What happens when a scalpel meets the unexpected? In this episode, we journey into the heart of global orthopedic surgery, where late-presenting cases, resource scarcity, and cultural nuances redefine the art of healing. We are joined by none other than Dr. David Spiegel as he discusses the challenges and triumphs of treating complex musculoskeletal conditions in austere settings over the last several decades - emphasizing the importance of adaptability and collaboration. From crafting a practical textbook for surgeons in the field to navigating the intricacies of low-resource environments, this conversation offers a behind-the-scenes look at orthopaedic care in various settings. From pioneering new surgical techniques to fostering research and education, Dr. Spiegel’s work continues to inspire the next generation of surgeons and advocates for equitable care.