Hip is a surgical anatomy station. Three of the seventeen examined stations in the MRCS Part B OSCE are surgical anatomy. The anatomy stations put a prosected specimen, a model or an image in front of you and ask you to identify structures and say what they do, what they relate to and what happens when they are injured.
What you need to know for the Hip station
The proximal femur with its attachments, a hip radiograph, and the muscles that move the joint. The classification question is the one candidates forget to prepare.
Siding and attachments
The head points medially and upwards; the greater trochanter is lateral and the lesser trochanter is posteromedial, which sides the bone. Gluteus medius inserts on the lateral surface of the greater trochanter and gluteus minimus on its anterior surface. In the trochanteric fossa on its medial side inserts obturator externus; along its upper border, piriformis, then obturator internus with the gemelli behind it. Quadratus femoris inserts on the intertrochanteric crest at the quadrate tubercle. Iliopsoas inserts on the lesser trochanter. The intertrochanteric line in front takes the iliofemoral ligament and the capsule; the ischiofemoral ligament attaches behind, above the crest.
Classifying intracapsular fractures
Garden's classification is the one still used: I incomplete or impacted valgus, II complete but undisplaced, III complete and partly displaced, IV completely displaced. In practice the decision is undisplaced (I and II, fix with screws) against displaced (III and IV, replace — a hemiarthroplasty or, in the fitter patient, a total hip). Pauwels classifies by the angle of the fracture line from horizontal, which predicts shear and non-union in younger patients. The AO/OTA system codes the whole proximal femur, with 31-B for the neck.
Hip flexors
Iliopsoas is the main one, helped by rectus femoris, sartorius, pectineus, tensor fasciae latae and the adductors in the first part of the range. Iliopsoas: psoas major from the sides of T12–L5 vertebral bodies, their discs and transverse processes; iliacus from the iliac fossa. They pass under the inguinal ligament through the muscular compartment, lateral to the femoral nerve, and insert together on the lesser trochanter. Psoas is supplied by L1–3 directly, iliacus by the femoral nerve (L2, 3). Together they flex the hip and, with the feet fixed, flex the trunk on the thigh.
Short external rotators
Piriformis, superior gemellus, obturator internus, inferior gemellus, obturator externus and quadratus femoris, from above down. The sciatic nerve emerges below piriformis and runs down over the rest, which is why they are divided in a posterior approach and why the nerve is at risk there.
Abductors
Gluteus medius and minimus, both inserting on the greater trochanter and both supplied by the superior gluteal nerve (L4–S1), with tensor fasciae latae acting through the iliotibial band. They hold the pelvis level when the opposite foot is lifted; failure of the nerve, the muscle or the lever arm gives a Trendelenburg sign, with the pelvis dropping on the unsupported side.
Images from this station
What are you asked at the Hip station?
The station runs to 12 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- Name and side the above structure
- Identify muscle attachments 1-3
- Identify attachments 4 and 5
- Identify attachments 6 and 7
- Identify attachments 8 and 9
- Which ligaments attach at 10 and 11?
- Describe the radiograph
- What classification systems do you know for intracapsular fractures?
- Name the flexors of the hip joint
- What is the origin, insertion and action of iliopsoas?
- Name the short external rotators of the hip joint
- What muscles abduct the hip and what are their insertions and nerve supply?
How is the anatomy station marked in MRCS Part B?
An anatomy station is marked out of 20, and all 20 marks go to clinical knowledge and its application. No communication, technical-skill or professionalism marks are available in an anatomy bay, which is unusual: in most other stations more than half the marks sit outside your factual knowledge.
FAQ
What does the Hip station ask?
It opens with "Name and side the above structure" and runs to 12 questions over nine minutes. An anatomy station is marked out of 20, and all 20 marks go to clinical knowledge and its application. No communication, technical-skill or professionalism marks are available in an anatomy bay, which is unusual: in most other stations more than half the marks sit outside your factual knowledge.
How many anatomy stations are there in MRCS Part B?
Three of the seventeen examined stations are surgical anatomy, and two more are surgical pathology. Together they make up the five Anatomy and surgical pathology stations of the Applied Knowledge component.
How are the anatomy stations marked?
Each station is marked out of 20 and all 20 marks are awarded for clinical knowledge and its application. You also receive a separate global rating of pass, borderline or fail for the station.
Are the specimens real?
Yes. Anatomy bays use prosected cadaveric specimens, models and images. Candidates report being shown photographs of specimens as well as the specimens themselves, so practise on real dissection photography rather than diagrams alone.
What happens if I get an early question wrong?
The intercollegiate guidance says that if a wrong answer would affect your performance on later questions at the same station, the examiner gives you the correct answer before moving on. One mistake does not have to cost you the whole bay.
How many stations are in the MRCS Part B OSCE?
Seventeen examined stations of nine minutes each, with a minute to read the task before each one. Two preparation stations and at least one rest station bring the circuit to about twenty, and the exam takes about three and a half hours.
What is the pass mark for MRCS Part B?
There is no published pass mark. The cut score is set separately for Applied Knowledge and Applied Skills, for each circuit, by borderline regression. Published pass rates across the 2024/25 diets ranged from 51% to 66%.
Can I fail a station and still pass?
Yes. There is no rule about how many stations you may fail: the cut score applies to your total mark in each component, so a weak station costs the marks you lost on it and strong stations elsewhere can make them back. Applied Knowledge and Applied Skills are passed separately and must both be passed at the same sitting, so a strong anatomy performance cannot rescue a weak communication one.
Dr Richard Miller, MBChB FRCS
Station summaries are reviewed against the current intercollegiate MRCS syllabus and the published marking blueprint. Guidance changes between diets: check the royal colleges' own pages before relying on a date, a fee or a threshold.
Practise this station
The question bank carries the model answer to every question above, with the rest of the anatomy stations.
More anatomy stations