.

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NATIONAL POSTGRADUATE MEDICAL COLLEGE OF
NIGERIA
Faculty of Orthopaedics
RESIDENCY TRAINING PROGRAMME
IN
ORTHOPAEDICS
Towards
THE FELLOWSHIP OF THE MEDICAL COLLEGE IN
ORTHOPAEDICS
(F.M.C.Ortho.)
A Handbook for Residents and their Trainers
2011

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TABLE OF CONTENTS
Programme Philosophy 3
Introduction 4
CHAPTER I - THE RESIDENCY TRAINING PROGRAMME 5 - 6
Admission Requirements
Registration of Residents
General Educational Objectives
Format of Training
CHAPTER II - BASIC MEDICAL SCIENCES 7
Course Objectives
Primary Examination
CHAPTER III - JUNIOR RESIDENCY TRAINING PROGRAMME 8 - 9
General Educational Objectives
Format of Training
CHAPTER IV - SENIOR RESIDENCY TRAINING PROGRAMME 10
Entry Requirement
General Educational Objectives
Format of Training
Objectives of the Dissertation Project
CHAPTER V - SYLLABUS FOR BASIC SCIENCES 11 - 15
CHAPTER VI - SYLLABUS FOR PARTS I & II 16 - 32
CHAPTER VII - FORMAL CONTENT OF TRAINING 33 - 35
Cognitive Skills
Psychomotor Skills
Research Skills
Teaching Skills
Communication Skills
Management Skills
CHAPTER VIII - EVALUATION 36 - 41
In-Course Assessment
Part I Fellowship Examination
Part II Fellowship Examination
Registration for the Part II Examination
The Dissertation
The Examination.
CHAPTER IX - CONTINUING EDUCATION 42
APPENDICES - List of Accredited Training Institutions as at December 2011
- Certificate of Training
- Accreditation Guidelines

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PROGRAMME PHILOSOPHY
The Faculty of Orthopaedics of the National Postgraduate Medical College of Nigeria seeks to
train specialists in Orthopaedics and some of the sub-specialties, who are able to meet the vast
majority of surgical needs of the Nigerian Society. The specialist, equipped with all the relevant
competences in “Clinical and Management Problem – Solving”, should be able to remain
effective in the changing local conditions. The residency training for the Fellowship of the
Medical College in Orthopaedics (F.M.C.Ortho.) should prepare him adequately for the
management and professional leadership roles that will be expected of him as a practicing
consultant Orthopaedic surgeon. Besides, each product of the programme is exposed to the
routine processes of teaching/learning and self-instruction to usher him into life-long continuing
surgical education.
In summary, this competency-based curriculum for the Residency programme is designed to
train an Orthopaedic surgeon with definite competencies in the four areas of professional
practice, clinical problem solving, research, education as well as Health Services Management.

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INTRODUCTION
The residency training programme in Orthopaedics was born out of the need to produce Nigerian
practitioners in reasonable numbers who are not only experts in the discipline of Orthopaedics
but are also able to perform well within the socio-cultural and economic context of Nigeria. This
postgraduate programme in Surgery was initially commenced in 1968 using the old curriculum,
which was revised in 1982 and subsequently in 1988 and 2003. With the passage of time
however, the need for a further revision has become apparent with the evolution of a distinct
Faculty of Orthopaedics out of the existing Faculty of Surgery.
The Revision of 2003 witnessed the re-introduction of sub-specialty fellowship training in
Paediatric Surgery, Urology, Burns and Plastic apart from Orthopaedics, which had remained as
a recognized surgical specialty since inception. Through the progamme, a sizeable number of
Fellows has been produced with FMCS (Ortho). The next level is to train for FMC Ortho.
There will be three levels of training, namely: the Basic sciences followed by Junior Residency
and Senior Residency programmes. The prescribed thirty months minimum period of training
has been maintained for each of the junior residency (Part I) and senior residency (Part II)
training stages.
It is hoped that this revised curriculum will facilitate the teaching/learning process and the over-
all training of the specialist Orthopaedic Surgeon who is well adapted to the needs and
peculiarities of the Nigerian society.

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CHAPTER I
THE RESIDENCY TRAINING PROGRAMME
The Residency Training Programme in Orthopaedics can only conducted in centres accredited by
the National Postgraduate Medical College of Nigeria (N. P. M. C. N.) on the recommendation
of the Faculty Board of Orthopaedics. The list of accredited training centres is published by
College from time to time. These centres are re-visited at periodic intervals (normally every 5
years) to ensure that training facilities and the training programmes are maintained at acceptable
level.
Accredited centres are responsible for providing the resources (men, money, materials and
management) to train the resident surgeons sufficiently to enable them to function as consultants
at the end of their training. The centres are also expected to monitor the progress of each
resident and provide appropriate feed-back to him. Besides, the Head of Orthopaedics at each
training centre provides annual reports on the performance of each resident as well as the overall
programme on prescribed Annual report (evaluation) forms. These evaluation and monitoring
forms are available from the office of the College Registrar. The training Institutions are
expected to issue a Certificate of Training (designed by each institution) to each resident that has
successfully completed the prescribed training, as required by College regulations.
ADMISSION REQUIREMENTS
Admission into the Residency Training Programme in Orthopaedics will be open to all medical
practitioners with basic medical degrees registrable with the Medical and Dental Council of
Nigeria. Where appropriate, the medical practitioner shall have completed or shall have been
exempted from National Youth Corps Service Year.
During the period of post-registration experience preceding admission to a residency training
programme candidates are expected to pass the Primary Fellowship Examination. It is only on
passing the Primary Fellowship Examination that a candidate may become eligible for enrolment
in the Residency Training Programme in Orthopaedics.
REGISTRATION OF RESIDENTS
In compliance with College Bye-Laws all residents undergoing the F.M.C.Ortho. residency
training must be registered simultaneously with their respective training centres and with the
College whose secretariat is based in Lagos. The registration of each Resident with the College
must be processed through and supported by the training centres. Registration with the College
confers on the resident the status of Associate Fellow of the College.
Application forms for registration as Associate Fellows are obtainable from the Head of each
accredited training centre. All completed forms should be returned to the College Registrar not
later than four months from the admission date into residency programme.
Candidates not registered as Associate Fellows of the College will not be allowed to sit for the
Part I or Part II Fellowship Examination of the College.

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GENERAL EDUCATIONAL OBJECTIVES
By the end of his over-all training in the Residency programme, each resident in Orthopaedics
should be able to:
1. Obtain, at first consultation, as complete a data base (History, Physical Examination) and
Laboratory data) as is compatible with the urgency and complexity of the patient’s
problems.
2. Recognise within the database, problems that:
(a). require further investigation or
(b) require therapeutic or supportive intervention.
3. Investigate clinical problems using relevant tests and other appropriate tools in order to
clearly define the patient’s problems.
4. Interprete clinical findings and the results of diagnostic investigations, and by a clear
process of deductive reasoning reach appropriate decision on clinical management and
therapeutic intervention.
5. Perform all common operative procedures required for the restoration and/or
maintenance of health for the individual patient.
6. Explain and defend the rationale of, and the technique and procedure employed in
standard surgical operations.
7. Effect adequate post-operative care and full rehabilitation of his patient.
8. Demonstrate a clear, knowledge of the pathology, pathophysiology, clinical features,
management options and result of therapy of common Orthopaedic diseases.
9. Provide effective supervision for his junior professional colleagues in their performance
of simple surgical procedures.
10. Teach surgical concepts and operating skills to Junior colleagues.
11. Explain concepts of surgical diagnosis and treatment not only to his patients, but also to
other members of the health team, so as to facilitate successful Orthopaedic care.
12. Demonstrate problem-solving ability by designing and implementing a simple research
project relevant to the needs of his local environment.
13. Demonstrate general management competence in the appropriate use of resources (man,
materials and money) to achieve effective surgical care.
14. Provide effective and purposeful leadership of the surgical team.
FORMAT FOR TRAINING
Training consists of two successive phases each lasting a minimum of thirty months viz:
(a) Junior Residency,
(b) Senior Residency.

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CHAPTER II
BASIC SCIENCE TRAINING
Because the Faculty Board regards a Pass in the Primary Fellowship Examination as entry point
into the Residency programme, there is no formal period earmarked for training in basic
sciences. Nonetheless, experience over the years has shown that it is not easy for candidates to
pass this examination with residual pre-2nd
M. B. knowledge.
Candidates are therefore advised to seek appointment as demonstrators or tutors in the Basic
Sciences departments of Colleges of Medicine for about a year before attempting the
examination. This advice does not however prevent those who are willing, from sitting the
examination as soon as they have completed the Internship year. It is also mandatory for
candidates to attend an intensive basic medical science course organized by the College or
equivalent bodies.
COURSE OBJECTIVES
A. Objectives:
1. The primary examination in basic sciences seeks to establish the candidates
trainability and his understanding of the basic principles of Orthopaedics in
general and the scientific bases of orthopaedics in particular.
2. To establish that the candidate is trainable
3. To ensure that the candidate understands the basic principles of Orthopaedics.
4. To ensure that the candidate is familiar with the scientific basis of Orthopaedics.
B. Format of Training
As at the moment there is no formal training in basic sciences in most training
institutions.
Candidates are expected to apply for and write the primary fellowship examinations after
completing the internship.
The faculty shall prepare a Basic Sciences Syllabus or course content for the guidance of
the candidate, teachers and examiners.
The faculty may offer short courses in Basic Sciences preparatory to the examination in
basic sciences.

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CHAPTER III
JUNIOR RESIDENCY TRAINING PROGRAMME
1. Pre-requisites
There shall be a residency programme in Orthopaedics to prepare the candidates for the
part 1 examination.
The residency programme shall be undertaken in hospitals accredited by the college.
The candidate is expected to attend a minimum of one up-date course organized by the
faculty .
The Part 1 examination may be taken any time after completion of minimum of thirty
months of approved junior residency training in Orthopaedics, Trauma and Allied
subspecialties.
A logbook containing a list of operations undertaken or assisted by the candidate shall be
submitted with the application.along with other docunments.
2. Objective
Upon completion of this programme a candidate is expected to demonstrate a satisfactory
level of knowledge, clinical competence and technical competence.
Specifically:
 He should be able to manage critically ill and multiple injured patient.
 He should demonstrate the ability to perform a compete history and physical
examination.
 He should be capable of interpreting the information obtained therefrom to form a
complete differential diagnosis.
 He should be capable of conducting a meaningful investigation of the differential
diagnosis by radiological and laboratory means.
 He should demonstrate the ability to formulate a treatment plan and prepare the patient
for surgery.
 He should be able to carry out minor to moderate elective surgical procedures including:
skin incision and closure, excisional biopsy of tumours, split skin graft, arthrotomy,
incision and drainage, manipulation and reduction of fractures, cut-down, bone grafting,

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open reduction and internal fixation of fractures, soft tissue releases, open reduction of
dislocation. He should be able to perform common emergency surgical procedures such
as wound debridement, suprapubic cystostomy,tube thoracostomy, laparotomy, burrhole,
amputation, application of external fixator, tracheostomy, skull traction etc.
3. Format of Training
Because of the tremendous scope and diversity of the specialty, the junior residency
programme shall last for a minimum of thirty months. During this period, the candidate
is expected to rotate through the following units:
A. Orthopaedic/Trauma Related Postings
1. Accident & Emergency 6 months
2. General Orthopaedics 6 months
-----------
12 months
=======
B. Other Mandatory Postings
1. General Surgery 6 months
2. Burns & Plastic 3 months
3. Neuro Surgery 3 months
-----------
12 months
=======
C. Elective Postings - (3 months in any 2) - 6 months
1. Anaesthesia & I.C.U.
2. Prosthetic & Orthotics/Physiotherapy
3. Urology
4. Paediatric Orthopaedic
(Candidates are advised to choose anaesthesia as one of the electives)
ELEMENTARY STATISTICS AND RESEARCH
The trainee should have a basic knowledge of:
Data collection
Discrete and continuous variables
Normal distribution and confidence intervals

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Parametric and Non-Parametric tests
Hypothesis testing and statistical inference
SCIENTIFIC BASIS OF ORTHOPAEDICS
a. Morphology, Biochemistry and Material Properties of the musculoskeletal system
– bone, cartilage, synovium and the synovial fluid.
b. Design of the locomotor system
Design of bone, muscles, tendon, tendon sheaths, synovial joints
Design of spinal column, intervertebral disc.
Blood supply of limb bones and spinal cord
Gait analysis.
c. Development, growth maintenance, breakdown and repair
Dynamics of skeletal growth and remodelling in Orthopaedics surgery
Friction, Lubrication and wear of joints
Mechanism of fracture. Healing of fracture
Bone and Cartilage grafting.
d. Scientific basis of diagnostic techniques
- Orthopaedic radiology
- Electrodiagnosis and radioisotopes in Orthopaedic Surgery
- Pre-natal investigations and diagnosis
e. Scientific basis of some therapeutic measures
Pain - its mechanism and treatment
Orthopaedic effects of immobilization
The physiology of Exercise – Kinesiology – Kinematics
Principles of splints in Orthopaedics
Implant Materials and their characteristics
Therapeutic Principles in metabolic bone diseases and musculoskeletal
Oncology.

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CHAPTER IV
SENIOR RESIDENCY TRAINING PROGRAMME
1. Pre-requisites
This is a residency programme that prepares the candidate for the Part II examination in
the Faculty of Orthopaedics.
Candidate must have passed the Part 1 examination of the faculty. The postings must be
undertaken in hospitals/departments with established relevant subspecialty units.
The candidate is expected to attend a minimum of one review course organized by the
faculty and also one Research Methodology Course and one Health Management course
organized by the college.
The Part II examination may be taken anytime after completion of minimum of thirty
months of approved senior residency training.
A logbook containing a list of operations undertaken by the candidate shall be submitted
with the application.
Candidate shall be required to submit a Dissertation at the time of application for Part II
examinations.
2. Objectives:
The senior residency training will
1. Afford the candidate unlimited exposure to the subspecialties in Orthopaedic &
Trauma
2. Give the candidate the opportunity to have a greater degree of responsibility in the
preop, intra-operative and post-operative management of patients thereby increasing
his level of clinical and technical competence (proficiency).
3. Enable the candidate to play a prominent role in the teaching of junior residents,
nurses, medical students and other paramedicals.
4. Expose the candidate to the principles of resource management and hence make him a
successful team leader.
5. Enable him plan and execute a research project.
The acquisition of these skills will make a senior resident, at the end of these postings,
capable of running on a day-to-day basis a consultant unit within a hospital setting.

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3. Format of Training
The senior residency-training programme shall last for a minimum period of thirty
months. During this period, the candidate is expected to rotate through the compulsory
posting, three major postings and one elective posting each of at least six months
duration.
A. Compulsory Posting: Trauma including Intensive Care of the Acutely injured
B. Major Postings:
i. Arthroplasty
ii.Arthroscopy (including Sports Medicine)
iii. Paediatric Orthopaedics
iv. Spine.
C. Elective Postings:
i. Burns & Plastic
ii.Orthopaedic Oncology.

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CHAPTER V
A. SYLLABUS FOR BASIC SCIENCES
The subjects of anatomy, applied physiology and applied pathology are regarded as being
of equal importance, and equally important but supplementary and necessary in
foundation of Orthopaedics (Orthopaedic materials and introductory biomechanics) and
elementary research.
ANATOMY
i. Scope
A sound knowledge of anatomy required for the practice of Orthopaedic Surgery
must include, general knowledge of regional, applied, surface, radiological and
cross-sectional anatomy. The candidate is expected to know the surface
projections, positions, relations, vascular supply, lymphatic drainage and
innervation of each individual organ. The candidate may know and can be asked
about integument and skin creases, incision and surgical approaches knowledge of
histology as basis of function and disease, and of embryology for genetic
principles and congenital anomalies may also be asked. Emphasis will be on
functional osteology, classification and description of joints of the body, and
gross anatomy and cutaneous innervation of the upper and lower extremities.
ii. Head and Neck
The scalp, cervical vertebrae
Topography of the anterior and lateral regions of the Neck
The root of the neck
Pharynx and larynx
Cervical fascia, carotid sheath
Brachial plexus.
Neuro anatomy
The brain surface anatomy
The cranial nerves
The meninges
Venous sinuses, cerebral vessels
CSF formation and flow
Spinal cord and its centers
Essentials of development of the brain, spinal cord and vertebra
Thorax and Abdomen
Anatomy of the thoracic and abdominal walls, abdominal incisions
Osteology of thoracic cage. Thoracic inlet
The thoracic vertebrae and approaches to it
Anatomy of the back and vertebral column.

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Pelvis and Perineum
Development, gross anatomy and microscopic structure of the pelvic
viscera and the perineum
Pelvic osteology
The Limbs
Osteology of the limb bones
Pelvic and shoulder Girdles
Classification and description of joints
Surgical Anatomy of the Hand
Axilla, cubital fossa, politeal fossa
APPLIED PHYSIOLOGY
i. Scope
This includes biochemistry, chemical pathology, pharmacology and biophysics.
Candidates will be expected to have a detailed knowledge of the various aspects related
to surgery.
ii. Aspects of Physiology to be covered
a. General physiological Principles
Structure, mechanism and integration of living cell
Osmotic pressure, membrane transport, ionic equilibrum, water, electrolytes, and
base balance.
Enzymes and co-enzymes
Regulation of body temperature.
b. Mineral Metabolism
Phosphate/Vit D/Ca – Parathyroid
Minerals and Trace elements.
c. Effects of Physical agents
Radiation, Nuclear Medicine, Hypothermia, Hyperbaric Oxygen
Principles of electronic-s
Ultrasound and magnetic therapy in Orthopaedics.
d. Haemopoietic system
Plasma, blood groups, immunoglobulins
Haemostasis and blood coagulation
e. Cardiovascular system
Haemodynamics, Haemorrhage, Shock, hypertension
f. Respiratory system

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Mechanism of ventilation
Gas exchange, Gas transport
Protective mechanism of breathing and respiratory failure
g. Renal system
Functions of nephron and tubular mechanism
Regulation of extra cellular fluid (ECF)
Endocrine functions and its relations to bone
Musculo-skeletal effects of acute and chronic renal failure.
h. Gastrointestinal System
Deglutition, gastrointestinal motility and its functional disorders
Gastrointestinal secretions, its control in health and disease
Digestion and absorption, disorders of absorption
Endocrine function and relations to bone
Nutritional deficiency syndrome in relation to Musculoskeletal system
i. Endocrine System
General Principles of endocrine physiology
Metabolic and Endocrine response to trauma/surgery
j. Nervous System
Control of movement and posture
The autonomic Nervous system, general principles of sensory and motor system
including muscular contractions, conduction of the nerve impulse. Reflexes,
synaptic transmission control of spinal injuries maintenance of muscle tone.
Consciousness and the higher integrative functions.
k. Applied Physiology
Physiology of transplanted heart, extracorporeal pump oxygenation
Hypothermia, shock syndrome
Intensive care, Renal shutdown and dialysis
l. Pharmacology
General principles, route of administration absorption, metabolism and excretion
of drugs.
Factors modifying the effect of drugs, Drug toxicity
Cancer Chemotherapy
Anti-TB drugs
Anti-hypertensive drugs
Non-steroidal anti inflammatory drugs
Drugs used in the treatment of diabetes mellitus

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PATHOLOGY
i. Scope:
A thorough and detailed knowledge of the basic principles of pathology including
biochemistry, haematology, immunology, microbiology, histopathology and molecular
biology.
ii. General Principles underlining disease processes:
Inflammation, Trauma, Degeneration, Regeneration, Repair, Hypertrophy, Atrophy,
Hyperplasia, Thrombosis, Embolism, Infarction Neoplasm, Circulatory disorder.
Pigments and its disorders
Heterotopic calcification and calculi Renal failure – Hepatic failure, jaundice
Amyloidosis.
Laboratory Diagnosis
iii. Haematology
Anaemia, Leukaemia, Myeloproliferative disorders
Haemorrhagic disorders and the Haemoglobinopathies.
Principles underlying blood transfusion.
iv. Microbiology
Acute pyogenic infection, Wound infections
Nosocomial infections
Tuberculosis, Syphilis, actinomycoses, Viruses
Principles of disinfectiona and sterilization.
v. Metabolic Pathology
Disorders of glucose metabolism – Diabetes, Glycogen storage diseases
Vit D deficiency, Osteoporosis, Osteomalacia
Fluid and electrolyte imbalance
vi. Tumors and Oncology
Carcinogenes
Spread of malignant tumours
The Physics and Effect of ionizing radiation
The Principles of therapy
Radiotherapy, Immunotherapy, Chemotherapy
vii. Genetics
Common inheritance patterns in musculoskeletal disorders, eg. Achondroplasia,
haemophilia, Osteogenesis imperfecta etc.

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THE PRIMARY EXAMINATION
The Primary examination features: A 3-hour MCQ paper consisting of 150 questions divided
into Section A (75 questions in Anatomy including Embryology, histology and genetics) and
Section B (75 questions in Physiology (including biochemistry and Pharmacology) and
questions in Pathology (including anatomic pathology, chemical pathology, microbiology and
haematology).
EXAMINATION RESULTS
In order to pass the examination the candidate must:
1. Obtain at least an aggregate of 50% (P) overall.
2. Normally obtain at least 50% (P) in each section of the paper of the examination provided
that:
(a) A borderline 45% (P-) in section B may be compensated by at least a very good
pass 55% (P+) in Section A.
(b) A fail of less than 45% (P-1) in any section would earn a Fail in the whole
examination.

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CHAPTER VI
B. SYLLABUS FOR PARTS I & II FMCOrtho
1. Management of Trauma Patient
While in the Accident and Emergency department the candidate will be expected to
participate in and demonstrate knowledge of emergency care for the trauma patient. The
candidates should be familiar with the principles of pre-hospital care including triage at
the scene of accident and on arrival in the hospital. Generally the candidates should be
involved in providing adequate, prompt emergency care to the injured patient.
Specifically the candidates must:
Be able to identify and treat life threatening or potentially life-threatening injuries.
Be conversant with the principles of primary and secondary patient assessment.
Be able to access and manage the patient in respiratory distress and shock, including the
use of crystalloids, cross-matched blood, types specific and type O blood and Orotracheal
intubation.
Recognize the indications for the complications of and demonstrate the ability to perform
the following:
Peripheral and central vascular access, Urethral catheterization, Thoracic needle
decompression, Chest tube insertion, Pericardiocentesis, Diagnostic paracetensis,
Celiotomy.
Know when to request for the following investigations: C Spine X-ray, Chest X-ray,
Pelvic X-ray, Abdominal Ultrasonography, CT Scan.
Recognise the significance of the following monitoring procedures: ECG,
Arterial blood gas analysis, Pulse oximetry/NIBP monitor, CVP.
Know the principles of management of chest, abdominal, pelvic, head, spine and burn
injuries.
Know the principles of initial management of musculoskeletal injuries including
treatment of acute fractures, compartment syndrome, crush injury, open fractures, and
joint injuries, and tetanus prophylaxis.
Be conversant with trauma scores as triage tools.

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2. Management of Orthopaedic emergencies
Candidates must be able to recognize Orthopaedic emergencies such as Septic arthritis,
pyomyositis, hand infection, acute osteomyelitis and institute appropriate initial care.
3. Imaging techniques and other Diagnostic Procedures
Candidates are expected to be familiar with all relevant radiological investigations that
assist in the management of the Orthopaedic Patient.
These include:
a. Principles of general radiological interpretation. (e.g. fractures, dislocation).
b. Principles of radiological investigations of trauma, indications and interpretation
of specialized techniques (e.g. Angiography, computerized tomography,
Arthrography etc).
c. Interpretation and Pathophysiological correlation or radiography of arthritic
disorders, infection, tumours, metabolic and reactive disorders.
d. Paediatric musculoskeletal radiology
e. Techniques and interpretation of radiological investigation of spine injuries and
disorders including myelography, computerized tomography and MRI
f. Principles of isotope scanning and ultrasonography
g. Histopathology of tissue specimens
h. Serum and urinary biochemistry etc.
4. Instrumentation and Implants in Orthopaedic and Trauma Surgery
Because of the scope of diversity of Orthopaedics and Trauma, there is emergence of
sophisticated and high-tech procedures. This has given birth to subspecialisation. The
candidates should be familiar with these subspecialties including their instrumentation,
implants, suture materials, orthoses etc.
Candidates must know the characteristics, indications and complications of these
implants. They must know how to handle and use these instruments.
5. Principles of Plaster techniques
Candidates must be familiar with the various casting materials used in the conservative
management of fractures (scotch cast, POP etc) and the principles of application.

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Candidates must also be familiar with the indications and complications of using these
materials.
6. Anaesthesis and ICU
The candidates must be familiar with the following:
Local and regional anaesthetic techniques including Biers block, axillary block and
spinal. and General Anaesthesia. Electrolyte disturbances and acid base imbalance.
Basic metabolic and nutritional requirements including Parenteral nutrition
Conduct of advanced cardiopulmonary resuscitation and techniques of monitoring.
7. Drugs
Pharmacology and Principles of use of these drugs: Analgesics, Antibiotics, Anti-TB,
Non-Steroidal Anti-Inflammatory drugs, Anti-Cancer therapy.
8. Surgical procedures
The candidates are expected to participate in the pre-op, intra-op and post-op
management of patients going for surgical operations.
Principles of pre and post op management – specifically the preop investigations, the
preop management and comorbid medical conditions, grouping and crossmatching,
bowel preparation, prophylactic antibiotics postop analgesia, management of drain.
Principles underlying every procedure in Orthopaedic Surgery.
Realignment osteotomy Synovectomy
Arthrodesis amputation
Epiphyseodesis tendon transfer
Arthroplasty Nerve tendon repair.
Open reduction and Internal fixation (ORIF)
Should be able to perform certain procedures in the emergency or elective situations
either as the main surgeon or being assisted by the consultant or as first assistant.
Should be familiar with the indications for various surgical approaches, patient

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positioning, various types of tourniquet its indications and complications.
Able to recognize and treat postop complications such as: wound infection, wound
dehiscence, haemorrhage, atelectasis, etc.
A. GENERAL ORTHOPAEDICS
a. Congenital anomalies
of the hip, the limbs, the hand, the feet, and the spine.
b. Tumours (Benign & Malignant)
General principles of diagnoses and management of tumours of Bone, Cartilage,
and Soft tissue
c. Metabolic and Endocrine Disease
i. i. Rickets
ii. Osteomalacia
iii. Pagets
iv. Osteoporosis
v. Hyperparathyroidism
vi. Hypoparathyroidism
vii. Hyperpituitarism
viii. Hypopituitarism
d. Infections of Bones and Joints
 Osteomyelitis (Subacute, Acute & Chronic)
 Supurative arthritis (acute)
 Tuberculous osteomyelitis and arthritis
 Syphilis
 Leprosy
e. Degenerative Diseases

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i. i. Rheumatic disorders – rheumatoid arthritis
ii. Ankylosing spondylitis
iii. Psoariatic arthritis
iv. Juvenile chronic arthritis
v. Crystal deposition – gout
vi. Osteoarthritis
vii. Osteonecroses & osteochondritis
viii. Heterotropic ossification
f. Skeletal Dysplasias
Achondroplasia, Spondyloepiphyseal dysplasia and Multiple exostosis
g. Connective Tissue Disorders
Marfans Syndrome, Ehler Danlos syndrome, Osteogenesis imperfecta
h. Neuromuscular Disorders
Cerebral palsy, Stroke, Spina bifida, Poliomyelitis, Arthrogryphoses multiplex
congenital, Reflex sympathetic dystrophy, Muscle dystrophy.
i. Haematological Diseases
Sickle cell disease, Multiple myeloma, Leukaemia, Haemophilia, Histocytosis
j. Others
Limb length discrepancies: congenital, acquired
Delayed union and non union fractures including pseudoathroses

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B. REGIONAL ORTHOPAEDICS
a. The Neck – Prolapsed cervical disc, cervical spondylosis, rheumatoid arthritis,
thoracic outlet syndrome
b. The shoulder – rotator cuff syndrome, bicipital tendonitis and rupture, frozen
shoulder, chronic shoulder instability, rheumatoid arthritis, osteoarthritis.
c. The Elbow – Osteochondritis diseases, loose bodies, rheumatoid arthritis,
osteoarthritis, stiffness at elbow.
d. The Wrist – radial club hand, ulnar club hand, madelung deformity, kienbocks
disease, tuberculoses, rheumatoid arthritis, osteoarthritis, carpal tunnel syndrome,
dequevains disease, ganglion
e. The Hand – tendon lesions – mallet finger, boutionniere – Dupuytrens
contractures, Rheumatoid arthritis, Acute hand infections.and injuries.
f. The Spine –
i. Scoliosis
ii. Kyphosis
iii. Tuberculosis of the
spine
iv. Pyogenic spondylitis
v. Disc degeneration and
prolapse
vi. Lumbar spondylosis
vii. Spinal stenosis
viii. Spondylolisthesis
g. The Hip – Congenital dislocations of the Hip and hip dysplasia
i.femoral anteverson
ii. irritable hip
iii. coax vara/coax valga
iv. Perthes disease
v. Slipped upper femoral
vi. Pyogenic arthritis of the hip
vii. Tuberculoses of the hip
viii. Osteoarthritis of the hip
ix. Rheumatoid arthritis of the hip
epiphysis

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h. The Knee
i. i. Angular deformities of knees
ii. Meniscal lesions
iii Dislocation of the patella
iv Chondromalacia patella
v Osteochondritis dissecans
vi.Tuberculosis of the knee
vii.Osteoarthritis of the knee
viii.Osgood schlatters disease
ix.Popliteal (Bakers Cyst)
x.Blount’s disease
i. The ankle & Foot – Talipes equinovarus
i. i. Flat foot
ii. Pes canvus
iii. Hallux valgus
iv. Hammer toes
v. Rheumatoid arthritis
vi. Osteoarthritis of the ankle
vii. Tarsal tunnel syndrome
viii. Ingrown toenail

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LIST OF PROCEDURES FOR PART I
1. ACCIDENT & EMERGENCY
Arthrocentesis Incision & Drainage
Arthrotomy Cut downs
Endotracheal intubation tracheostomy
Tube thoracostomy spinal immobilization techniques
Including skull traction
Wound debridement digital amputations
Closed reduction of dislocations manipulation and splintage of acute
Under anaesthesia fractures
Suprapubic cystostomy
2. ORTHOPAEDICS AND TRAUMA
Skeletal and skin traction for fractures open reduction of dislocation
biopsy – incisional/excisional soft tissue releases for clubfoot, contractures etc.
Tenolysis Bracing for scoliosis
Tenotomy major amputations
Elongation of tendons corrective osteotomy
Tendon transfer open reduction & internal fixation of fractures
Fasciotomy sequestrectomy
Ganglionectomy Diagnostic arthroscopy
Nerve repair application of halovest
Ligament repair
External musculoskeletal fixation.

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3. BURNS AND PLASTIC SURGERY
Split skin graft tendon repairs
Debridement for hand injuries flap surgery
Cleft lip & palate repair soft tissue release for contractures
Reconstructive surgery eg. Syndactyly
4. GENERAL SURGERY
Herniorrhaphy Appendicectomy
Laparatomy tracheostomy
Intestinal resection & anastomosis Excisional surgery of soft tissue masses
SSG Splenectomy
5. NEUROSURGERY
Burr holes
Drainage of scalp abscesses
Repair of Spinal Bifida
Skull traction
Application of halovests
Discketomy

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LIST OF PROCEDURES FOR PART II AND MINIMUM NUMBER TO BE
PERFORMED
GENERAL PROCEDURES
1. Incision and drainage 5
2. Excision biopsy 5
3. Tenolysis 3
4. Tenotomy 3
5. Neurolysis 3
6. Elongation of tendons 5
7. Bone grafting 5
8. Tendon transfer 3
9. Nerve transposition 2
10. Wound closure
- release incisions)
- skin grafts ) = 10 - flaps )
11. Nerve repair 3
12. Ligament repair 3
13. Manipulations (MUA) 10
(Manipulation Under Anaesthesia)
14. Traction procedures 5
15. Synovectomy 3
16. Capsulotomy 3
17. Fasciotomy 3
18. Wound Debridement 5
19. Escharectomy 5
20. Arthrocentesis 10

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REGIONAL
A. HIP
1. Total Hip replacement 2
2. Hemiarthrosplasty 3
3. Girdle Stone Arthroplasty 3
4. Angle blade plating 4
5. Intertrochanteric Osteotomy 2
6. Hip Arthrotomy 5
7. Hip Arthrodesis 2
8. Interpositional Arthroplasty 2
9. Pinning of Slipped Capital
Femoral Epiphysis 2
10. Osteotomy (Type) 2
B. FEMUR
1. Open Reduction & Internal Fixation – intramedullary Nailing
5
2. ORIF – plate and screws 3
3. Removal of implants 5
4. Condylar plating distal femur 3
5. Supracondylar corrective
osteotomy 5
6. Amputation (A/K) 3
7. Application of External Fixator 2

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C. KNEE REGION
1. Open Arthrotomy 3
2. Meniscectomy 2
3. Arthroscopy 3
* Diagnostic
* Surgical repairs – (cruciates etc)
4. Intra-Articular Fracture Fixation 2
5. Tension Band wiring of patella fracture)
3
6. Cerclage wiring of patella fracture )
7. Knee Arthrodesis 2
8. Removal of loose bodies 2
9. Total Knee Replacement 2
D. LEG
1. Tibial corrective osteotomy 3
2. ORIF – plate and screws 3
3. ORIF – Intramedullary Nailing 2
4. Application of external fixator 3
5. B/K Amputations 5
6. Knee disarticulation 2
7. ORIF – screw fixation 2
E. ANKLE
1. Manipulative reductions 5

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2. ORIF – plate and screws 3
3. Amputations (Type) 2
4. Arthrodesis 3
F. FOOT
1. Soft tissue release (STR) – club foot 3
2. Triple Arthrodesis 3
3. STR + osteotomy
for Hallux Valgus 2
4. Amputations 2
5. Ingrown Toe-Nail 3
6. K-wire fixation of fractu 3
7. Evans Procedure 2
8. Dywers Procedure 2
* Tarsometatasal
* Mid-tasal
* Symes etc.
UPPER LIMB
G. CLAVICLE
1. ORIF – plate and screw for fracture clavicle 2
H. SHOULDER
1. Shoulder Arthrotomy 3
2. Putti-Platt procedure 2
3. Amputations 2
4. Shoulder arthroplasties 2

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I. HUMERUS
1. ORIF – plate and screws 3
2. ORIF–intramedullary
Nailing 2
3. Humeral Osteotomy 2
4. External Fixator Application 2
5. Amputations A/E 2
J. FOREARM
1. Excision of radial Head + replacement 3
2. Open reduction elbow dislocation 2
3. Interpositional Arthroplasty of elbow 2
4. ORIF – plate and screws 2
Intramedullary nail 2
5. Excision of Distal Ulna (Darachs) 2
6. ORIF – Olecranon fractures? 2
- TBW (Tension Bad Wiring)
- Screw
- Nail
7. Amputation (B/E) 3
K. WRIST
1. STR De Quervain 3
2. Carpal tunnel release 2
3. Arthrodesis 2
4. ORIF – K-wire fixation 2

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Plate & screws
5. Arthroscopy 2
6. Amputation 2
L. HAND (As in Burns & Plastic Posting)
1. Drainage of abscesses 5
2. ORIF K-wires 3
Plate and screw
Screws
Intramedullary Nailling
3. External fixation device 2
4. Release of trigger finger 3
5. Release of contractures 2
6. Surgery for congenital anomalies 3
7. Amputations/Refashioning 3
8. Transfer of fingers 2
M. SPINE
1. Laminectomy 2
2. Posterior Spinal
fusion (Type) 2
3. Harrington Rod
instrumentation for
Scoliosis etc 3
4. Costo – transversectomy 2
5. TB – Drainage of Psoas Ahscess 2

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6. Closure of meningomyelocoele 2
N. TUMOUR SURGERY
1. Needle biopsy 3
2. Open biopsy 5
3. Trucut Biopsy 2
4. Limb Salvage Surgery 2

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CHAPTER VII
FORMAL CONTENT OF TRAINING
COGNITIVE SKILLS
Throughout the duration of the Residency programme, the programme director or Head of
Department has the responsibility to expose the residents to a systematic schedule of didactic
teaching covering the core knowledge pertinent to the rational practice of orthopaedics.
This should be presented in form of:
a. Seminars, group discussions and lectures
b. Clinical, clinico-pathological and clinic-radiological case conferences
c. Clinical Discussions on the management of clinical problems during teaching ward
rounds.
d. Systematic Review of contemporary surgical literature in journal club sessions.
e. Research Seminars.
The planned schedule should be such as to seek to cover the identified scope of core knowledge
in cycles of thirty months, so that an average resident has at least 2 opportunities (one as a Junior
Resident, one as a Senior Resident) to cover the same ground.
Each training institution may rightly identify what it regards as the pertinent core knowledge and
may draw up its own schedule for covering it in thirty months. This provision allows enough
flexibility to enable each institution to develop its own programme character and reputation
within the overall national guidelines.
PSYCHOMOTOR SKILLS
Each training institution is also expected to design and execute a systematic approach to the
teaching/learning of operative skills, so that from the first to the fifth year of the programme,
residents are expected to master specific psychomotor skills of hierarchically increasing degree
of complexity, such as:
a. The handling and care of surgical instruments and equipment.
b. The organization, washing packing and sterilization of surgical sets appropriate to
particular operations.
c. The preparation and positioning of patients for particular operations.
d. Non-operative manipulations
e. Surgical incisions and exposures

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f. Surgical haemostasis
g. Wound closure
h. Tendon and nerve repair
i. Vascular anastomoses
j. Exposure, internal fixation or prosthetic reinforcement or replacement of bone and joint
structures.
MANAGEMENT SKILLS
The Secretariat of the College also conducts Management courses twice a year, which senior
resident doctors are encouraged to attend.
Besides, the need for management expertise in Surgical practice is so great, that training
institutions are expected to also make deliberate effort to give each resident specific opportunity
during training to attend one of these formal courses in Management.
It is ideal to appoint each 2nd
or 3rd
year Senior Resident into the management post of
“Administrative Chief Resident” at least for six months each so as to give each of them an
opportunity to acquire some management skills.
Finally, residents are themselves asked to take personal interest in management matters because
there is no denying that resource allocation and resource utilization, both at the institutional
level, and indeed at the national level impinge directly on the effectiveness of their surgical skill,
especially in a nation with limited and diminishing resources. It is an asset to have learnt to
tailor surgical decisions to the available resources and so obtain optimal results with minimal
frustration both of self and patients.

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CHAPTER VIII
EVALUATION
Two types of evaluation are instituted by the Faculty of Orthopaedics for its Fellowship
programme. These are formative evaluation (in-course assessment) and Summative evaluation
(Parts I and II Fellowship Examinations)
A. IN-COURSE ASSESSMENT
Constant evaluation is expected to be carried out during the course of Training by each
institution. Procedure which are mandatory for each clinical posting are assessed and
graded as the resident carries them out. Once adjudged satisfactory, such procedures are
credited for the resident concerned, at which point the Residents port-folio is signed by
the supervising consultant. To be signed off for each posting the resident must have been
judged to have satisfactorily performed all the mandatory procedures for that posting,
failing which a remedial period may be recommended. It is not mandatory to have an
end-of-posting tests, although this is highly recommended. It is part of good training that
residents should have frequent written tests under examination conditions, so as to
acquire appropriate examination techniques (for both Essays and MCQs) during training.
Each year an annual report on the progress of each resident is required to be sent by the
training Institution to the College Secretariat for their records.
The objectives of the formative evaluation are as follows:
1. To diagnose the degree of convergence of educational goals and students
achievement.
2. To provide a basis for feedback to students in order to help them improve their
knowledge and competence.
3. To furnish teachers and clinical supervisors with relevant information about the
quality of their teaching – its strengths and weakness.
4. To serve as an effective tool for ensuring the maintenance of high quality health
care for patients.
5. To certify students for admission to the Part I and Part II F.M.C.Ortho.
Fellowship Examinations.
B. APPLICATION FOR COLLEGE CERTIFYING EXAMINATIONS
The Fellowship Examinations are held twice a year, in May and November. A call for
application is published in at least one of the National Dailies during the first week of
June (for the November Examinations) and the first week of December (for subsequent

37. 37
May examinations). Candidates are advised to watch out for, and comply with the
requirements of these advertisements.
B1. (PART I FELLOWSHIP EXAMINATIONS)
To be eligible so sit the Part I Fellowship Examination, Candidates should have
completed at least 30 months of Training and should have satisfactorily
performed all the prescribed surgical procedures relevant to each clinical posting,
and should have been duly signed up in the certificate of Training, to that effect.
Candidates must therefore submit their Residents Portfolio at the same time as
they submit their applications for the examination.
The Part I Fellowship Examination which consists of:
1. Two theory papers
2. Clinical Examinations
3. Orals (Viva Voce)
1. Theory Papers
These shall consist of:
a. One 3 hour written paper (including MCQs) in General Principles
of Surgery including Applied Basic Medical Sciences.
b. One 3 hour written paper including a question in General Surgery
and two questions in Orthopaedic Surgery and Surgical Pathology.
2. Clinicals
Clinical examinations will be conducted both in Orthopaedics and in
Surgery in general. Each candidate is presented with one “long case” in
Orthopaedics and will participate in objective structured clinical
examination (OSCE) which will cover various surgical specialties of the
approved postings. For Long case candidates are assessed for the quality
and thoroughness of:
a. History taking and Clinical Examination
b. Case presentation
c. Interpretation of findings
d. Patient management
Special attention is paid to candidate’s ability to foresee and prevent
complications associated with his management strategy.
3. Orals (Viva Voce) – (20 minutes)

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The purpose of this aspect of examination is to cover as wide a field as
possible with the candidate. Each candidate is subjected to one oral
examination in two halves/parts, one dealing with principles of surgery, as
well as pre and post operative management, while the other deals with
Surgical Pathology, diagnostic modalities, and operative surgery.
4. EXAMINATION RESULTS
In order to pass the Examination, a candidate must:
1. Pass at least one of the two written Parts and obtain a border-line
pass in the other;
2. Obtain a Pass (P) in the Clinical Examinations;
3. Obtain an aggregate Pass (P) overall;
4. Normally obtain a Pass (P) in each section of the Examination, i.e.
Written Paper, Orals and Clinicals provided that:
(a) a candidate who has passed at least 4 of the questions in the
written paper may compensate with at least a good pass P+
in the oral or clinical examination.
(b) a borderline Pass (P-) in the Orals may be compensated by
good Pass (P+) in Clinicals;
(c) there can be no compensation at all for a borderline Pass
(P-) in two sections or for Fail (P-1) in any section of the
examination.
(d) there can be no compensation at all for a border-line Pass
(P-) in the Clinical Examination.
NOTE: Candidates must retrieve their Residents’ Port-folio
at the end of the examination before they return to
training centre.
B2. PART II FELLOWSHIP EXAMINATIONS
1. The Part II examination is designed to complete the assessment and
certification of professional competence in Orthopaedics and
Traumatology for the award of the Fellowship in Orthopaedics.

39. 39
2. Registration for Part II F. M. C. ORTHO. Examination
Not later than 15 months before the date of the examinations in which the
candidate proposes to appear and in order to be eligible to appear in the
Part II Examinations, a candidate must:
a. register the names of 2 supervisors nominated by his/her training
centre, one of who should be a Fellow of the College of Surgery or
Orthopaedics.
b. submit written attestations by the supervisors indicating their
willingness to supervise the project, i.e. planning the project,
collection of data, analysis of data and the general write up of the
dissertation, not merely serving as proof readers of the dissertation.
c. submit a certificate of clearance by his institution’s Ethical
committee in case of a research project involving human subjects.
d. in addition to the above, the candidate must submit a detailed
proposal, clearly defining the subject chosen for study, the scope of
the study, and its objective(s). The proposal must also contain a
critical review of the literature as well as the materials and
methods of the study. The Faculty Secretariat would provide a
feedback to the candidate on the suitability or otherwise of his
proposal within 3 months of this submission.
NOTE:It is in the Resident’s own interest to so plan the submission of his
proposal that he is able to receive the feedback during the first 12
months of his Senior Residency training.
3. The Dissertation
The objective of the Dissertation is, among others, to give the candidate a
chance to demonstrate that the is able to clearly define a research topic,
define his research objective, design a study methodology that is capable
of leading to the objectives, analyze and discuss his results scientifically
and objectively.
The final dissertation submitted should follow the approved format,
namely:
3.1. A title page featuring
The title of the work
“submitted by”

40. 40
The name of the author to
“The National Postgraduate Medical College of Nigeria”
in part fulfillment of the requirements of the award of the Final Fellowship
of the Medical College in Orthopaedic F.M.C.Ortho “May 1988”
(Appropriate date).
3.2. The Declaration page. In which the candidate declares that the work
presented has been done by him under the appropriate supervision, and
that it has not been submitted in part or in full for any other examination.
3.3. A Dedication page which is optional, may be included here.
3.4. The Attestation page
In which the Supervisors themselves attests to the fact that the work has
been done and the dissertation written under their close supervision.
3.5. The Acknowledgement Page
In which the candidate specifically acknowledges all the assistance he has
received in the course of the work, including copyright permissions.
3.6. The Summary or Abstract
The main work begins with a summary of the dissertation featuring the key
points, in about 200 words. Nothing should feature in the summary that
has not been presented in greater detail in the main body of the work.
3.7. Introduction
The introductory chapter should contain a clear definition of the problem
to be studied, including a justification for the study, a delimitation of the
scope of the study.
3.8. Review of the Literature
3.9. Statement of objectives of the study.
3.10. A description of the study design, otherwise titled “Materials and Method”
of study, including a description of the statistical analysis intended to be
used for processing the results.
3.11. The Results

41. 41
3.12. The Discussion
3.13. Conclusions and Recommendations and finally
3.14. References, using the system proposed by the International Committee of
medical Journal Editors, “Uniform Requirements for manuscripts
submitted to biomedical Journals” Br. Med. J. 1988, 296. 401 – 5 which is
also reproduced in the College’s Research Methodology Handbook.
Candidates are advised not only to acquire a copy of this handbook, but
also to endeavour to attend at least one of the yearly intensive courses in
Research Methodology mounted by the College.
When a candidate is appearing for the oral examination on his/her
dissertation, he/she is required to bring a copy of the dissertation paged in
the same way as the 3 copies previously submitted for the examination.
4. The Examination
The Part II Fellowship Examination shall consist of
a. Clinical Examiantion including Long and Short cases
b. A comprehensive oral examination on the candidate’s dissertation.
This “Dissertation Orals” shall focus on candidate’s
accomplishment of those objectives of the dissertation earlier
stated in this handbook.
c. Two other Orals on the General Principles and Practice of
Orthopaedics Surgery which shall focus respectively on
a. Principles of Surgery
b. Surgical Pathology and Operative Surgery
NOTE: Candidates for the Part II Fellowship must submit their Training
Certificates (including courses), Residents Port-folio along with
the dissertations at the time they submit their applications for the
examination. They should however bring their file of operation
notes with them to the venue of the Oral /examination.
It is also their responsibility to retrieve both their portfolio and
their dissertations at the end of the examination.
5. Examination Results
In order to pass the Examination, a candidate must:

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(a) Have his Dissertation accepted
(b) Pass The Clinical Examinations and
(c) Pass both sections of the Viva Voce.
However, a candidate who has his Dissertation accepted at P or P+
level
but fails in the Viva Voce, shall be referred in the Clinicals/Orals against
the next examination.
A candidate whose Dissertation needs some significant corrections i.e. P-
level pass, but who has passed the Clinicals/Orals shall be referred in the
Dissertation.
A candidate, having passed the Clinicals/Orals but whose Dissertation
needs major restructuring i.e. P-1
level shall be referred in the Dissertation.
A candidate having passed the Clinical/Orals but whose dissertation needs
minor typographic correcton shall have a Provisional Pass.
No candidate may earn a Reference in Clinicals/Orals and a Provisional
Pass.
The following considerations shall subsist:
(a) A borderline (P-
) in the orals may be compensated by a good Pass
(P+
) in Clinicals
(b) There can be no compensation at all for a borderline Pass (P-
) in
the Clinicals.
(c) There can be no compensation for a P-1
in any section of the
examination.

43. 43
CHAPTER IX
CONTINUING EDUCATION
The need for continuing medical education and continuing professional development especially
in the field of Orthopaedics is just as vital as the period of Fellowship training if not more.
Fellows of the Faculty of Orthopaedics are actively encouraged to continue their surgical training
throughout their active practice life. Among other means to achieve this, Fellows are encouraged
to take active interest in the activities of the Faculty and the College and to be of good financial
standing.
Fellows are encouraged to subscribe to two or three reputable journals including at least one
foreign.
Fellows are also encouraged to attend National Workshops and Learned Conferences at least
once a year in an effort to keep abreast with developments in the discipline.
Fellows are reminded that the idea of periodic recertification as a means of quality assurance in
the practice of Orthopaedics is not only desirable, but may soon be required by Law.