BOAST Guidelines: The 2027 Interview Summary

Six BOA standards do most of the heavy lifting in the ST3 Trauma & Orthopaedics clinical station: Open Fractures, The Care of the Older or Frail Orthopaedic Trauma Patient, Compartment Syndrome (revised July 2025), First Time Lateral Patellar Dislocation (December 2024), Musculoskeletal Soft Tissue Infections (July 2025) and Arterial Injuries (June 2026). Learn the headline timings from each, quote them by name and date, and you sound like a registrar rather than a candidate reciting a textbook. Here is each standard in one paragraph, with the numbers that score.

Are BOAST guidelines still numbered?

No — and this catches candidates out every cycle. The BOA retired the old "BOAST 1–14" numbering; standards are now published by title, and several have been replaced or archived (the spinal clearance standard was archived in May 2025, superseded by Assessment of the Spine in the Trauma Patient, April 2025). In your answer, say "the BOAST on open fractures" or "the 2026 arterial injuries BOAST" — citing "BOAST 4" dates you. It also signals that you actually read them, which is precisely what the interviewers are probing when they push a trauma scenario towards a management decision.

Which numbers should you memorise first?

What are the open fracture timings?

The joint BOA/BAPRAS standard (December 2017, sitting alongside NICE NG37) is the most quoted document in the whole interview. IV prophylactic antibiotics as soon as possible, ideally within 1 hour of injury. Debridement is immediate for highly contaminated wounds (agricultural, aquatic, sewage) or when there is vascular compromise; within 12 hours of injury for other solitary high-energy fractures; within 24 hours for all other low-energy open fractures. Debride along fasciotomy lines, then treat anything further at the same sitting as clean surgery — fresh instruments, re-prep and re-drape. Definitive soft-tissue cover comes within 72 hours of injury if not achieved at debridement, fixation and coverage are planned jointly by orthoplastic consultants, and a delayed primary amputation, when indicated after MDT assessment, happens within 72 hours. Full breakdown in our lower limb open fractures guide.

What does the frailty BOAST actually require?

The Care of the Older or Frail Orthopaedic Trauma Patient (May 2019) extends hip-fracture-style care to every fragility fracture and to major trauma patients with a Clinical Frailty Scale of 5 or more. The numbers: a frailty pathway with Comprehensive Geriatric Assessment commencing within 72 hours of injury; eligible patients discussed and transferred to a Major Trauma Centre within 24 hours of admission (with MDT review of all ISS > 15 patients who stay local); chest-wall stabilisation within 48 hours of the decision to operate; and surgery performed to allow full weight-bearing, within 36 hours of admission, in line with hip fracture care — with physiotherapy on postoperative day one. Ceilings of treatment are set jointly, at consultant level, before any surgery. Interviewers love pairing this with a neck of femur fracture scenario, so know the 4AT, nutrition and anticoagulation-reversal standards too.

What changed in the compartment syndrome BOAST?

Diagnosis and Management of Compartment Syndrome of the Extremities was revised in July 2025, so quote the update. At-risk patients are assessed hourly, with analgesic doses (especially opiates) documented. Symptoms or signs mean circumferential dressings are released to skin and the limb re-evaluated within 30 minutes. Where clinical assessment is inconclusive or impossible, measure compartment pressures: a delta pressure (diastolic minus compartment) under 30 mmHg indicates increased risk, and an absolute pressure over 40 mmHg should prompt consideration of urgent decompression, with the decision made by a consultant. Once diagnosed, decompression is immediate — NCEPOD 1: open decompression of all involved compartments, a two-incision, four-compartment fasciotomy for the lower leg, plastic surgery discussion within 24 hours and re-exploration within 72 hours or earlier. Delayed presentations need two consultants, and non-operative management is an option with renal assessment and protection. More in our compartment syndrome article.

What does the December 2024 patellar dislocation standard say?

The FTLPD standard (BOA with BASK and BSCOS, December 2024) is the newest knee guideline most candidates have never read — which is exactly why it appears in scenarios. Reduce an acute lateral patellar dislocation without delay; do not aspirate an associated haemarthrosis. After reduction: AP and lateral radiographs plus a skyline patellar view, no cast immobilisation, and immediate unrestricted weight-bearing. Review in an appropriate clinic within 2 weeks and by an MSK physiotherapist within 3 weeks. MRI is reserved for defined indications — suspected osteochondral fracture, an injury that cannot be excluded, difficult assessment, planned surgery or failed conservative treatment. Surgery solely to stabilise the patella is not offered routinely after an isolated first dislocation, and isolated lateral retinacular release is never indicated. See first-time patellar dislocation.

What are the July 2025 soft-tissue infection standards?

Management of Musculoskeletal Soft Tissue Infections (July 2025) covers necrotising fasciitis and myositis, native joint infections, abscesses and cellulitis. The interview-critical line: where necrotising infection is suspected, surgery is required urgently and should not be delayed by medical or ICU management, imaging, or inter-hospital transfer. Initiate the sepsis six immediately, start broad-spectrum parenteral antibiotics without delay under microbiology guidance, and take the patient for immediate debridement — NCEPOD 1. Any amputation decision needs at least two consultants, primary closure is not performed at the index operation, and every patient is reviewed within 6 hours of diagnosis or surgery; failure to improve mandates further exploration. The advisory notes give you a ready-made viva answer: debride zones 1 and 2 with a 3 cm cuff of normal zone-3 skin and fascia, taking around 5 samples from all zones. Revise it alongside necrotising fasciitis and septic arthritis.

What is new in the June 2026 arterial injuries BOAST?

The newest standard — BOA, BAPRAS and the Vascular Society, June 2026 — replaces the fixed "warm ischaemia window" thinking: these are time-critical emergencies with no safe ischaemic time, so the emphasis is immediate revascularisation. Control haemorrhage immediately with direct pressure, packing or a tourniquet as distal as possible — never blind clamping. A pulseless deformed limb is urgently realigned and splinted, with arterial examination repeated and documented; if the pulse does not feel the same as the other side, assume vascular injury until CT angiography — performed concurrently with whole-body CT — proves otherwise. Revascularisation is NCEPOD 1 and should be commenced within one hour of arrival at hospital, using a temporary vascular shunt to restore flow rapidly, then skeletal stabilisation before definitive repair (interposition grafts preferred; bypass only for blast or ballistic injury). Fasciotomies must always be considered after revascularisation, and early amputation decisions need two consultants from different specialties. This pairs naturally with knee dislocation — the classic vascular-injury scenario.

How do you use BOASTs in the interview itself?

The Clinical Judgement station is a 10-minute scenario worth 50 of the 234 interview marks, scoring Technical Knowledge, Problem Solving, Situational Awareness and both communication domains — and Technical Knowledge is scored again in the Communication station. The pattern that scores is: safe first assessment (ATLS), then the named standard with its timing — "this is an NCEPOD 1 emergency; the June 2026 arterial injuries BOAST requires revascularisation to be commenced within an hour of arrival" — then escalation and the MDT. The 2027 interviews are expected online in March 2027; the full station-by-station scoring matrix and the 13-question self-assessment are on our 2027 self-assessment page. When you can recite the timings, pressure-test them: the orthointerview.com question bank runs every one of these standards through interview-style scenarios with model answers, which is where the marks are actually won.