / dislocation ORIF

 Ligament repair hand

 Metacarpal fracture (not 1st or 5th) non-op

 Metacarpal fracture (not 1st or 5th) MUA & Percutaneous wires

 Metacarpal fracture (not 1st or 5th) MUA +/- POP

 Metacarpal fracture (not 1st or 5th) ORIF

 Phalangeal fracture non-op

 Phalangeal fracture MUA & percutaneous wires

 Phalangeal fracture MUA +/- POP

 Phalangeal fracture ORIF

9) Tendon repair:  Tendon repair extensor

 Tendon repair flexor

 MCPJ fracture / dislocation:

 MCPJ fracture / dislocation MUA & Percutaneous wires

 MCPJ fracture / dislocation MUA +/- POP

1D Lower Limb 1) Hip joint

1a) Dislocated hip: Dislocated hip closed reduction

Acute dislocated hip open reduction +/- fixation

Neglected dislocated hip open reduction +/- fixation

1b) Extracapsular

fracture:

Extracapsular fracture CHS / DHS

Extracapsular fracture intramedullary fixation

Extracapsular fracture other fixation

Intracapsular fracture:

Intracapsular fracture hemiarthroplasty

Intracapsular fracture internal fixation

Intracapsular fracture intracapsular fracture THR 2) _Femur

2a) Diaphyseal

fracture closed:

Diaphyseal fracture traction or spica in child

Diaphyseal fracture intramedullary nailing

Diaphyseal fracture plate/screw fixation

Fasciotomy for compartment syndrome

2b) Subtrochanteric

fracture:

Subtrochanteric fracture intramedullary fixation

Subtrochanteric fracture plate/screw fixation

2c) Supracondylar

fracture (not intraarticular):

Supracondylar fracture (not intraarticular) DCS / blade plate etc

Supracondylar fracture (not intraarticular)

intramedullary fixation 3) Knee Joint

Acute haemarthrosis arthroscopy

Acute ligament repair

Intraarticular fracture distal femur ORIF

Patella dislocation closed reduction +/- open repair

Patella fracture ORIF

Patella tendon repair

Quadriceps tendon repair

Simple tibial plateau fracture

Complex tibial plateau fracture

Tibial plateau fracture arthroscopically assisted fixation

Tibial plateau fracture ORIF with plates & screws

4) _{Tibia & Fibula}

Diaphyseal tibial fracture external fixation

(including frame)

Diaphyseal tibial fracture intramedullary nailing

Diaphyseal tibial fracture MUA & POP

Tibial shaft plating

Fasciotomy for compartment syndrome

Tibial

non-union:

Tibial non-union circular frame management

 Tibial non-union intramedullary nailing +/- bone grafting

5)

Ankle

Ankle fracture / dislocation:

Ankle fracture / dislocation MUA & POP

Ankle fracture / dislocation ORIF Pilon fracture: Simple pilon fracture ORIF

Complex pilon fracture ORIF

Pilon fracture with circular frame

Tendoachilles repair

6) _Foot

Amputation toe / ray for trauma

Simple calcaneal fracture ORIF

Complex calcaneal fracture ORIF

Metatarsal fracture ORIF

Phalangeal fracture MUA +/- K wire +/- ORIF

Talar, subtalar or midtarsal fracture / disloc:

Talar, subtalar or midtarsal fracture / dislocation MUA +/-POP +/- K wires

Talar, subtalar or midtarsal fracture / dislocation ORIF

Achilles Tendon Repair 2. ELECTIVE (NON TRAUMA)

2A Non Specific Site

Aspiration / injection joint

Benign tumour excision (not exostoses)

Biopsy bone - needle

Biopsy bone - open

Bursa excision

Cyst bone curettage +/- bone graft

Epiphysiodesis

2B _{Axial Sceleton}

1) Cervical Spine Anterior decompression +/- fixation / fusion (C2-C7)

Atlantoaxial fixation +/- fusion

Biopsy cervical spine

1) Cervical Spine

(cont)

Excision cervical / 1st rib

Nerve root / facet joint injection cervical spine

Occipito-cervical fusion +/- fixation

Posterior decompression +/- fixation / fusion (C20C7)

2) Thoracic Spine Anterior decompression +/- fixation / fusion

Biopsy thoracic spine

Posterior decompression +/- fixation / fusion

Scoliosis correction - anterior release +/- instrumentation

Scoliosis correction - posterior fusion +/- instrumentation

3) Lumbar Spine Caudal epidural injection

Decompression lumbar spine with fusion +/- fixation

Decompression lumbar spine without fusion (not disectomy alone)

Discectomy open / micro

Nerve root / facet joint injection lumbar spine

4) Pelvis Salter Innominate Osteotomy

Reconstruction Acetabulum

Excision Sacrum

5) Brachial Plexus Exploration / repair / grafting brachial plexus

Neurolysis 2C Upper Limb

1) Shoulder Acromioclavicular joint excison - arthroscopic / open

/ lateral clavicle

Acromioclavicular joint reconstruction (e.g. Weaver Dunn)

Acromioplasty open

Anterior repair for instability arthroscopic

Anterior repair for instability open including capsular shift

Arthroscopic subacromial decompression

Arthroscopy diagnostic

Rotator cuff repair (open or arthroscopic) +/- acromioplasty

2) Elbow Arthrolysis elbow (open/arthroscopic)

Arthroscopy elbow diagnostic

Arthoscopy elbow therapeutic

Arthrotomy elbow

Excision radial head +/- synovectomy

Radial head replacement

Tennis / golfer elbow release

Total elbow replacement

Ulnar nerve decompression / transposition

3) Wrist Arthrodesis wrist (includes partial arthrodesis)

Arthroscopy wrist

Carpal tunnel decompression

De Quervain's decompression

Excision distal ulna

Ganglion excision at wrist

Ulna shortening

Ulnar nerve decompression at wrist

4) Hand Dupuytrens contracture operation

Excision synovial cyst

Fusion of MCPJ or IPJ

MCPJ replacement

Soft tissue reconstruction hand

Tendon transfer hand

Trapezium excision or replacement

Trigger finger release

Trigger thumb release

2D _{Lower Limb}

1) Hip Joint  Arthrodesis hip

 Arthrogram hip

 Arthroscopy hip – diagnostic

 Arthroscopy hip – therapeutic

 Arthrotomy hip

 Excision arthroplasty hip (e.g. Girdlestone)

 Open reduction for DDH

 Osteotomy hip – pelvic for DDH

 Osteotomy hip – proximal femoral for DDH

 Osteotomy pelvis – not for DDH Slipped upper

femoral epiphysis:

Slipped upper femoral epiphysis open reduction

Total Hip Replacement: THR cemented THR hybrid THR surface replacement THR uncemented

Revision THR acetabular component

Revision Total Hip Replacement

Revision THR both components

Revision THR femoral component

2) Femur Amputation above knee

Femoral lengthening

Osteotomy corrective (not for DDH)

3) Knee Joint Open ACL reconstruction

Injection & aspiration Joint

Arthroscopy ACL reconstruction

Arthroscopic lateral release

Arthroscopic partial meniscectomy

Arthroscopic removal loose bodies knee

Arthroscopic synovectomy

Arthroscopic knee diagnostic

Osteotomy distal femoral

Osteotomy proximal tibial

Patella realignment

Patella resurfacing alone

Revision TKR

TKR

Unicompartmental knee replacement

4) Tibia & Fibula Amputation below knee

Tibial lengthening

Harvesting Fibular Graft

5) Ankle Joint: Arthrodesis ankle

Arthroplasty ankle

Arthroscopy ankle diagnostic

Arthroscopy ankle therapeutic

Arthrotomy ankle

Decompression tendons at ankle

6) Foot Amputation toe / ray

Calcaneal osteotomy

CTEV correction

Fifth toe soft tissue correction

First metatarsal osteotomy

First MTPJ arthrodesis

First MTPJ excision arthroplasty

First MTPJ soft tissue correction

Hindfoot arthrodesis

Ingrowing toenail operation

Lesser metatarsal osteotomy

Lesser toe arthrodesis

Lesser toe excision part/all phalanx

Lesser toe tenotomy

Tendon decompression or repair

Tendon transfer foot

2.3.

Bidang Afektif (

Professional & Management and Good

Clinical Practice)

1. Professional Behaviour The Objective

1 _{To achieve an excellent level of care for the individual patient} a. to elicit a relevant focused history

b. to perform focused, relevant and accurate clinical examination

c. to formulate a diagnostic and therapeutic plan for a patient based upon the clinic findings

d. to prioritise the diagnostic and therapeutic plan

e. to communicate a diagnostic and therapeutic plan appropriately

2 To produce timely, complete and legible clinical records to include case-note records, handover notes, and operation notes.

3 To prescribe, review and monitor appropriate therapeutic interventions relevant to clinical practice including non – medication based therapeutic and preventative indications.

4 To prioritise and organise clinical and clerical duties in order to optimise patient care.

5 To make appropriate clinical and clerical decisions in order to optimise the effectiveness of the clinical team resource.

6 To prioritise the patient’s agenda ncompassing their beliefs, concerns expectations and needs

7 To prioritise and maximise patient safety. 8 To understand that patient safety depends on;

a. The effective and efficient organization of care b. Health care staff working well together

c. Safe systems, individual competency and safe practice

9 To understand the risks of treatments and to discuss these honestly and openly with patients

10 To systematic ways of assessing and minimizing risk

11 To ensure that all staff are aware of risks and work together to minimise risk 12 To manage and control infection in patients, Including;

a. Controlling the risk of cross-infection

b. Appropriately managing infection in individual patients

c. Working appropriately within the wider community to manage the risk posed by communicable diseases

Examples and Descriptors Patient assessment

a. Introducing self clearly to patients and indicates own place in team b. Checks that patients comfortable and willing to be seen

c. Informs patients about elements of examination and any procedures that the patient will undergo