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.

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.