Questions, operative experience and evidence-led discussion.
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?
After closed reduction of an extra-articular Colles fracture, radial height and inclination are acceptable but the lateral X-ray shows neutral tilt rather than volar tilt. In a middle-aged patient, would you accept this or attempt another reduction? At what point does repeated manipulation cause more harm than benefit?
For routine unstable intertrochanteric fractures without subtrochanteric extension, do you generally prefer a short or long cephalomedullary nail? What specific fracture or patient factors make you choose a long nail?
In an extra-articular distal radius fracture in a 55–65-year-old active patient, suppose reduction restores length and inclination reasonably well but leaves around 5–10° of dorsal tilt. Would you accept this, woudl attempt reduction again and cast, or consider fixation? How much do age, occupation and dominant hand influence your threshold?
