ABPS Orthopedic Surgery common mistakes
ABPS Orthopedic Surgery · Understand the traps and how to avoid them.
Committing to a single diagnosis in a fracture case and omitting the standard differential (e.g., calling a distal radius fracture 'Colles' without considering volar Barton, Smith, or radiocarpal dislocation) before the examiner asks.
Candidates pattern-match the first familiar eponym and stop generating alternatives; the written format rewards a single best answer, so the habit carries into the oral where the examiner probes alternatives.
What to do instead
Use a fixed differential script for each region (fracture pattern, joint involvement, associated injury) and rehearse saying 'the main alternatives I would exclude are...' before committing.
Describing a fracture classification from memory but misassigning the grade or stage (e.g., swapping Garden III and IV, or Salter-Harris III and IV).
Classifications are memorized as lists without the discriminating rule (displacement vs. joint involvement vs. physeal anatomy), so recall collapses under pressure.
What to do instead
For each high-yield classification, memorize the single decision rule that separates adjacent grades and drill it with three self-generated example descriptions rather than the list order.
Presenting a management plan without stating the indication, the goal, and the alternative that was rejected.
Candidates treat the plan as a single correct action and skip the reasoning, which is what the oral examiner is actually scoring.
What to do instead
Structure every plan as indication, goal, chosen option, rejected alternative with reason, and expected outcome; practice this template aloud until automatic.
Skipping the neurovascular and soft-tissue examination in the history-taking vignette, going straight to imaging findings.
Written stems emphasize imaging and the candidate mirrors that emphasis, forgetting that limb-threatening findings drive urgency in the oral.
What to do instead
Adopt a mandatory opening checklist (skin, compartments, pulses, sensation, motor) recited for every trauma vignette before discussing imaging.
Giving pediatric doses, weight-bearing status, or duration of immobilization as vague ranges ('a few weeks', 'weight-bear as tolerated') instead of specific figures.
Candidates fear being wrong on numbers and hedge, but hedging reads as lack of knowledge to examiners.
What to do instead
Build a one-page numeric reference (immobilization durations, weight-bearing timelines, pediatric mg/kg ceilings) and commit to a specific figure with a stated rationale.
Failing to prioritize in a polytrauma or multi-injury scenario, addressing the extremity fracture before life-threatening injuries.
The orthopedic lens dominates attention, so the candidate sequences treatment by specialty relevance rather than by physiological threat.
What to do instead
Rehearse ATLS-style prioritization explicitly at the start of any multi-injury vignette, then transition to the orthopedic plan.
Confusing the indications and contraindications for common procedures (e.g., arthroplasty vs. fixation in an elderly proximal femur fracture, or when to choose ORIF vs. conservative management of a clavicle fracture).
Indications are learned as lists tied to procedure names rather than to patient factors, so the candidate cannot map a specific patient to the right option.
What to do instead
For each high-yield procedure, memorize two patient profiles (one clear indication, one clear contraindication) and match vignettes to profiles rather than to procedure names.
Not stating complications with their timeframe and prevention when asked about a procedure.
Candidates list complications as a flat set without timing, so the examiner cannot tell whether the candidate understands mechanism.
What to do instead
Organize complications into immediate, early, and late, and attach one prevention or surveillance measure to each.
Misreading the question stem on the written exam - answering the 'next best step' when asked for the 'most likely diagnosis', or vice versa.
Time pressure and familiar vignette patterns cause the candidate to answer the question they expected rather than the one asked.
What to do instead
Underline the interrogative phrase in every stem before selecting an answer, and flag any stem where two options seem correct for re-reading.
Abandoning a correct answer under examiner challenge, reversing a defensible position without new clinical information.
Candidates interpret examiner probing as a signal they were wrong and capitulate to appear receptive.
What to do instead
Practice holding a position with 'I would keep that as my working plan because...' and only change when a specific new fact is introduced.