MRCS Part B Revision · Surgical pathology
Open Fracture — MRCS Part B Surgical pathology
By Dr Richard Miller, MBChB FRCS · Reviewed
Open Fracture is a surgical pathology station. Two of the seventeen examined stations in the MRCS Part B OSCE are surgical pathology. The surgical pathology stations ask you to reason from a specimen, a slide, a report or a vignette to a diagnosis, and then to say what it means for the patient in front of you.
What you need to know for the Open Fracture station
Open Fractures
Management of open fractures should follow ATLS protocols and the BOA/BAPRAS BOAST 4 guidelines for open fractures. The primary concern should be the neurovascular status of the limb distal to injury. The acute guidelines are outlined below:
• Early Broad-spectrum IV antibiotics and Tetanus, continue antibiotics until 72hrs or skin coverage
• Assess neurovascular status and for compartment syndrome, correct vascular impairment within 3-4 hrs (6 maximum)
• Photograph wound then clean and dress with saline soaked gauze, minimise wound handling
• Splint fracture above and below
• Early transfer to a specialist centre if severe injury unless unsafe to transfer
• Involve Plastic Surgeons for definite wound coverage
What are you asked at the Open Fracture station?
The station runs to 15 questions over nine minutes. These are the questions as they are put to you; the model answers are in the question bank.
- How would you manage this patient acutely?
- What principles dictate the timing of surgery?
- What is the Gustilo-Anderson Classification?
- When should the Gustillo-Anderson classification be used and what is its major bias?
- You are called to review the patient 48 hours following the injury. He is on VTE prophylaxis. He is agitated with low oxygen saturations, fever, shortness of breath, subconjunctival haemorrhages and a petechial rash over his chest. What is likely to have occurred?
- How would you manage this patient?
- What are the two possible methods of bone healing?
- Describe how this fracture would heal if it was not anatomically fixed
- If the fracture was anatomically fixed using a compression plate how would the bone heal?
- What factors influence the rate and success of bone healing?
- What important patient-related factors that influence bone healing would you want to find out when assessing the patient?
- The skin defect overlying the fracture is 22x10cm in size. Assuming the wound did not become infected and healed without direct closure how would the wound heal?
And 3 more at this station.
How is the surgical pathology station marked in MRCS Part B?
Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
FAQ
What does the Open Fracture station ask?
It opens with "How would you manage this patient acutely?" and runs to 15 questions over nine minutes. Like the anatomy stations, a surgical pathology station is marked out of 20 with all 20 marks going to clinical knowledge and its application. The second of the two may be a microbiology station.
How many pathology stations are in MRCS Part B?
Two of the seventeen examined stations. The intercollegiate blueprint titles the second one surgical pathology and/or microbiology, so infection and antimicrobial topics appear here rather than in a station of their own.
How is the pathology station marked?
Out of 20, with every mark awarded for clinical knowledge and its application. There are no communication or professionalism marks available in it.
What should I revise for surgical pathology?
The general processes the syllabus names, inflammation, healing, neoplasia and infection, applied to the specimens and reports a surgical trainee meets. Candidates most often report malignancies and their mutations, inherited cancer syndromes, and obstructive jaundice.
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 surgical pathology stations.
More surgical pathology stations