Questions, operative experience and evidence-led discussion.
Different surgeons have different persepctives about when to start weight bearing after surgery. It depends on factors like the bone, fracture patter, fixation etc. What are your preferred weight bearing and rehab protocol for the following? 1) Ankle surgeries 2) ACL recon 3) Meniscal repair 4) Distal femur fractures 5) TKA and THA
What fixation method for syndesmotic injuries? When to remove the screw if you use one? When to WBAT? When do you fix?
Which humerus fractures would you nail and which would you plate?
With modern functional rehabilitation protocols showing good outcomes, what patients with acute Achilles rupture are you still recommending surgery for? Does tendon gap on ultrasound in plantar flexion influence your decision?
For a Zone 1 avulsion fracture with a small but clearly displaced or rotated fragment, what makes you choose fixation rather than functional treatment? Do displacement measurements alone influence you, or are joint involvement and symptoms more important?
The patient had normal radial nerve function initially but develops a complete radial nerve palsy after manipulation/reduction of a closed humeral shaft fracture. Would you observe with serial examinations/EMG or proceed to early exploration? Does the fracture pattern alter your decision?
For displaced 2-part and 3-part proximal humerus fractures in patients above 60, what patterns are you still fixing? With the outcomes of conservative management and concerns regarding fixation failure, has your threshold for surgery changed over the last few years?
MRI shows a full-thickness supraspinatus tear with mild retraction in an otherwise active 65-year-old. Pain is significant but strength is reasonably preserved. How long would you trial physiotherapy/injection before offering repair, and which MRI features make you operate earlier?
For a longitudinal meniscal tear extending partly into the white-white zone in a young adult, do you still attempt repair if the tissue quality is good? What factors make you decide that a tear is simply not worth repairing?
A recreationally active adult has MRI-confirmed complete ACL tear but minimal symptoms during daily activities and no recurrent giving-way episodes. Would you initially rehabilitate or recommend reconstruction based on activity goals? What makes you change from conservative treatment to surgery?
Textbooks give displacement and articular step-off cutoffs, but how strictly do you use them? If the extensor mechanism is intact but there is a 3–4 mm gap or articular incongruity, would you operate? Does fracture pattern matter more to you than the measured gap?
For an isolated Weber B fracture with a congruent mortise and no medial clear-space widening, are you allowing immediate weight bearing in a boot? Do you routinely obtain stress or weight-bearing radiographs before deciding that it is stable?
This age group often creates a difficult decision. For a physiologically young, active patient with a displaced intracapsular neck of femur fracture, what factors push you towards fixation versus THA? Is chronological age still a useful cutoff in your practice?
Suppose the helical blade is central on AP but slightly anterior on lateral, with good reduction and a TAD below 25 mm. Would you accept the construct or revise the blade position? How much importance do you give to Cleveland zone versus TAD/calTAD?
For an adult with a displaced midshaft clavicle fracture with >2 cm shortening but no skin threat or neurovascular issue, are you routinely offering fixation? In your experience, which patients genuinely benefit enough from surgery to justify the implant-related complications?
