Rheumatoid Arthritis (RA) is the most frequent inflammatory rheumatic disease. At the beginning of the disease, where after today‘s knowledge the therapeutic possibilities are largest, the diagnostic methods do not permit a differentiated estimation of the prognosis. Conventional x-rays are mostly normal and serum markers unspecific. So far – in contrast to other diseases – only few information has been drawn from the pathomorphologic substrate “synovium” itself to assess the prognosis. Reasons therefore are found in difficulties in obtaining synovial tissue without surgical intervention, particularly in patients with early arthritis.

By minimalizing the diagnostic instruments and improvement of the technique, nowadays synovial tissue sampling in RA has become minimal invasive and even possible from smallest joints, such as finger joints. Hereby, synovial analysis is open for detecting pathways of inflammation and joint destruction, which might support the advancement of new therapeutic strategies, followed by a better prognosis and outcome of RA.

We have reviewed the early complications of 121 surgically treated closed ankle fractures; the complication rate was 30%, with 14 major and 22 minor complications. Fractures with skin blisters or abrasions had more than double the overall complication rate. Fracture-dislocations had three times as many major complications as simple fractures, and those not fixed within 24 hours had a 44% major complication rate compared to 5.3% in those operated upon as emergencies. Patients transferred from another medical facility had high complication rates, especially if they had fracture-dislocations. We conclude that operative treatment of ankle fractures must be delivered in a timely fashion, especially in severe fractures. We would caution against the practice of transferring patients with serious ankle fractures before completion of definitive care.