Questions, operative experience and evidence-led discussion.
What fixation method for syndesmotic injuries? When to remove the screw if you use one? When to WBAT? When do you fix?
We occasionally finish a fixation where reduction or implant position is acceptable but not what we ideally wanted. The construct is stable and revising it would require significant additional surgical trauma. What findings make you reopen and revise immediately, and what imperfections are you willing to accept? Interested in examples from actual practice.
A patient has a large L4–5/L5–S1 disc extrusion on MRI but pain is improving, power is preserved and there are no red flags. How much weight do you give the MRI appearance itself? Apart from neurological deficit, what makes you recommend earlier surgery?
For a child with a Gartland II supracondylar humerus fracture, what radiographic or clinical findings make you choose CRPP rather than closed reduction and casting? Do you distinguish strongly between IIA and IIB when making the decision?
We know remodeling depends heavily on age and fracture level, but what limits do you actually use clinically? For an 8–10-year-old with a midshaft radius/ulna fracture, how much residual angulation and rotation would make you re-manipulate?
Patient presents months after TKA with persistent pain. Plain radiographs look satisfactory and there is no obvious instability on initial examination. What is your step-by-step investigation sequence before labeling it unexplained pain? When do you obtain CT, aspiration or nuclear imaging?
For patients with severe bilateral knee OA requesting both knees to be replaced together, what are your selection criteria? Which comorbidities or age cutoffs make you strongly prefer staged procedures?
A 52-year-old has severe tricompartmental OA, significant daily pain and failed conservative treatment. Do you still try to delay TKA primarily because of age, or do symptoms and quality of life outweigh revision risk? What is your counselling in this age group?
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?
