Fever, fatigue, reduced appetite, or weight loss may occur, but their absence does not make osteosarcoma unlikely. Many patients present with local symptoms alone because the disease begins in bone rather than producing a systemic inflammatory syndrome. Constitutional findings broaden the differential to infection, inflammatory disease, and advanced malignancy; they do not replace a focused limb examination. Ask about fever pattern, weight trajectory, energy, and night sweats while still prioritizing the more specific clues: persistent focal pain, swelling, focal tenderness, and altered function. Clinical trajectory check Link new findings to the underlying process and the compensatory response that is succeeding or failing. Reassess objective trends such as perfusion, oxygenation, mental status, pain pattern, labs, and response to time-limited interventions so the next action reflects improvement or deterioration rather than a memorized label. Clinical trajectory check Link new findings to the underlying process and the compensatory response that is succeeding or failing. Reassess objective trends such as perfusion, oxygenation, mental status, pain pattern, labs, and response to time-limited interventions so the next action reflects improvement or deterioration rather than a memorized...