A 41-year-old patient presented with chronic, left-sided trochanteric bursitis, unresponsive to conservative treatments including intensive physiotherapy, local and systemic anti-inflammatory therapy, and neuromodulation. A novel surgical approach was used, involving an adducting trochanteric closing wedge osteotomy to reduce the lateral prominence of the greater trochanter without relevantly affecting the abductor lever arm. The procedure resulted in substantial symptom relief, with excellent functional outcomes. This case underscores the potential of the adducting trochanteric closing wedge osteotomy as a potential biomechanical solution for recalcitrant trochanteric bursitis, providing durable pain relief and enhanced function.

A 25-year-old severely obese woman sustained a knee injury with foot drop after an electric scooter crash. Initially diagnosed with a knee sprain and advised to follow-up with her primary care physician, she was later diagnosed with chronic multiligamentous knee instability and complete common peroneal nerve (CPN) palsy. Surgery 7 months postinjury demonstrated a severed intra-articular CPN scarred to the anterior cruciate ligament stump, necessitating arthroscopic-assisted extrication. Clinicians should maintain high suspicion for ligament injury and peroneal palsy after low-energy knee trauma in severely obese patients. Attentive neurovascular examination, imaging, and dissection are critical given possible aberrant nerve displacement.

A 35-year-old man with known gouty arthritis of the right knee and an extension block was found to have persistent tophi and reduced range of motion despite urate-lowering therapy. Arthroscopic surgery excised nodules of tophi in the intercondylar notch and a large central osteophyte that had obstructed full knee extension. The patient achieved full knee extension and satisfactory functional outcomes at 1 year postoperatively. Arthroscopic surgery can be effectively used in gouty knees with an extension block, resulting in excellent outcomes.

A 56-year-old woman presented with bilateral hip pain status postmechanical fall. Imaging confirmed bilateral AFFs with lateral cortical beaking. The patient was found to be on a calcitonin gene-related peptide (CGRP) antagonist, Erenumab, for treatment of recurrent migraines. CGRP is a neuropeptide and vasodilator produced by neurons in both the central and peripheral nervous system. She was treated with bilateral femoral intramedullary nails, followed by postoperative rehabilitation with physical therapy and outpatient follow-up visits. Erenumab is a CGRP antagonist, which increases bone formation, and may be associated with atypical femur fractures. Further investigations are warranted.

We present the case of a 42-year-old woman with an infected distal humeral shaft nonunion treated with plate-assisted bone segment transport (PABST) using a magnetic lengthening intramedullary implant. At eight months postoperatively, the patient had consolidation of distraction osteogenesis and transport docking sites, equal humeral length, and ability to perform activities of daily living. We demonstrate the successful treatment of humeral shaft nonunion using PABST. To our knowledge, this is the first documented case using this technique to treat a large bone segment defect in the humerus.

A 37-year-old man developed chronic ankle instability because of the complete absence of the anterior talofibular and calcaneofibular ligaments after previous ankle arthroscopy, confirmed by magnetic resonance imaging. Arthroscopic lateral ligament reconstruction with a gracilis tendon autograft yielded excellent outcomes, with the patient achieving stability, being pain-free, and attaining normal functional scores at 12 months postoperatively. This case highlights the importance of surgical expertise to prevent complications of the arthroscopy procedure, describing a rare complication: iatrogenic chronic ankle instability, and demonstrates the efficacy of arthroscopic ligament reconstruction using grafts in the absence of native ligaments.

We report a 65-year-old man with complete heel pad avulsion and large full-thickness skin defect on the anterolateral foot and ankle. The heel pad was reattached to the calcaneus using two 1-0 nylon sutures with intravenous tubing pledgets. The defect was covered with an anterolateral thigh (ALT) flap. At 13 months postoperatively, the heel pad remained securely attached, and the ALT flap was healthy. The patient could fully weight bear and perform single-leg stance and calf raises without pain. This novel approach to repairing complete heel pad avulsions has not been previously described. It offers a simple, cost-effective option, particularly suited for resource-limited settings.

Monozygotic 19-year-old female twins with Treacher Collins syndrome presented with progressive scoliosis; their primary thoracic curves measured 73° in Twin 1 and 52° in Twin 2. Both patients underwent posterior spinal fusion with low-density pedicle screw constructs and, at 1 year, demonstrated marked radiographic correction and improved quality of life. Although often overshadowed by craniofacial findings, extracraniofacial manifestations, such as spinal deformity, in Treacher Collins syndrome can cause severe morbidity. Early detection and timely fusion with low-density constructs provide safe, durable correction in severe cases. IV.

An upper trunk brachial plexus injury patient underwent ulnar motor fascicular to biceps motor nerve transfer. At 6 months postoperative, the patient had trace biceps firing but was diagnosed with an unrecognized rupture of the distal biceps tendon, requiring reconstruction. Another patient with C5-T1 injury was noted to have distal biceps tendon rupture at the time of gracilis muscle transfer. Both patients had gravity-assisted elbow flexion at 1-year follow-up. Biceps rupture is an uncommon concomitant injury with brachial plexus trauma and challenging to diagnose in the context of a paretic limb. Thorough history and intraoperative biceps tendon palpation will ensure these injuries are identified.

Hill-Sachs lesions and reverse Hill-Sachs lesions (HSLs) are common in patients with shoulder instability, and addressing these lesions effectively is crucial for patient outcomes. Our study investigates a novel technique using talus osteochondral allografts (TOA) for the treatment of these lesions. The TOA offers several advantages, including congruency to the humeral head, dense bone structure, and a reduced risk of contamination compared with other allografts. We present 3 patients with large engaging Hill-Sachs lesions or reverse HSLs, who were treated using a TOA, highlighting its feasibility and positive clinical outcomes.