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Short Cases

A 45-year-old man presents following a high-speed motor vehicle accident as a restrained driver. He reports severe right hip pain and is unable to move his leg. On examination, his right leg is shortened, internally rotated, and adducted. Dorsalis pedis and posterior tibial pulses are palpable. He has decreased sensation in the first dorsal web space and weakness of ankle dorsiflexion.

A 42-year-old recreational tennis player presents to the emergency department after feeling a sudden "pop" in his left heel while lunging for a shot. He felt as if someone had kicked him in the back of the leg. He was unable to continue playing and has difficulty walking. On examination, there is a palpable gap 5cm proximal to the heel. The Thompson test is positive bilaterally compared (no plantar flexion on squeezing the calf). He can weakly plantar flex using his toe flexors.

A 24-year-old male semi-professional soccer player presents with right knee instability 8 weeks after a non-contact pivoting injury during a match. He describes his knee "giving way" when changing direction. MRI confirms complete ACL rupture with intact medial and lateral menisci. Clinical examination reveals grade 2 Lachman (soft endpoint), positive pivot shift, and full range of motion. There is no effusion. He wishes to continue competitive sport. MRI images are provided showing the ACL rupture.

A 28-year-old male professional rugby player presents following a direct blow to his right shoulder during a tackle. He complains of pain over the top of his shoulder and difficulty lifting his arm. Examination reveals a prominent step deformity at the AC joint with tenderness. There is no neurovascular deficit. He is keen to return to contact sport. Shoulder radiographs are provided.

A 28-year-old male motorcyclist is brought to the emergency department after a high-speed collision. He was found with no movement in all four limbs at the scene. On arrival, he is conscious with BP 70/40, HR 55. He has complete loss of motor and sensory function below the clavicles. He has priapism and absent anal tone. His C-spine is immobilized.

A 13-year-old girl is referred by her school nurse with a positive forward bend test. She had menarche 6 months ago. Her mother noticed asymmetry in her waist and shoulders. She has no back pain, no neurological symptoms, and no family history of scoliosis. On examination, she has a right thoracic prominence on forward bending and her shoulders and pelvis appear level.

A 55-year-old obese female nurse presents with progressive right medial ankle pain and flattening of her arch over 2 years. She reports fatigue with prolonged standing and lateral foot pain after walking. She cannot rise onto tiptoes on the right side. Clinical examination reveals pes planus with hindfoot valgus, forefoot abduction ("too many toes" sign), and tenderness along the posterior tibial tendon. Single-leg heel rise is weak and painful with no inversion of the hindfoot. The hindfoot corrects to neutral passively. Weight-bearing radiographs and clinical photographs are provided.

A 14-year-old girl presents with 3 months of progressive right knee pain and swelling. She denies trauma or constitutional symptoms. On examination, there is a firm, non-tender swelling over the proximal tibia with no warmth or erythema. X-ray shows an eccentric, expansile lytic lesion in the proximal tibial metaphysis with a thin cortical shell. MRI demonstrates multiple fluid-fluid levels within the lesion.

A 52-year-old woman presents to the emergency department following a twisting injury to her right ankle while walking down stairs. She heard a "crack" and was unable to weight-bear. On examination, there is significant swelling around the ankle with tenderness over both malleoli. The foot is neurovascularly intact. AP, lateral, and mortise radiographs reveal a displaced fracture of the distal fibula at the level of the joint line with a transverse medial malleolar fracture. The medial clear space is widened to 6mm.

A 22-year-old male rugby player presents with recurrent right shoulder dislocations. His first dislocation occurred 2 years ago during a tackle, requiring Emergency Department reduction. He has since had 5 further dislocations, with the most recent occurring while putting on a jacket. He reports apprehension with the arm in abduction and external rotation and avoids certain positions. He wishes to continue playing rugby. Clinical photographs and imaging are provided.

You are asked to discuss the evidence for prosthesis selection in joint arthroplasty with a registrar. A patient has also asked about the "best" hip replacement. You need to interpret registry data to guide clinical practice and counsel patients appropriately.

A 72-year-old male presents with progressive left groin and thigh pain 12 years after uncemented THA for osteoarthritis. Pain is activity-related with start-up pain and is now limiting walking to 100m. He denies fevers or systemic symptoms. CRP is 3 mg/L (normal). Radiographs show extensive osteolysis around both components.

A 68-year-old female presents with progressive right knee pain 8 years after primary TKA for osteoarthritis. Initially had excellent pain relief for 6 years. Now has start-up pain, pain with stairs, and night pain. CRP is 5 mg/L. On examination, there is a small effusion, full extension, flexion to 100°, and tenderness over the medial tibial plateau. Radiographs show tibial component subsidence with progressive radiolucent lines.

A 28-year-old man presents after diving into a shallow pool and striking his head on the bottom. He has severe upper neck pain and is holding his head with his hands. He is neurologically intact. CT scan shows a burst fracture of C1 with bilateral lateral mass displacement. Open-mouth odontoid view shows combined lateral mass displacement of 8mm.

A 76-year-old woman presents after sudden onset of left thigh pain while walking across her living room. She has been on alendronate for 9 years for osteoporosis. She reports prodromal left thigh pain for 4 months. Examination reveals a shortened, externally rotated left leg with proximal thigh tenderness. She also mentions occasional right thigh discomfort.

A 38-year-old male presents with a 6-month history of progressive right hip pain. He has a background of systemic lupus erythematosus treated with long-term corticosteroids. He reports groin pain aggravated by weight-bearing and at rest. Examination reveals reduced internal rotation and an antalgic gait. Radiographs and MRI of the hip are provided.

A 60-year-old man with a 15-year-old uncemented THA presents for routine follow-up. He is asymptomatic with excellent function. X-rays show eccentric position of the femoral head within the acetabular component and progressive periacetabular osteolysis that was not present 2 years ago. Components appear well-fixed. Additionally, a 48-year-old active male construction worker is discussing THA options and is concerned about implant longevity.

A 3-year-old obese girl is referred for assessment of progressive bowing of both legs. Her parents noticed the bowing when she started walking at 12 months, and it has become worse. She has no pain and walks normally. On examination, she has bilateral varus deformity of the knees. There is no ligamentous laxity. Internal tibial torsion is present. She is above the 95th percentile for weight.

A 72-year-old female presents with a distal radius fracture after a fall from standing height. She has a history of previous vertebral compression fracture and takes no medications for bone health. Her DXA scan shows T-score of -3.2 at lumbar spine and -2.8 at femoral neck. She asks about treatment to prevent future fractures. Laboratory results and DXA report are provided.

A 15-year-old boy is referred with a destructive lesion of the distal femur. Imaging shows a metaphyseal lesion with periosteal reaction and soft tissue mass, concerning for osteosarcoma. The referring orthopaedic surgeon asks about biopsy technique. You explain the critical importance of proper biopsy planning and technique to avoid compromising definitive surgical treatment.

A 38-year-old roofer presents after falling 3 metres from scaffolding, landing on his feet. He has severe bilateral heel pain and swelling and is unable to weight bear. He also reports low back pain. Examination reveals bilateral heel ecchymosis extending to the plantar arch (Mondor's sign), tense swelling, and tenderness over the calcanei. The right heel has posterior skin tenting with blanching.

A 35-year-old construction worker fell 3 meters from scaffolding, landing on his feet. He has severe bilateral heel pain and is unable to weight-bear. On examination, both heels are swollen with ecchymosis extending to the plantar surface. The hindfoot width is increased bilaterally. Radiographs show decreased Böhler's angle and widening of the calcaneus. CT scan reveals a three-part fracture of the posterior facet on the left (Sanders III) and a two-part fracture on the right (Sanders II).

A 52-year-old woman presents with a 6-month history of numbness and tingling in her right hand that wakes her at night. She shakes her hand to relieve symptoms. The symptoms affect her thumb, index, and middle fingers. She has noticed weakness when gripping objects and occasionally drops things. She works as a supermarket checkout operator. On examination, there is reduced sensation to light touch over the median nerve distribution. Thenar wasting is present. Phalen's and Tinel's tests are positive.

A 45-year-old woman presents to the emergency department with a 2-day history of worsening low back pain and bilateral leg pain. She now reports difficulty passing urine and has not opened her bowels for 24 hours. On examination, she has reduced perianal sensation bilaterally and a post-void residual of 350mL.

A 72-year-old man presents after falling forward onto his forehead. He has disproportionate weakness in his arms compared to his legs. He can wiggle his toes but cannot grip or extend his fingers. He has a band of numbness across both arms and reports burning pain in his hands. He has a history of neck stiffness for years. Examination shows 2/5 power in upper limbs, 4/5 in lower limbs, and intact bladder function.

A 52-year-old man presents with sudden onset severe hip pain after feeling a "crack" while rising from a chair. He had a ceramic-on-ceramic THA 8 years ago for avascular necrosis. He reports immediate inability to weight bear and describes a grinding sensation with any attempted movement. On examination, the hip is held in flexion and any passive motion elicits severe pain with audible crepitus.

A 7-year-old girl with spastic diplegic cerebral palsy is referred for gait assessment. She was born at 28 weeks gestation with periventricular leukomalacia. She walks with a posterior walker and can take some independent steps. Her parents are concerned about worsening crouch gait and increased toe-walking. She has previously had botulinum toxin injections to her calf muscles. On examination, she has bilateral hip flexion contractures of 20 degrees, popliteal angles of 60 degrees bilaterally, and ankle dorsiflexion of -10 degrees with knee extended.

A 35-year-old man is brought in after a motorcycle accident. He was found with neck pain and left arm weakness. On examination, he is neurologically intact except for weakness of left triceps (3/5) and numbness in the left middle finger. His head is rotated slightly to the right and he resists attempts at movement. His cervical spine is immobilized.

A 62-year-old man presents with a 12-month history of progressive difficulty walking and hand clumsiness. He reports difficulty buttoning shirts and notices his handwriting has deteriorated. He also describes intermittent electric shock sensations down his spine with neck flexion. He has mild neck pain but his main complaints are functional limitations.

A 48-year-old office worker presents with a 6-week history of left arm pain radiating from the neck to the middle finger. He describes associated numbness and tingling. The pain is worse at night and exacerbated by neck extension. He has tried physiotherapy and NSAIDs with limited relief. On examination, he has weakness of left triceps (4/5), reduced triceps reflex, and a positive Spurling test on the left.

A 62-year-old male with Type 2 diabetes mellitus of 18 years duration and diabetic peripheral neuropathy presents with a swollen, warm right foot for 6 weeks. He denies significant trauma but recalls "twisting" his ankle while gardening. He has no pain but reports difficulty fitting into his shoe. His diabetes is poorly controlled (HbA1c 9.2%). Clinical examination reveals a diffusely swollen, warm (3°C warmer than contralateral) right midfoot with palpable bony prominences plantar-medially. Sensation is absent to monofilament testing. Pedal pulses are palpable. There is no break in the skin. Weight-bearing radiographs are provided.

A 52-year-old man presents with a 12-month history of progressive right hip pain. The pain is deep, aching, and worse at night. He has noticed increasing difficulty walking. He has no prior history of bone lesions. On examination, there is tenderness over the proximal femur with reduced hip range of motion. X-ray shows an expansile lesion with calcification in the proximal femur extending into the soft tissues.

A 28-year-old female netball player presents with recurrent right ankle sprains over 4 years since an initial severe inversion injury. She reports 6 significant giving-way episodes requiring time off sport in the past year, with persistent ankle pain and swelling after activity. She has completed supervised physiotherapy for 4 months without improvement. Clinical examination reveals anterior drawer test grade 2+ positive, talar tilt 12° (contralateral 5°), tenderness over the ATFL, and mild peroneal weakness. She has flexible joints throughout (Beighton 6/9). Stress radiographs and MRI are provided.

A 31-year-old woman presents 4 months after an injury sustained while hiking overseas. She had limited medical care at the time and now has a stiff, deformed elbow. She has pain with attempted use and significant functional limitation. The elbow is held in approximately 60° flexion with minimal further motion.

A 22-year-old male is reviewed 8 hours after sustaining a closed tibial shaft fracture in a soccer match. He has had an intramedullary nail inserted and is in a below-knee backslab. Nursing staff report he is requiring escalating opioid analgesia and the pain seems disproportionate to his injury. He reports tingling in his toes. On examination, the calf is tense and he has severe pain with passive toe extension.

A 70-year-old patient presents with severe left hip pain failing non-operative management. They recall "hip trouble" as a child with prolonged hospitalization and a draining wound. On examination, there is a healed sinus scar behind the hip, the leg is shortened by 4cm, and fixed flexion deformity of 20°. Hip ROM is severely restricted.

A 4-month-old girl is referred by her pediatrician for a head tilt noticed since birth. The parents report she always looks to the left side. Delivery was vaginal with breech presentation. On examination, the head is tilted to the right with chin rotation to the left. A firm, non-tender 2cm mass is palpable in the right sternocleidomastoid muscle. There is 30 degrees of passive rotation to the right (normal 80 degrees). Facial asymmetry is noted with right-sided flattening. Hip examination is normal.

A newborn male is referred from the postnatal ward with bilateral foot deformities noted at birth. There is no family history of clubfoot. The pregnancy was uncomplicated with normal antenatal scans. On examination, both feet demonstrate the classic clubfoot deformity with forefoot adduction, midfoot cavus, hindfoot varus, and ankle equinus. The deformities are rigid with deep medial and posterior skin creases. The calves appear thin.

A newborn girl is noted to have rigid bilateral foot deformities at birth. The feet appear to have a "rocker-bottom" shape with a prominent talar head palpable on the medial plantar surface. The forefoot is dorsiflexed and abducted. The hindfoot is in rigid equinus. Passive plantar flexion of the forefoot does not correct the deformity. The infant has generalized hypotonia and a sacral dimple. Family history is unremarkable.

A 48-year-old accountant presents with a 6-month history of numbness in his right small finger and ulnar half of the ring finger, worse at night and when using his phone. He has noticed weakness of grip and dropping objects. On examination, there is decreased sensation in the ulnar 1.5 digits, positive Tinel's at the cubital tunnel, and a positive elbow flexion test at 30 seconds. The first dorsal interosseous and hypothenar eminence appear wasted. Froment's test is positive. Cross-body adduction of the small finger is weak.

A 32-year-old new mother presents with 3 months of radial wrist pain, worse when lifting her baby. She notices swelling over the radial styloid and pain with thumb movement. She has difficulty opening jars and gripping. On examination, there is tenderness and swelling over the first dorsal compartment. Finkelstein's test reproduces her pain. There is no crepitus with movement. Thumb and finger range of motion is full.

A 68-year-old woman presents with a 2-year history of bilateral leg pain and heaviness when walking. She can walk approximately 200 meters before needing to stop and sit or lean forward. Standing and walking uphill are particularly difficult. Her symptoms are relieved by sitting or leaning on a shopping trolley. She has tried physiotherapy and epidural injections with limited relief.

A 6-week-old female infant is referred by her GP for a 'hip click' detected at the newborn check. She was born at 38 weeks via breech presentation to a primiparous mother. The family history reveals a maternal aunt who had 'hip problems' as a baby. On examination, both hips are stable but you feel a subtle clunk on Ortolani testing of the left hip.

A 45-year-old right-hand dominant male tradesman presents 5 days after feeling a "pop" in his right elbow while lifting a heavy object. He reports pain in the antecubital fossa and difficulty with elbow flexion and forearm supination. On examination, there is bruising in the antecubital fossa, loss of normal biceps contour, and a palpable mass in the upper arm. Hook test is positive (unable to hook finger under biceps tendon). MRI of the elbow is provided.

A 70-year-old woman with osteoporosis presents after a fall at home. She has obvious thigh deformity with shortening. X-rays show a comminuted supracondylar femur fracture with intra-articular extension. There is no vascular compromise. She has a well-functioning TKA in the other knee.

A 58-year-old right-hand dominant female presents to ED 2 hours after falling onto an outstretched hand while walking her dog. She has immediate pain, swelling, and deformity of the right wrist. She has well-controlled type 2 diabetes and osteopenia on recent DEXA. On examination, there is a dinner fork deformity, dorsal swelling, and tenderness. She has intact radial pulse and normal finger sensation and movement.

A 62-year-old man of Northern European descent presents with progressive difficulty straightening his right ring finger over the past 2 years. He is a retired builder with a history of heavy alcohol use and type 2 diabetes. On examination, there is a palpable cord from the palm to the proximal phalanx of the ring finger. The MCP joint has a 35° fixed flexion contracture and the PIP has a 25° contracture. He cannot place his palm flat on the table. The small finger has a nodule but no contracture. Sensation is intact.

A 35-year-old woman is referred after an X-ray for a hand injury incidentally revealed a bony lesion in her proximal phalanx. She has no pain or swelling in the affected finger. On examination, there is no mass, tenderness, or limitation of movement. The X-ray shows a well-defined lytic lesion in the proximal phalanx with stippled calcification and no cortical breach.

A 12-year-old boy presents with a 6-week history of left thigh pain and swelling. He has been febrile intermittently and appears unwell. His mother noticed the thigh swelling increasing. On examination, he is febrile (38.2°C), has a tender, warm swelling of the mid-thigh, and walks with a limp. Laboratory tests show elevated ESR (85), CRP (120), WCC (14), and LDH. X-ray shows a permeative lesion with periosteal reaction in the femoral diaphysis.

A 68-year-old man felt a pop in his knee when rising from a chair 2 weeks ago. He has a 5-year-old TKA for osteoarthritis. Now unable to extend his knee against gravity. On examination, there is significant swelling, bruising over the anterior knee, and a palpable gap inferior to the patella. He has diabetes and takes prednisone for COPD.

A 28-year-old cricketer presents with inability to extend his right ring finger DIP joint after being struck on the fingertip while fielding. The DIP rests in approximately 30° flexion. He can actively flex but cannot actively extend the DIP. There is tenderness over the dorsum of the DIP joint. X-ray shows no fracture. Separately, his teammate presents with a PIP joint injury where the finger is stuck in flexion at the PIP with the DIP hyperextended.

A 28-year-old male motorcyclist presents following a high-speed collision. He has severe left hip pain and is unable to weight bear. The leg is shortened and externally rotated. He has no other injuries identified. This is an isolated injury to an otherwise healthy young man.

A 28-year-old male professional footballer presents with 18 months of progressive right groin pain. The pain is worse with prolonged sitting, squatting, and kicking. He describes mechanical catching and limited range of motion. He has failed physiotherapy and cortisone injection. He wishes to continue playing professionally. Clinical examination and imaging are provided.

A 25-year-old woman presents with progressive right hip pain over 5 years. She walks with a limp. On examination, she has a leg length discrepancy of 3cm (right shorter). X-ray shows an expansile lesion in the proximal femur with a "ground-glass" appearance and coxa vara deformity (shepherd's crook). She has no skin lesions or endocrine abnormalities. Laboratory tests including calcium, phosphate, and alkaline phosphatase are normal.

A 32-year-old chef presents 4 hours after sustaining a laceration to the volar aspect of his right ring finger while preparing food. The wound is over the proximal phalanx. On examination, the finger rests in relative extension compared to adjacent fingers. He is unable to flex the DIP joint when the PIP is held. He also cannot flex the PIP when adjacent fingers are held extended. Sensation is intact to both digital nerves. There is no active bleeding.

A 35-year-old male motorcyclist presents following a high-speed collision. He has obvious deformity of his left upper limb with swelling of the arm and forearm. He can move his fingers but has wrist drop. He is haemodynamically stable and this is his only significant injury.

A 35-year-old male motorcyclist is brought to the trauma center following a high-speed collision. GCS is 15 and he is hemodynamically stable after initial resuscitation with 2 units blood. His left thigh and leg are deformed with an open wound over the proximal tibia exposing bone. The foot is warm with palpable dorsalis pedis pulse but decreased sensation in the first dorsal web space.

A 22-year-old male had a closed reduction of a distal radius fracture 8 hours ago and is now in a below-elbow cast. The nursing staff is concerned as he is requiring escalating doses of opioid analgesia and is complaining of severe pain. The pain seems out of proportion to the injury.

A 35-year-old male presents 4 months after closed treatment of a midshaft tibial fracture. Radiographs show persistent fracture lines with minimal callus formation. He has pain with weight-bearing and tenderness at the fracture site. He has been non-weight-bearing and is a smoker (20 pack-years). Radiographs at 4 months are provided.

A 28-year-old woman presents with 4 months of right knee pain and swelling. The pain is worse with weight-bearing and she has noticed increasing stiffness. She has no systemic symptoms. On examination, there is a palpable swelling at the proximal tibia, tenderness, and reduced knee range of motion. X-ray shows a lytic lesion extending to the subchondral bone of the proximal tibia. Laboratory tests are normal.

A 58-year-old male accountant presents with progressive pain and stiffness of his right great toe over 2 years. He reports pain with walking, especially push-off, and difficulty squatting. He cannot wear dress shoes due to dorsal prominence. He has tried NSAIDs and orthotics with minimal relief. He is active and wants to maintain recreational walking. Clinical examination reveals palpable dorsal osteophyte at the first MTP joint, with dorsiflexion limited to 20° (contralateral 60°) and pain at end-range. The plantar aspect of the joint is relatively preserved. There is no significant hallux valgus. Gait shows shortened stride with early heel-off. Weight-bearing radiographs are provided.

A 54-year-old female primary school teacher presents with progressive pain and deformity of her right great toe over 3 years. She reports difficulty fitting into standard footwear and pain over the medial eminence when walking. She has tried wider shoes and padding without relief. Clinical examination reveals obvious bunion deformity with hallux valgus angle estimated at 35°. The first metatarsal head is prominent medially with overlying bursa. The hallux is reducible but the first MTP joint is stiff with 40° dorsiflexion. Second toe shows early hammer toe deformity with crossover tendency. Weight-bearing radiographs of the foot are provided.

A 35-year-old man presents to ED with a 2-day history of increasing pain and swelling in his right middle finger. He sustained a puncture wound to the fingertip 4 days ago while working in his garden. On examination, the finger is swollen and held in flexion. There is tenderness along the entire flexor sheath. Passive extension is extremely painful. He is febrile (38.4°C). His WCC is elevated at 15 × 10⁹/L.

A 32-year-old man is brought in after a high-speed motor vehicle accident. He was an unrestrained driver who hit the steering wheel with his face. He complains of severe neck pain and holds his neck in his hands. He is neurologically intact. CT cervical spine shows bilateral C2 pars fractures with anterior translation of C2 on C3.

A 35-year-old man presents after an arm wrestling injury. He reports sudden pain and a "crack" in his right arm during the contest. His arm is deformed, and he immediately noticed he could not lift his wrist or extend his fingers. Examination confirms wrist drop, inability to extend MCP joints, and numbness over the dorsal first web space.

A 28-year-old right-hand dominant manual laborer presents with 12 months of progressive right wrist pain and stiffness. He cannot recall any specific injury. Pain is worse with gripping and loading the wrist. On examination, there is dorsal wrist tenderness over the lunate, reduced grip strength, and decreased wrist range of motion (40° extension, 30° flexion). X-ray shows a sclerotic lunate with preserved carpal alignment. Ulnar variance is -3mm.

A 6-year-old boy presents with a 4-week history of a painful lump on his head. His mother noticed swelling over the right parietal area. He is otherwise well with no fever, weight loss, or other symptoms. On examination, there is a tender, soft swelling over the right parietal skull with normal overlying skin. Laboratory tests show normal inflammatory markers. Skull X-ray reveals a well-defined "punched-out" lytic lesion.

An 18-month-old girl presents with a waddling gait noticed since she started walking at 14 months. Her mother is concerned that she "walks funny." She was born at term with no complications. Newborn hip screening was normal. On examination, she has a Trendelenburg gait on the left. The left limb appears shorter. Hip abduction is limited to 40 degrees on the left versus 70 degrees on the right. Galeazzi sign is positive.

A 10-year-old boy presents with a limp and his parents have noticed his left leg appears shorter. He had a proximal tibial fracture at age 5 years which was treated in a cast. On examination, there is apparent limb shortening with pelvic obliquity. Block testing reveals a 4cm discrepancy. His current height is 140cm, and both parents are of average height. He is Tanner stage 2. A scanogram confirms 4cm total shortening (2cm femur, 2cm tibia). The question is whether to lengthen or shorten.

A 54-year-old woman presents 6 weeks after primary right THA for osteoarthritis. She complains that her operated leg feels "too long." She has developed a limp and low back pain. Preoperatively her legs were equal length. Nerve function is normal but she reports a tight feeling in the groin. On examination, she walks with a shortened stride on the left.

A 7-year-old boy presents with a 3-month history of progressive left hip pain and limp. The pain is in the groin and anterior thigh, worse with activity. He has no history of trauma or systemic symptoms. On examination, he has an antalgic gait. Left hip examination reveals limited abduction (30°) and internal rotation (10°). He can straight leg raise without pain.

A 28-year-old footballer presents after landing awkwardly on a plantar-flexed foot. He experienced immediate severe midfoot pain and was unable to continue playing. On examination, there is marked midfoot swelling with plantar ecchymosis. He has point tenderness over the TMT joints and pain with passive abduction of the forefoot. Weight-bearing radiographs show loss of the normal alignment between the 2nd metatarsal and middle cuneiform with widening of the interval between the 1st and 2nd metatarsals.

A 42-year-old office worker presents with a 6-week history of left leg pain radiating from the buttock to the calf and foot. The pain is worse with sitting and coughing. He has tried physiotherapy and NSAIDs with limited relief. On examination, SLR is positive at 30 degrees on the left, he has weakness of left ankle plantar flexion (4/5), and absent left ankle jerk.

A 70-year-old retired farmer presents with a 3-year history of bilateral leg heaviness and pain when walking. He can manage approximately 100 meters before needing to stop and lean forward or sit down. He finds walking uphill harder than downhill, and can cycle without problems. His symptoms are relieved within minutes of sitting. He has tried physiotherapy and two epidural injections with temporary relief.

A 30-year-old farmer presents following a farm machinery accident. He has a severe injury to his right leg with extensive soft tissue loss, exposed bone, and contamination. The foot is pale and cool with absent pulses. He is haemodynamically stable with an isolated injury.

A 35-year-old female presents with right knee pain and mechanical symptoms following a twisting injury 6 weeks ago. She reports intermittent locking, catching, and giving way. The knee swells after activity. Clinical examination reveals joint line tenderness medially, positive McMurray test with a painful click on external rotation, and a small effusion. The knee has full range of motion with no ligamentous instability. MRI of the knee is provided.

A 55-year-old female with bilateral metal-on-metal hip resurfacing performed 8 years ago presents with right groin pain and clicking for 6 months. Initially pain-free for 6 years. She also reports new onset of lateral thigh numbness. Routine surveillance shows whole blood cobalt level of 45 μg/L (previously 5 μg/L two years ago).

A 62-year-old woman with known breast cancer treated 5 years ago presents with 6 weeks of progressive left thigh pain. The pain is constant, worse at night, and she has difficulty weight-bearing. She has lost 5kg over the last 3 months. On examination, she has tenderness in the proximal thigh and walks with an antalgic gait. X-ray shows a lytic lesion in the subtrochanteric region with 70% cortical destruction.

A 67-year-old man with known prostate cancer presents with 6 weeks of progressive back pain and 5 days of increasing leg weakness. He is now unable to walk unaided. On examination, he has 3/5 power in both legs, brisk reflexes, and a sensory level at T10. Bowel and bladder function are currently normal.

A 17-year-old male presents to the Emergency Department with right thigh swelling 12 days after a motorbike accident. He was initially treated conservatively for minor pelvic injuries. On examination, there is a large, fluctuant swelling over the lateral thigh with skin that appears mobile over the underlying fascia. The overlying skin has some abrasions but no open wounds.

A 48-year-old female office worker presents with a 12-month history of burning pain in the ball of her right foot radiating to the 3rd and 4th toes. Pain is worse in narrow shoes and high heels, with relief when removing footwear and massaging the foot. She describes occasional "electric shock" sensations. Clinical examination reveals tenderness in the third intermetatarsal space with positive Mulder's click. Sensation is diminished in the adjacent sides of the 3rd and 4th toes. Ultrasound of the forefoot is provided.

A 32-year-old male motorcyclist is brought to the Emergency Department following a collision. His right knee is grossly unstable, swollen, and deformed. Initial assessment reveals a GCS 15, hemodynamically stable patient. The knee shows circumferential swelling with ecchymosis, and there is no palpable dorsalis pedis or posterior tibial pulse. The limb is cool compared to the contralateral side. Anteroposterior stress testing shows gross laxity in all planes. X-rays and CT angiography are pending.

A 68-year-old man presents with progressive low back pain for 3 months. He feels fatigued and has lost 8kg. He has noticed increased thirst and urination. On examination, he appears pale and has tenderness over the lumbar spine. X-rays show multiple lytic lesions throughout the spine with a compression fracture at L2. Laboratory tests show normocytic anemia (Hb 95), hypercalcemia (3.2), elevated creatinine (180), and total protein 95 with low albumin.

A 9-month-old male infant is brought to the emergency department by his mother who reports that he has not been moving his right leg since yesterday. She says he "rolled off the couch." The father is not present. On examination, the infant is quiet and withdrawn. There is swelling of the right thigh. You notice multiple bruises of different ages on the trunk and arms. The right leg is painful with passive movement. There is a healing bruise on the right cheek.

A 3-month-old male infant is referred for assessment of his left arm. He was born at term with birth weight 4.5kg following a prolonged second stage and shoulder dystocia. Apgar scores were 6 and 9. The left arm was noted to be flaccid at birth. On examination, the left arm is held adducted at the shoulder with the elbow extended and forearm pronated. There is no active shoulder movement. Active elbow flexion is absent. Hand grasp is present. Moro reflex is asymmetric.

An 82-year-old woman presents after a fall at home. She has neck pain and restricted movement. She has a history of hypertension, osteoporosis, and atrial fibrillation on warfarin. She is neurologically intact. Her INR is 3.2 on presentation.

A 28-year-old motorcyclist presents to the emergency department following a high-speed road traffic accident. His left leg is deformed with an 8cm wound over the anterolateral tibia. There is exposed bone and moderate soil contamination. He is hemodynamically stable with no other apparent injuries. Distal pulses are palpable but weak.

A 62-year-old female is scheduled for total hip arthroplasty for primary osteoarthritis. She asks about the different material options for her hip replacement. Her surgeon needs to discuss bearing surfaces, fixation methods, and material properties. She has good bone quality and is moderately active.

A 14-year-old boy presents with a painless hard lump on the inner side of his right knee that he first noticed 2 years ago. It has gradually increased in size but is not painful. On examination, there is a firm, non-tender, immobile bony prominence on the medial aspect of the distal femur. Range of motion is full. X-ray shows a bony outgrowth from the metaphysis with cortical and medullary continuity with the parent bone.

A 3-year-old boy presents with a femoral shaft fracture after falling from a standing height. His parents report he has had 8 previous fractures. On examination, he is short for his age with blue sclerae. He has frontal bossing and triangular facies. Multiple healed fractures are palpable with limb deformities. His teeth appear discolored and abnormal. There is generalized ligamentous laxity. Family history reveals his father has hearing loss and multiple fractures.

A 14-year-old boy presents with 6 months of left thigh pain that is worse at night and dramatically relieved by aspirin. He has been waking at 2am with severe pain. On examination, there is localized tenderness over the proximal femur. There is no swelling or mass. X-ray shows cortical thickening in the proximal femur. CT scan reveals a <1cm lucent nidus with surrounding sclerosis.

A 16-year-old male presents with a 3-month history of progressively worsening left knee pain. The pain is worse at night and not relieved by rest or NSAIDs. He has noticed swelling around the knee. There is no history of trauma. On examination, there is a firm, non-tender mass in the distal thigh with restricted knee movement. Laboratory tests show elevated ALP and LDH. X-ray shows an aggressive bone lesion.

A 65-year-old male presents with progressive left groin pain 3 years after cemented THA for osteoarthritis. He initially had an excellent outcome with pain-free walking for 2 years. Now pain limits walking to 200m and disturbs sleep. He reports low-grade fevers. On examination, he walks with an antalgic gait, has limited hip rotation, and pain on axial loading.

A 65-year-old man presents with persistent anterior knee pain 18 months after primary TKA for osteoarthritis. He describes diffuse pain, worse with stairs and kneeling. He had been progressing well until 6 months ago when symptoms began. The knee has "never felt right." On examination, he walks with a limp. Range of motion is 5-95 degrees. Ligaments are stable. There is tenderness over the medial joint line and pes anserinus area.

A 55-year-old woman presents after a direct blow to the knee from falling onto the kneecap. She is unable to perform a straight leg raise. There is significant swelling with a palpable gap over the patella. Distal neurovascular examination is intact.

A 65-year-old woman presents with anterior knee pain 2 years after primary TKA for osteoarthritis. Pain is worse with stairs and rising from chairs. She reports an audible clicking from the patellofemoral joint. On examination, there is patellar crepitus, tenderness over the lateral patellar facet, and lateral patellar tilt. No effusion. Flexion is to 115° with a palpable clunk at 30° during active extension.

A 6-year-old boy is brought to the emergency department after falling from playground equipment. He is unable to weight bear and has obvious deformity of his left thigh. He is otherwise well with no head injury or other complaints. On examination, there is swelling and deformity of the left thigh. The limb is neurovascularly intact. Radiographs confirm a midshaft femoral fracture.

A 5-year-old girl is brought to the emergency department after falling onto her outstretched hand. She has pain and swelling over the lateral aspect of her left elbow. She is reluctant to move the elbow. On examination, there is focal tenderness over the lateral condyle with soft tissue swelling. The elbow is held in flexion. She has full finger movement and normal sensation. Radial pulse is present.

A 12-year-old right-handed baseball pitcher presents after feeling a "pop" in his right elbow while throwing. He has immediate pain and swelling on the medial side of the elbow. He reports tingling in his small and ring fingers. On examination, there is marked tenderness over the medial epicondyle with swelling. Valgus stress produces pain. He has decreased sensation in the ulnar nerve distribution. Finger and wrist flexion strength is normal.

A 6-year-old boy presents after falling from playground equipment onto his outstretched right arm. He complains of pain in the elbow and forearm. On examination, there is swelling and tenderness over the proximal forearm. The elbow appears slightly prominent anteriorly. He is reluctant to supinate or pronate. Finger movements are normal. Pulses are present.

A 9-year-old girl falls onto her outstretched left hand while playing. She has immediate elbow pain with swelling over the lateral aspect. She is unable to fully extend or supinate the forearm. On examination, there is tenderness over the radial head/neck region. Attempted pronation and supination produce pain. Finger movements are normal with intact radial pulse and sensation.

A 2-year-old boy presents with a 2-day history of fever, irritability, and refusal to bear weight on his left leg. He has been crying when his hip is moved. On examination, his temperature is 39.2°C. He holds the left hip in flexion, abduction, and external rotation. There is exquisite pain with any hip movement, particularly internal rotation. He appears toxic. Blood tests show WCC 18 × 10⁹/L, CRP 95 mg/L, and ESR 65 mm/hr.

A 6-year-old girl is brought to the emergency department after falling from monkey bars onto her outstretched hand. She has a painful, swollen left elbow held in flexion. The elbow appears S-shaped with posterior prominence. Radial pulse is palpable but weak compared to the contralateral side. She has difficulty extending her thumb and index finger. The hand is cool but capillary refill is 3 seconds.

A 10-year-old boy presents after a twisting injury to his right knee during a soccer game. He felt a "pop" and immediate swelling developed. He is unable to weight bear due to pain. On examination, there is a large tense effusion. He has marked pain with passive extension. Lachman test is difficult to assess due to guarding but appears positive. There is no ligamentous laxity at 30 degrees flexion. Neurovascular examination is normal.

A 35-year-old male motorcyclist presents following a high-speed collision. He is hypotensive (BP 80/50) with tachycardia (HR 130). GCS is 14 (confused). The pelvis is unstable on examination. Paramedics have applied a pelvic binder. There is blood at the urethral meatus. He is receiving IV fluids via large bore cannulae.

A 32-year-old male sustains a deep laceration to the medial aspect of his elbow from broken glass. He presents with numbness in the small finger and ring finger (ulnar half), weakness of finger abduction, and a positive Froment's sign. Examination reveals absent sensation in the ulnar nerve distribution and weakness of intrinsic muscles. The wound is clean and explored, revealing complete transection of the ulnar nerve. Intraoperative photograph is provided.

An 82-year-old woman presents after a fall at home. She had a cemented total hip arthroplasty 8 years ago for osteoarthritis. She was previously mobile with a frame but had progressive hip pain for the past 6 months before the fall. She cannot weight bear and the leg is shortened and externally rotated.

A 78-year-old woman with a cemented THA performed 10 years ago presents after a fall at home. She has severe right hip and thigh pain with inability to weight bear. Her leg is shortened and externally rotated. She is hemodynamically stable. She takes bisphosphonates for osteoporosis. Radiographs show a fracture around the femoral stem with evidence of proximal loosening.

An 80-year-old female with TKA performed 5 years ago presents after a fall at home. She is unable to weight bear with gross deformity of the distal thigh. She is hemodynamically stable. On examination, there is obvious varus angulation of the distal thigh. Neurovascular status is intact. Radiographs show a displaced supracondylar femur fracture above the well-fixed TKA.

A 72-year-old male presents 8 months after primary right total knee arthroplasty with persistent wound drainage for 3 weeks and increasing knee pain. He had an uneventful initial recovery but developed a superficial wound infection at 3 weeks post-op treated with oral antibiotics. He is febrile (38.2°C) with a swollen, warm, and erythematous knee. The wound has purulent discharge. Inflammatory markers show CRP 156mg/L and ESR 78mm/hr. Radiographs and aspiration results are provided.

A 35-year-old rock climber presents after falling 4 metres, landing on his feet. He has severe right ankle pain with marked swelling and fracture blisters. The foot is neurovascularly intact but compartments feel tense. He also reports bilateral heel pain and low back pain.

A 45-year-old man presents after a fall from 4 meters, landing on his feet. He has severe pain and swelling of his right ankle with visible deformity. On examination, the ankle is markedly swollen with fracture blisters developing. The skin is tented anteriorly. There is a fractured fibula and the tibial plafond is comminuted on initial radiographs. CT scan confirms a high-energy pilon fracture with articular impaction and metaphyseal comminution.

A 32-year-old unrestrained driver presents following a high-speed motor vehicle collision. GCS is 12 (E3V4M5), BP 85/60, HR 130, temperature 34.8°C. Primary survey reveals decreased breath sounds on the left with tracheal deviation. He has an obvious deformity of the right thigh and an unstable pelvis on examination. Blood gas shows pH 7.18, base excess -8, lactate 6.2. INR is 1.8 and he has received 4 units blood en route.

A 35-year-old right-hand dominant female presents 6 months after ORIF of a left radial head fracture (Mason II). She complains of progressive elbow stiffness affecting her work as a hair stylist. Examination reveals flexion to 100° and extension deficit of 40°. Supination is 60° and pronation 70°. There is no instability and neurovascular examination is normal. CT scan and radiographs are provided.

A 25-year-old male presents following a motor vehicle collision where he was an unrestrained driver. He has anterior chest pain and difficulty swallowing. On examination, there is a palpable depression over the medial clavicle on the left side. He has no respiratory distress but feels like there is something stuck in his throat.

A 72-year-old right-hand dominant female presents following a fall onto her outstretched hand. She complains of severe left shoulder pain and inability to move her arm. She has a background of osteoporosis and takes alendronate. On examination, there is swelling and bruising around the shoulder with tenderness over the proximal humerus. Neurovascular examination is intact. Shoulder radiographs and CT are provided.

A 55-year-old male with type 2 diabetes presents with 3 weeks of progressive back pain, fever, and malaise. He has been treated for a urinary tract infection recently. His temperature is 38.5°C, WBC 18,000, CRP 180. On examination, he has severe tenderness over the lumbar spine and has developed leg weakness over the past 48 hours.

A 70-year-old female presents with acromial pain and difficulty with overhead activities 18 months post reverse shoulder arthroplasty for cuff tear arthropathy. Initial postoperative function was excellent with pain-free forward elevation to 140°. She now reports progressive weakness and aching over the lateral shoulder. On examination, there is tenderness over the acromial spine and pain with resisted abduction.

A 2-year-old girl of African descent is brought in by her parents who are concerned about her bowed legs. They have been living in the UK for 3 years. She was exclusively breastfed until 18 months. Her diet is limited and she spends most time indoors. On examination, she has frontal bossing and a rachitic rosary (palpable costochondral junctions). There is genu varum bilaterally with widened wrists and ankles. She has delayed motor milestones.

A 58-year-old right-hand dominant male carpenter presents with a 12-month history of progressive right shoulder pain and weakness. He reports difficulty with overhead activities and night pain affecting sleep. There was no specific injury. Clinical examination reveals positive Jobe's test (supraspinatus weakness), positive external rotation lag sign, and weakness of external rotation in adduction. There is no pseudoparalysis. Range of motion shows 150° forward flexion and 40° external rotation. MRI of the shoulder is provided.

A 12-year-old boy presents after an inversion injury to his right ankle while playing basketball. He heard a "crack" and has immediate swelling and inability to weight bear. On examination, there is significant swelling around the distal tibia with point tenderness over the physis. The ankle is in slight varus. There is no open wound. Distal pulses and sensation are normal.

A 24-year-old male motorcyclist presents after a fall onto his outstretched right (dominant) hand. He has pain and swelling on the radial side of the wrist. On examination, there is tenderness in the anatomical snuffbox and over the scaphoid tubercle. Axial loading of the thumb reproduces pain. Wrist movements are restricted by pain. Standard wrist X-rays appear normal but a scaphoid view shows a minimally displaced waist fracture.

A 55-year-old motorcyclist presents after a high-speed collision with multiple injuries. Chest injuries have been managed by the trauma team (rib fractures and haemothorax). He has significant right shoulder pain and difficulty moving his arm. On examination, there is bruising over the scapula and shoulder with painful limited range of motion. Peripheral neurovascular status is intact.

A 14-year-old boy is referred with progressive "round back" deformity noticed by his parents over the past 2 years. He has occasional mid-back aching that worsens with activity. He is otherwise healthy and has no neurological symptoms. On examination, he has a fixed thoracic kyphosis that does not correct with hyperextension. His Adams forward bend test shows a smooth thoracic roundback. He is Tanner stage 3.

A 13-year-old obese boy presents with a 4-week history of right hip pain and limp. The pain radiates to his knee. He has no history of trauma. He is Tanner stage 2. On examination, he has an antalgic gait and holds his right leg in external rotation. Hip flexion causes obligate external rotation. Internal rotation is severely limited to 5 degrees.

A 55-year-old man presents with a 6-month history of a growing lump in his left thigh. It is painless but has been increasing in size. He has no systemic symptoms. On examination, there is a 10cm firm, deep mass in the anterior thigh. It is fixed to underlying structures but not to skin. There is no lymphadenopathy. MRI shows a heterogeneous mass deep to the fascia, >5cm in size.

A 62-year-old man with known ankylosing spondylitis presents after a fall from standing height. He has severe neck pain and is unable to move his head. He has progressive weakness in all four limbs over the past 2 hours. He has a long-standing rigid kyphotic spine. On examination, he has 2/5 power in upper limbs and 3/5 in lower limbs with hyperreflexia.

A 62-year-old woman presents 10 weeks after primary TKA for osteoarthritis. She reports persistent stiffness with ROM 5-75° despite intensive physiotherapy. Pre-operative ROM was 0-115°. She has difficulty with stairs and rising from chairs. The knee is not particularly painful at rest. There is no warmth, erythema, or wound concerns.

A 35-year-old man is brought in after diving into shallow water. He has neck pain and weakness in both arms worse than his legs. He has numbness in a cape distribution. CT shows a C5 burst fracture with 50% canal compromise. His motor exam shows 3/5 power in biceps and deltoids bilaterally, 4/5 in triceps, and 4/5 in lower extremities.

A 28-year-old motorcyclist is brought to the emergency department following a high-speed collision. He has a deformed right foot and ankle with the foot held in equinus. He is unable to move his toes and has diminished sensation in the first web space. Radiographs reveal a displaced fracture through the talar neck with posterior subluxation of the talar body. The tibiotalar joint appears intact. CT scan confirms a Hawkins Type II fracture with additional comminution.

A 13-year-old boy presents with a 6-month history of right foot and ankle pain, worse with activity and sports. He has noticed his foot appears flat. He denies trauma. On examination, he has a rigid flatfoot with limited subtalar motion. There is tenderness over the sinus tarsi. Heel valgus does not correct with toe raise. The peroneal muscles appear tight. He has similar but less symptomatic findings on the left.

A 42-year-old male recreational basketball player presents 2 days after an acute Achilles tendon rupture while playing. He felt a sudden "pop" with immediate inability to push off. He was treated initially with a plaster backslab. Physical examination confirms the diagnosis with a palpable gap 4cm proximal to insertion and positive Thompson test. He is keen to return to sport and asks about treatment options. MRI of the ankle is provided.

A 45-year-old right-hand dominant male presents after falling from a ladder onto his outstretched right hand. He has significant elbow swelling, pain, and inability to move his elbow. Examination reveals gross instability. Neurovascular examination shows intact radial, median, and ulnar nerve function with palpable pulses. Elbow radiographs and CT scan are provided.

A 34-year-old tennis player presents with 4 months of ulnar-sided wrist pain after a fall onto his outstretched hand. Pain is worse with gripping and rotation, especially on his backhand stroke. On examination, there is tenderness at the ulnar fovea and positive DRUJ ballottement. The piano key sign is positive. Ulnar variance appears neutral. MRI shows a tear at the ulnar attachment of the TFCC.

A 68-year-old woman presents to the Emergency Department 3 weeks after primary right THA via posterior approach for osteoarthritis. She reports sudden onset severe right hip pain after bending to tie her shoelaces. Her leg appears shortened, externally rotated, and adducted. She is unable to weight-bear. Neurovascular examination is intact.

A 28-year-old construction worker fell from scaffolding approximately 4 meters. He has severe back pain and weakness in both legs. On examination, he has 3/5 power in hip flexors bilaterally, reduced sensation below L1, and intact perianal sensation with voluntary anal contraction. He has no other injuries.

A 32-year-old woman presents to the emergency department after falling while skiing. Her thumb was caught in the ski pole strap and forced into radial deviation. She has immediate swelling and pain at the base of the thumb. On examination, there is ecchymosis and swelling over the ulnar aspect of the thumb MCP joint. Stress testing reveals 40° of laxity compared to 15° on the contralateral side, with no firm endpoint. A palpable mass is felt at the ulnar MCP joint. X-ray shows no fracture.

A 52-year-old motorcyclist presents following a high-speed collision. His right knee is swollen and deformed with a large hemarthrosis. He is unable to weight bear and describes severe pain. On examination, there is tense swelling around the knee, bruising, and valgus instability. The leg compartments feel tense. Distal pulses are palpable but the common peroneal nerve territory shows decreased sensation.

A 32-year-old motorcyclist presents after a collision. He is unable to weight bear with obvious deformity of the left leg. GCS 15, isolated injury. On examination, the leg is swollen but the skin is intact. Pedal pulses are palpable and sensation is intact.

A 68-year-old woman presents 6 months after primary PS TKA for osteoarthritis. She reports recurrent giving way episodes, particularly on stairs and uneven ground. She feels unstable and has had several near-falls. There has been no trauma. On examination, there is valgus alignment with palpable lateral thrust during gait.

An 18-month-old boy is brought by his parents because he has been refusing to walk since yesterday. The parents report he was playing normally but then cried and wouldn't stand up. There was no observed fall. He has been crying when picked up. On examination, he refuses to weight bear on the left leg. There is no obvious swelling or deformity. He has tenderness on palpation of the distal tibia. His foot is warm with normal sensation.

A 62-year-old retired female teacher presents with severe right ankle pain over 5 years, progressively limiting her walking distance to 200 meters. She has post-traumatic ankle arthritis following a pilon fracture 12 years ago treated with ORIF. She requires daily analgesia and a walking stick. Clinical examination reveals a stiff, painful ankle with 15° total arc of motion (10° dorsiflexion, 5° plantarflexion), neutral hindfoot alignment, and no significant ligament laxity. The subtalar joint is well-preserved. She is a non-smoker with well-controlled Type 2 diabetes (HbA1c 6.5%). Weight-bearing radiographs and CT are provided.

A 4-year-old boy presents with a 2-day history of right hip pain and limp. His mother reports he had an upper respiratory tract infection last week. He is afebrile and looks well. On examination, he walks with an antalgic gait favoring the right leg. The right hip has mildly reduced internal rotation with pain at extremes of motion. Passive range is nearly full. He is otherwise well with no systemic features. Blood tests show WCC 9 × 10⁹/L, CRP 8 mg/L, and ESR 15 mm/hr.

A 25-year-old male unrestrained driver is brought to the Emergency Department following a high-speed motor vehicle accident. He complains of severe right hip pain and is unable to move his leg. On examination, the right leg is shortened, internally rotated, and adducted. There is no distal neurovascular deficit. A secondary survey reveals no other significant injuries. Pelvic radiograph is provided.

A 55-year-old woman with type 2 diabetes presents with 6 months of painful clicking in her right ring finger. She now notices the finger locks in flexion in the morning and she must use her other hand to straighten it. On examination, there is tenderness over the A1 pulley region at the metacarpal head. A nodule is palpable on the flexor tendon. The finger triggers with active flexion and extension, with an audible click. She has similar but milder symptoms in her middle finger.

A 45-year-old man from India presents with 4 months of progressive back pain, weight loss, and night sweats. He has developed weakness in both legs over the past 2 weeks and difficulty walking. He has a history of treated pulmonary TB 10 years ago. On examination, he has a thoracic kyphotic deformity, spasticity in both legs, and hyperreflexia with upgoing plantars. He has 3/5 power in hip flexors bilaterally.

A 10-year-old boy presents after falling during soccer and developing immediate left arm pain. He denies any previous symptoms. On examination, the upper arm is swollen and tender with limited shoulder movement. X-ray shows a well-defined lytic lesion in the proximal humerus metaphysis with a pathological fracture. A fragment of cortex has fallen to the bottom of the lesion.

A 62-year-old male with medial compartment osteoarthritis presents considering surgical options. He has an active lifestyle and is a keen golfer, hoping to return to sport. He has tried physiotherapy, injections, and activity modification without sufficient relief. On examination, he has varus alignment passively correctable to neutral, full extension, and flexion to 125°. His ACL is intact. Weight-bearing radiographs confirm isolated medial compartment bone-on-bone changes with preserved lateral and patellofemoral compartments.

A 22-year-old man presents following a motor vehicle collision. He had a posterior knee dislocation that was reduced in the Emergency Department. On examination, the knee is now reduced but the foot is pale, cold, and pulseless. He can wiggle his toes but sensation is diminished in the foot.

A 68-year-old male is scheduled for elective total hip arthroplasty for osteoarthritis. His past medical history includes hypertension, type 2 diabetes, and a previous DVT in the contralateral leg 5 years ago following immobilization for an ankle fracture. He is on aspirin 100mg daily. BMI is 32. He asks about blood clot prevention after surgery.