Rheumatoid arthritis (RA) is a lifelong, systemic autoimmune disease that affects women three times more frequently than men, often in their most productive and childbearing years. This chronic inflammatory disease occurs mainly due to immunological dysfunction and infiltration of T cells secreting cytokines causing inflammation and arthritis due to cartilage destruction and systemic symptoms. The primary feature being inflammatory synovitis which usually involves the peripheral joints. The mainstay of management of rheumatoid arthritis includes Disease Modifying Antirheumatic Drugs (DMARDs), most of which are contraindicated in pregnancy, thus causing a significant complexity in management during pregnancy. In our case, A 28 year old female, Primigravida with 26 weeks of gestation came to the OPD of department of Obstetrics and Gynaecology, MGM hospital with complaints of pain in the left knee joint for the past one year, aggravated two weeks back and diffuse swelling over the joint since 1 month. A diagnosis of monoarticular Rheumatoid arthritis was formed after ruling out other pathologies like reactive arthritis, tuberculosis of knee joint, referred pain due to pathologies in the neighbouring joints. Since the patient was pregnant, a decision based on level five evidence, was taken to avoid the DMARDs due to their potential teratogenicity and she was managed with an intra-articular injection of corticosteroid which showed no improvement in the patient's symptoms. Hence it was followed by an intra-articular injection of 8ml of Platelet rich plasma (PRP) which resulted in an improvement in VAS scores from 8 to 2, 4weeks after injection along with a clinical reduction in joint swelling and pain even at extremes of movements. The clinical benefits of PRP in RA can possibly be explained by its antiinflammatory effects.

Floating Knee is the term applied to the flail knee joint segment resulting from a fracture of the shaft or adjacent metaphysis of the ipsilateral femur and tibia The fractures range from simple diaphyseal to complex articular types. The word floating knee was introduced for the first time by Mc Bryde in 1965. The incidence of these injuries is increasing. They are associated with potentially life threatening injuries of the head, chest, and abdomen. Not less frequently these injuries cause infection, excessive blood loss, fat embolism, mal union, delayed or non-union, knee stiffness, prolonged hospitalization, and inability to bear weight. Malunion is one complication which drastically affects the functional outcome. Hence we tried to find the factors that may result in malunion more often than not which will help to prepare us in a more suitable manner in treating these injuries We analysed 30 cases of floating knee which were surgically treated regarding the pattern of injuries, type of injuries, closed/open, fixation methods, associated injuries, union rates, malunion and functional outcome. All cases were followed up to a minimum of 1 year. We found that malunion in a floating knee injury which was surgically treated drastically affected functional outcome. The mechanism of injury, type of fracture, open/closed injury, level of fracture whether diaphyseal or juxta articular or intraarticular, type of initial fixation all had a significant correlation with occurrence of malunion.

Background: Open fractures of tibial shaft are important for the reason that they are most commonly fractured long bone in the body & subcutaneous location of the anteromedial surface of the tibia makes their management controversial. The precarious blood supply and lack of soft tissue cover of the shaft of the tibia make these fractures vulnerable to delayed union, nonunion, malunion and infection. The treatment of tibial fractures has developed from a strictly non-operative to a variety of operative techniques. While reamed Intramedullary nailing offer improved stability of the fracture, their use carries a theoretical risk of infection and nonunion as a consequence of disturbing endosteal blood supply. Recent reports suggest that the reaming is safe for grade I, II and IIIA open fractures of tibia. Material & Method: A total of 25 patients presented to Father Muller Hospital, Mangalore from Jan'06 to July'07 with type I and II open tibial shaft fractures were included in the study and all cases underwent debridement within 6 hours of admission and treated with reamed intramedullary interlocking nailing. They were reviewed at every 2 weeks for 6 weeks and then monthly post operatively and x-rays were repeated at 6,12,24 weeks to check for fracture healing. The average duration of follow-up was 32 weeks. Functional results were graded according to criteria by klemm & borner. Result:The average time to union was 19.68 weeks. Type I united in 18.86 weeks as compared to 20.5 weeks for Type II fractures. The average range of motion in the knee joint was 135.6 degrees. Full ankle motion was observed in 19 patients. One patient showed a loss >25° of motion at ankle compared to normal side while 5 patients showed < 25 0 loss of joint motion. 92% patients achieved good or excellent results, fair results were obtained in one patient & in one patient functional results were poor. Conclusion: Anatomical & functional outcome of open tibial fractures type I and type II treated with reamed intramedullary interlocking nailing is excellent to good and it is safe and effective technique for the management of Gustilo type I and type II.

Variations in the arterial pattern of the upper limb are very common as observed in many cadaveric and angiographic studies. Knowledge of variations in the origin and course of the radial artery is important because they are used for many diagnostic procedures as well as vascular and reconstructive surgeries like coronary angiography, percutaneous coronary intervention and coronary artery bypass surgery. During routine dissection in our institute, we observed a case of high origin of the radial artery in a 33 year old male cadaver. It was found to be unilateral; on left side, radial artery was taking origin from 3 rd part of the axillary artery at the lower border of pectoralis minor before the origin of subscapular artery and anterior circumflex humeral artery. It had a superficial course in the arm crossing the median nerve from medial to lateral side. The further course of this superficial radial artery in the forearm was normal and it terminated by forming a deep Palmar arch in hand. These variations may be of great clinical implications for vascular and plastic surgeons and radiologists. Superficial course of radial artery makes it vulnerable to accidental injuries.

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