Complex hip dysplasia surgery starts before theatre. In a young adult with cerebral palsy, CT, contracture planning and identifying the true hip centre matter more than classification labels; mistaking the pseudoacetabulum for the socket risks a high, unstable cup.

Articular cartilage is avascular and load-sensitive. Superficial defects rarely heal meaningfully, while lesions crossing the tide mark fill with weaker fibrocartilage, so rehabilitation should favour graded loading and patients with intra-articular fractures still need counselling about later post-traumatic arthritis.

A spinal pressure ulcer over congenital kyphosis rarely heals until the underlying gibbus is removed. The practical lesson is to treat the bony cause, confirm shunt function before prolonged prone surgery, and resect to the curve of lordosis so the spine apposes for fusion.

When recurrent anterior shoulder instability involves subcritical glenoid bone loss, distal clavicle autograft can restore bone and cartilage arthroscopically. Button fixation suits a round graft better than screws, and a flush articular surface matters more than over-tensioning or over-preparing the bed.

Persistent hip pain after arthroscopy needs a fresh look at version, not just the labrum. Reduced internal rotation, targeted examination, MRI and CT version assessment can uncover acetabular retroversion and stop repeat arthroscopy when reorientation surgery is the better plan.

Clue first: a child with arm or shoulder pain after minor trauma and a proximal humerus fracture may have a unicameral bone cyst. This is worth opening for the fallen leaf sign, rising bubble sign, and the reminder that many non-displaced upper-limb fractures need immobilisation, not urgent surgery.

A child with a low-energy proximal humerus fracture and a central metaphyseal lucency should prompt a search for a unicameral bone cyst. The key bedside point is that a non-displaced proximal humerus fracture usually needs immobilisation and follow-up, whereas proximal femoral lesions need earlier orthopaedic escalation.

A focused operative teaching episode for anyone who sees elbow trauma or reviews complex elbow imaging. The useful move is to stop calling these fracture-dislocations ‘scary’ and classify them by coronoid attachment, because that changes fixation priorities, radial head checks and the search for ligament injury.

Useful for anyone who sees complex revision cases or recurrent falls. The teaching point is that painful non-union after plated periprosthetic fracture needs more than another fixation attempt: infection work-up, CT or CTA planning, bone quality, and distal fixation all drive the revision strategy.