FRACS Orthopaedic Surgery (SET) Exam 2026 Study Guide: What You Actually Need to Know

A practical guide for orthopaedic SET trainees sitting the FRACS Orthopaedic Surgery Fellowship Exam in the next twelve months. PRIMEX started in 2025 when an anaesthetic trainee at a regional NSW hospital built study tools for the ANZCA Primary. It now covers 21 colleges because trainees from each specialty asked us to build for them. The FRACS Orthopaedic Surgery (SET) Exam curriculum on PRIMEX is maintained against the college's published syllabus, with topic mapping reviewed for accuracy.

The exam at a glance

The FRACS Orthopaedic Surgery Fellowship Examination is the gateway exit assessment from the SET (Surgical Education and Training) programme in orthopaedic surgery. It is jointly governed by the Royal Australasian College of Surgeons and the Australian Orthopaedic Association, and the syllabus follows the AOA 21 Training Program Orthopaedic Surgery Curriculum. Most candidates attempt the written component late in SET 4 or in SET 5, with the viva block following only after the Written has been passed. Pass both and the trainee is eligible for Fellowship; fail either and most candidates extend training to re-sit at the next available sitting, which adds at least six months to the path.

Format

• Two examinations across two stages: a Written Examination using Single Best Answer (SBA) and Extended Matching Question (EMQ) format, then a Viva Examination of four 30-minute oral stations
• The Written must be passed before the candidate is eligible to sit the Viva at the next sitting
• Four viva stations, each 30 minutes, each with two consultant orthopaedic examiners: Anatomy, Pathology, Trauma, and Clinical
• The Anatomy station is built on cadaveric specimens, prosections, or anatomical images, probing named surgical intervals, structures at risk, and the relations of neurovascular anatomy at risk during common approaches
• The Pathology station works from histology, radiographs, and pathology stems, probing diagnosis, Enneking staging where relevant, ancillary investigations, and management decisions including limb salvage versus amputation
• The Trauma station works from radiographs and clinical scenarios, probing fracture classification, ATLS principles where relevant, fixation choice with rationale, named approach, and complications with incidence
• The Clinical station works from elective case stems, probing assessment, targeted investigation, operative versus non-operative reasoning, implant choice, surgical approach, rehabilitation, and outcome data

Sittings, prerequisites and timing

• The Written runs once or twice per year depending on the cycle; the Viva is held in a defined block after Written results have been released
• Prerequisite for sitting the FRACS Ortho exam is satisfactory progress through the AOA SET programme, including operative logbook volume, in-training assessments, and college sign-off through the AOA Board of Orthopaedic Education
• The RACS Generic Surgical Sciences Examination (GSSE) is a separate prerequisite for entry into SET and is sat earlier in training; PRIMEX covers the GSSE as a distinct exam, not part of this guide
• Re-sit at the next available sitting if unsuccessful, usually with a structured remediation plan agreed through the AOA Board
• As of 2026, confirm current sitting dates, fees, and venue list directly with the AOA and RACS websites before locking in a study plan, because cycle changes are not always announced far in advance

Pass marks and standardisation

The college does not publish a fixed numerical pass mark for the FRACS Orthopaedic Surgery exam in the way some colleges publish a percentage cut score. Both Written and Viva are criterion-referenced against examiner consensus on what a safe consultant orthopaedic surgeon needs to demonstrate, with standard-setting performed within each domain. The candidate report released after each sitting describes themes and recurring weaknesses; that report is the most useful document a re-sit candidate will read because it tells the cohort which domains lost marks and where the examiner panel set the threshold.

Day-of logistics

• Photo identification required at every component, plus your AOA candidate number
• The Written is computer-based at AOA-approved venues; expect a timed SBA and EMQ paper with on-screen image presentation for radiographs and clinical photographs
• No personal materials at the desk: no phone, no smartwatch, no books, no operative logbooks, no own pens unless permitted
• Vivas use prepared anatomical specimens, prosections, digital radiograph displays, and case stems on screen; bring nothing into the viva room except your candidate number
• The viva day is structurally long: four 30-minute stations with reading time before each, and short transitions between stations. Sleep, hydration, and a planned eating window between sessions matter more than people admit

What the college actually tests

The PRIMEX FRACS Orthopaedic Surgery curriculum holds 156 mapped learning objectives across 18 sections, drawn from the AOA 21 Training Program Orthopaedic Surgery Curriculum (Australian Orthopaedic Association, 2024) and supplemented by the RACS Guide to SET. The 18 sections span Orthopaedic Basic Sciences, Orthopaedic Anatomy, Trauma of the Upper Limb, Trauma of the Lower Limb and Pelvis, Hip and Knee Arthroplasty, Spine, Shoulder Elbow and Hand, Foot and Ankle, Paediatric Orthopaedics, Oncology and Metabolic Bone Disease, Orthopaedic Infections, Sports Medicine, Nerve Compression and Upper Limb, Perioperative and Orthopaedic Medicine, Reconstructive Orthopaedics, Arthroscopy and Minimally Invasive Surgery, Evidence-Based Orthopaedics, and Advanced and Subspecialty Topics. The PRIMEX index also holds 130 mapped study topics that group those learning objectives into testable practice units. Trauma carries the largest single weight, with around twenty learning objectives split across upper limb, lower limb and pelvis. Arthroplasty, the Shoulder Elbow and Hand block, and Basic Sciences are the next largest. Anatomy, Foot and Ankle, Paediatrics, Sports, and Spine each carry between roughly seven and ten learning objectives apiece.

The highest-yield areas to anchor your study

Trauma of the lower limb and pelvis

• Pelvic ring injuries classified by Young-Burgess (APC, LC, VS, CM), with stratified management by haemodynamic stability, including external fixation as resuscitative tool, definitive ORIF, and the place of REBOA in current Australian major-trauma practice
• Acetabular fractures classified by Letournel, with operative approach selection between Kocher-Langenbeck, ilioinguinal, and Stoppa, and the principles guiding acute THA conversion in the elderly with comminuted posterior wall
• Hip fractures classified by Garden and AO with operative decision-making across DHS versus IMN versus hemiarthroplasty versus THA, supported by the FAITH and HEALTH trial evidence base
• Tibial plateau fractures classified by Schatzker, with articular reduction principles, spanning external fixation as a temporising step, and the rationale for delayed definitive ORIF after soft tissue settling
• Tibial shaft fractures with reamed versus unreamed IMN supported by SPRINT data, plus active recognition and management of compartment syndrome with named pressure thresholds and a fasciotomy technique that is rehearsable out loud
• Talar and calcaneal fractures, with Hawkins classification for the talus and Sanders CT classification for the calcaneus, including the proper interpretation of the Hawkins sign as evidence of preserved vascularity rather than a guarantee of avascularity when absent

Trauma of the upper limb

• Distal radius fractures classified by Frykman or AO, with volar locking plate decision-making, the DRAFFT trial evidence comparing K-wire to volar plate, and indications for carpal tunnel release at the time of fixation
• Scaphoid fractures classified by Herbert, with attention to vascular supply, non-union risk factors, and the choice between percutaneous and open Herbert screw fixation
• Proximal humerus fractures by Neer classification, with ORIF versus arthroplasty decision-making and the deltoid-splitting approach with axillary nerve safe distance from the lateral acromion
• Humeral shaft fractures with attention to radial nerve palsy, the role of functional bracing, and the decision between IM nail and plate fixation
• Forearm fractures including both-bones, Galeazzi, and Monteggia patterns, with anatomical reduction principles and the named approaches
• Olecranon fractures and elbow dislocations, with tension band wiring principles, ORIF for displaced fractures, and the recognition and management of the terrible triad injury

Hip and knee arthroplasty

• Total hip arthroplasty approaches (posterior, anterolateral, direct anterior using Hueter's interval), implant selection by patient age and activity, bearing surface decisions, and cup and stem positioning to avoid impingement and dislocation
• THA complications including dislocation, periprosthetic fracture classified by Vancouver, aseptic loosening, adverse reaction to metal debris (ARMD) in metal-on-metal historical context, and clinically meaningful leg length discrepancy
• Total knee arthroplasty with component alignment philosophy (mechanical, kinematic, functional), PCL retention versus sacrifice, the patella resurfacing decision, and the early versus late management of stiffness and arthrofibrosis
• Periprosthetic joint infection diagnosed against the ICM (International Consensus Meeting) criteria, with synovial WBC, alpha-defensin, CRP, and ESR thresholds, the criteria for DAIR versus single-stage versus two-stage exchange, and antibiotic regimen principles
• Revision arthroplasty bone defect management classified by AORI on the femoral side and Paprosky for acetabular defects, with augments, cones, and structural allograft as graded options

Shoulder, elbow, hand and the upper limb soft tissue exam

• Rotator cuff tears with Goutallier fatty infiltration grading, decision-making between arthroscopic and open repair, the role of patch augmentation, and the threshold for reverse total shoulder arthroplasty in the irreparable cuff with arthritis
• Shoulder instability with Bankart lesion, Hill-Sachs defect, the glenoid track concept, on-track versus off-track lesions, the bone loss thresholds for soft tissue versus bony procedures, and the indications for the Latarjet procedure
• Carpal tunnel and cubital tunnel syndromes with named clinical tests, electrophysiological criteria, McGowan grading for cubital tunnel, and the operative options including in-situ decompression versus transposition
• Hand infections including flexor sheath infection recognised by Kanavel signs, paronychia, felon, and necrotising fasciitis with urgent debridement
• Wrist instability including scapholunate dissociation tested by the Watson test and graded by Geissler, plus TFCC tears and repair principles

Foot and ankle, paediatric orthopaedics, and spine

• Hallux valgus with the HV and IM angles, surgical option selection across Scarf, Lapidus, and chevron osteotomies, and the recurrence risk by underlying deformity
• Flatfoot and adult acquired flatfoot with PTTD staging, calcaneal osteotomy, and the place of triple arthrodesis in advanced disease
• Diabetic foot complications with Charcot arthropathy classified by Eichenholtz, ulcer classification, the threshold for amputation, and the principles of offloading
• Developmental dysplasia of the hip with Graf classification, the Pavlik bracing window, and operative reduction timing in late-presenting cases
• Perthes disease with Herring classification, containment principles, and operative options stratified by age at onset
• Slipped capital femoral epiphysis with stable versus unstable distinction and the principles of in-situ pinning versus controlled reduction
• Paediatric fractures with the Salter-Harris classification, the Gartland classification of supracondylar fractures, and the principle of remodelling potential by age and plane
• Cervical and lumbar spine pathology including ACDF versus ACDR for cervical disc disease, microdiscectomy and TLIF for lumbar disc disease, decompression for spinal stenosis, and TLICS or SLIC classification for spinal trauma

Evidence-based orthopaedics and the named trial bank

• FAITH trial: DHS versus cancellous screws for displaced femoral neck fractures in younger fit patients
• HEALTH trial: total hip arthroplasty versus hemiarthroplasty for displaced femoral neck fractures in the elderly
• FLOW trial: aspirin versus low-molecular-weight heparin for VTE prophylaxis after hip and knee arthroplasty in current Australian practice
• SPRINT trial: reamed versus unreamed intramedullary nailing of tibial shaft fractures
• DRAFFT trial: K-wire versus volar locking plate for distal radius fractures
• CSAW trial: arthroscopic subacromial decompression versus sham surgery for subacromial pain
• The Moseley and Ottawa trials for knee arthroscopy in osteoarthritis, including the implications for indications today
• BMI and arthroplasty outcomes, including the evidence for preoperative weight optimisation and morbid obesity thresholds

Common pitfalls that fail candidates

• Vague anatomy in the Anatomy viva. Examiners do not accept "near the rotator cuff"; they want the named interval (deltopectoral, Kocher, Henry, Smith-Petersen), the structures at risk at each step (axillary nerve below the inferior border of teres minor, posterior interosseous nerve through supinator), and the safe distances quoted in centimetres where they exist
• Quoting fracture classifications without the management threshold attached. Schatzker, Garden, Vancouver, and Salter-Harris are not test of memory; the examiner wants the threshold at which classification changes the operation
• Misreading the Hawkins sign. Its presence (subchondral lucency in the talar dome at six to eight weeks) is reassuring of preserved vascularity. Its absence does not confirm avascular necrosis. Candidates routinely lose marks by saying "no Hawkins sign means AVN"
• Ignoring the named trial bank. FAITH, HEALTH, FLOW, SPRINT, DRAFFT, CSAW and the Moseley arthroscopy trial all reliably appear; quoting one of them by name with the headline finding turns a Borderline answer into a Pass
• Treating compartment syndrome as a knowledge question rather than a recognition and action question. The viva probes the moment between two clinical observations: rising opioid requirement, pain on passive stretch, an inconsistent pulse oximeter trace. The candidate who jumps straight to fasciotomy technique without the recognition story is signalling a gap
• Operative steps recited as a list. The viva probes the moment between two steps: when do you reduce, when do you fix, when do you call for senior help, when do you abandon a planned approach for a damage control alternative
• Defaulting to a metropolitan tertiary answer when the case stem is set in a regional or rural Australian context. Examiners write rural scenarios deliberately and reward candidates who adjust transfer timing, image transfer, retrieval logistics, and consultant escalation accordingly

Realistic study timelines

The right run-up depends on operative volume already accumulated in trauma, arthroplasty and the subspecialty rotations, on how strong the candidate's base anatomy is from earlier training, and on how heavy the on-call roster is during the study window. The plans below assume a working SET trainee on a normal full-time roster with consultant-of-the-week or registrar-on-call commitments, not a study-only year. Adjust honestly. If the week genuinely contains no protected hours, the four-month plan is not realistic.

Nine-month plan, around 8 to 10 hours per week

• Months 1 to 3: read across the curriculum at a topic-a-day pace, building a one-page summary for every PRIMEX study note. Anchor each summary on a current AOA position statement, the AAOS guideline where relevant, or a landmark trial paper rather than a textbook chapter alone. Begin a personal anatomy notebook of named intervals and structures at risk by region
• Months 4 to 5: start untimed SBA and EMQ blocks from the question bank, plus a single SAQ-style structured written answer per evening on a rotating module. Focus on writing in orthopaedic-framework format from the first answer: anatomy, classification with thresholds, investigation, operative decision, named approach, complications, evidence
• Months 6 to 7: shift to timed SBA and EMQ blocks at exam pace. Begin viva practice at one station per week, alternating between Anatomy, Pathology, Trauma and Clinical, with a partner or the PRIMEX viva simulator
• Months 8 to 9: full mock written papers at exam pace, plus a viva day per fortnight at full station length across all four stations. Re-loop on weak areas the candidate report from past cohorts has flagged
• Last two weeks: light retrieval practice using flashcards on classifications, named trials, anatomical relations, and operative steps. No new content. Sleep hygiene

Six-month plan, around 12 to 15 hours per week

• Months 1 to 2: rapid pass through the 156 learning objectives, reading the PRIMEX study note for each and tagging the topics where operative or rotational exposure has been thin. Be honest about the modules that were avoided as a junior registrar
• Months 3 to 4: untimed SBA and EMQ blocks each weeknight, structured to the weakest tag list first; weekend blocks for guideline reading on hip fracture management, tibial plateau fixation, periprosthetic joint infection, and shoulder instability bone loss thresholds
• Month 5: timed written blocks at exam pace, alternated with viva station practice in voice mode for the Anatomy and Trauma stations; begin Pathology viva practice with histology and radiograph stems
• Month 6: two full mock written papers, two full viva days under examination conditions across all four stations, candidate report review, and focused remediation on the bottom-three modules

Four-month plan, around 18 to 22 hours per week

• Month 1: triage the weakest five modules, read the relevant study notes, and start writing two structured SAQ-style answers per night without timing. Begin daily anatomy retrieval drills, ten named intervals or structures at risk per session
• Month 2: timed SBA and EMQ blocks every weeknight, weekend mock blocks of three SAQ-style answers at exam pace; introduce viva station practice three times a week with a mix of Anatomy and Trauma cases
• Month 3: two full mock written papers and a full mock viva day, candidate report review, and a second loop on weak areas with operative scenarios at exam pace
• Month 4: maintenance only. Light flashcards on classifications, named trials, and anatomical relations, sleep, and a final read-through of high-yield AOA position statements and trial summaries

The single biggest mistake people make

The pattern that breaks competent candidates in FRACS Orthopaedics is treating the Anatomy viva as a recall test rather than a verbal performance under specimen. You spend month one through month four reading textbooks, scrolling through 3D anatomy apps, and watching cadaver dissection videos, you build pages of beautifully labelled diagrams, and you tell yourself that knowing the anatomy cold will be enough. It is not. The Anatomy viva is engineered to find the moment when the candidate must point at a real specimen, name the interval being used, list the structures at risk in the correct sequence as the dissection deepens, and quote the safe distance to a nerve in centimetres. Most candidates have never said any of that out loud before walking in. You can label a perfect deltopectoral approach in a textbook and still fail the Anatomy station, because the examiner asks where the axillary nerve is, what the safe inferior margin of dissection is, and which retractor is sitting on which structure. The candidates who pass cleanly are the ones who practised speaking through anatomical specimens out loud, ideally with a senior registrar or fellow pushing back on every vague answer, from month one. Start saying the anatomy. Rough, ugly, hesitant talk-throughs are fine in week one. The point is to make the verbal sequence reflexive, so that on the day the cognitive load is the medicine and the specimen, not the words.

How PRIMEX helps

• Written grader (SBA, EMQ and SAQ-style): write an FRACS Ortho-format structured written answer or work an SBA or EMQ stem, and get a marking-point breakdown with model answers at examiner standard. Available inside the app and on the public SAQ grader for unauthenticated trial use.
• Curriculum tracker: all 156 mapped learning objectives are visible on the FRACS Orthopaedic Surgery app page with progress tracking by topic, so the candidate can see at a glance which sections have been studied and which need attention.
• Ask PRIMEX: a question-and-answer interface that returns guideline-aligned answers across AOA position statements, AAOS guidance and current Australian orthopaedic practice, useful for a quick sanity check on a management plan or operative principle being drafted.
• Four-station viva simulator with voice mode: separate Anatomy, Pathology, Trauma and Clinical station formats, each timed to the real 30-minute station length, with a structured debrief after each session. Speak the answer out loud and have an AI examiner probe further. Available through the FRACS Orthopaedic Surgery study tools.

Frequently asked questions

Related study guides

• FRACS General Surgery 2026 Study Guide
• RACS GSSE 2026 Study Guide