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Panax notoginseng, a well-known and commonly used traditional Chinese herb, has been used in China for six hundred years. Panax notoginseng Saponins (PNS) were extracted from the root of the plant. This is the first study on anti-hyperglycemic and anti-obese effects of PNS in genetic model mice. Additionally, the preventive effect on diabetic nephropathy was investigated. Animals received intraperitoneal injections of PNS 50 or 200 mg/kg daily. On day 12, 22 and 30, PNS-treated groups had significantly lower fasting blood glucose levels and smaller body weight incremental percentage. After a 12-day treatment, glucose tolerance of PNS groups were significantly improved; these indices in PNS-treated mice exhibited a dose-dependent improvement. Furthermore, on day 30, the serum insulin resistance index and triglyceride levels of PNS-treated groups decreased significantly, and the development of the mice glomerular lesions was prevented significantly. The results in this present paper indicate that PNS possesses anti-diabetes and anti-obese activities and may prove to be of clinical importance in improving the management of type 2 diabetes.

Cinnamon is one of the world’s oldest and most popular spices, and is derived from the inner bark of several tree species from the genus Cinnamomum. During the last two decades, cinnamon has demonstrated beneficial metabolic effects not only in animal experiments but also in clinical trials. Even recent meta-analyses have shown the protective effects of cinnamon on different components of metabolic syndrome and their complications. In the last 5 years, several experimental studies have unraveled the intricate molecular mechanisms underlying the antihypertensive, antihyperglycemic, lipid-lowering, weight-lowering, and cardioprotective properties of cinnamon. This review paper will discuss how cinnamon and its active components, particularly cinnamaldehyde, suppress inflammation and oxidative stress, modulate mitochondrial dysfunction, and regulate glucose uptake, insulin resistance, lipogenesis, beta-oxidation, Ca2+ signaling, and other cellar events at the molecular level. Specifically, we will delve into the molecular mechanisms involved in the metabolic effects of cinnamon to provide a deeper insight into how cinnamon can bring such beneficial effects. This review hopes to encourage the use of cinnamon in clinical settings, guide the combination of cinnamon with other drugs used to treat different components of metabolic syndrome based on their mechanism of action, and support the concept of complementary medicine for metabolic diseases.

One of the two English-language reports on the results of surgery for trigger finger reported frequent complications and poor results and the other, few complications and good results. We reviewed 72 patients with 84 operated digits 8½ (7–11) years after surgery. One patient was re-operated because of persisting symptoms, and another had a moderate recurrence. There were two transitory neuropraxias, but no permanent nerve damage could be detected. It was concluded that in cases where symptoms persist after steroid injection, surgery may be recommended. However, the risk of troublesome complications, even after this minor operation, should be borne in mind.

We report three cases of an unusual aggressive type of Mycobacterium marinum infection of the hand which had been a nightmare both for us and the patient. These were the patients in which even after repeated thorough surgical debridement and appropriate (drug sensitive) medical treatment over a period had resulted in amputation or devastation of the soft tissues so extensively that almost only the neurovascular bundle, bone and the skin were the only structures left (cosmetic fingers — no function) at the last debridement after which the infection has not recurred. By presenting this article we want to stress on certain points pertaining to diagnosis, management, varied presentation and of course the dreadful complications of deep-seated M. marinum infection.

The management of anticoagulated patients requiring surgery presents a challenge to hand surgeons. The risk of bleeding related complications needs to be weighed up against the increased risk of thrombotic events if anticoagulants are altered or ceased. There is literature reporting the safety of hand, skin, eye and dental surgery on patients taking anticoagulants, and there is literature highlighting the risks associated with altering regular anticoagulant medication. However, it is common practice to cease or alter patients' anticoagulants peri-operatively for hand surgery.

We report a prospective study of 107 patients taking anticoagulants who underwent 121 hand operations from December 2005 to August 2009. There was only one significant complication, that being a haematoma which occurred in a patient taking clopidogrel. We conclude that interruption to therapy with warfarin (provided the INR is not greater than 3.0), clopidogrel or clopidogrel with aspirin is unnecessary for patients undergoing hand surgery.

The purpose of this systematic review is to determine the incidence of complications and the recurrence rate of a volar wrist ganglion following arthroscopic resection.

We performed a systematic review of English and non-English articles using Google Scholar, Medline, and Web of Knowledge. Articles were screened for study inclusion by three independent reviewers using the terms "arthroscopic treatment of volar wrist ganglion" and "arthroscopic resection of volar wrist ganglion". Inclusion criteria: (1) level I–V evidence, (2) documentation of the number of wrists subjected to surgery, (3) documentation of surgical techniques used on wrists, and (4) documentation of surgical or post-surgical complications and recurrence rate of a volar wrist ganglion after arthroscopic resection. A complication was defined as an adverse outcome that was directly related to the operative procedure. Between 2001 and 2012, 13 articles met the inclusion criteria. Two articles were excluded and 11 were reviewed. A total of 232 wrists underwent arthroscopic surgery with 14 recurrences.

The recurrence rate ranged from 0 to 20%, with mean of 6.03%. There were 16 (6.89%) complications. There was no connection with the ganglion in six wrists, three haematomas, three cases of neuropraxia of the dorsal radial nerve, two partial lesions of the median nerve, and two lesions of a branch of the radial artery. Patients did not have a decrease in the arc range of motion. Treatment of volar ganglia of the midcarpal joint was technically difficult and associated with a higher number of complications.

In general, arthroscopic resection results in fewer complications and lower recurrence rates than an open surgical approach, but there is no clear evidence of such an advantage for arthroscopic resection of a volar wrist ganglion. Additional prospective, controlled clinical trials will be essential to address this important issue.

Introduction: Total Knee Arthroplasty (TKA) is usually performed with a tourniquet. Previous studies investigated the relationship between tourniquet and blood loss. This study evaluated tourniquet usage regarding parameters such as blood loss, drainage, blood administration, knee flexion, and complications. Patients and Methods: A cohort of 77 patients who underwent total knee arthroplasty was reviewed. Results: No difference in 24-hours postoperative hemoglobin levels was observed. Blood collected in drains was slightly higher in the tourniquet group, yet there was more overall administration of blood for non-tourniquet group: a mean of 1.2 units of packed RBC versus a mean of 0.63 units for the tourniquet group. Complication rate was comparable, but a higher rate of local infection in tourniquet group was observed. No thromboembolic events were observed. Conclusion: With regards to direct blood loss parameters, there was no statistical difference between groups, provided that meticulous hemostasis is undertaken. Operating without a tourniquet poses a risk of increased demand for blood products. There is also some concern regarding local complication rate when tourniquets are used.

The distal radioulnar joint (DRUJ) allows forearm rotation and load transmission across the wrist. Post-traumatic and degenerative joint disease of DRUJ may cause pain and disability. Deficiency of the soft tissue or bony supports may result in DRUJ instability. Various techniques have been developed to address arthritis and / or instability of the DRUJ. A comprehensive review of the spectrum of surgical techniques and arthroplasty options is presented. The concepts of these procedures are discussed in detail, with a focus on special points of interest to optimise outcomes and to avoid complications. The salvage of the complications of arthroplasties is also presented in detail.

Background: Intramedullary fixation for distal radius fractures is reported to be free of hardware irritation and less invasive than other fixation methods. Some specific complications associated with intramedullary fixation, such as radial nerve sensory neuritis, have been reported, but no study has focused on the complication rates of intramedullary fixation for distal radius fractures in the elderly population. Furthermore, no studies have analyzed common complications, such as carpal tunnel syndrome and flexor tenosynovitis including trigger finger, among patients with distal radius fractures treated by intramedullary fixation based on a comprehensive complication checklist.

Methods: We reviewed the medical records of 52 elderly patients with distal radius fractures treated with intramedullary nail fixation. We investigated the postoperative complications in these patients using McKay’s complication checklist.

Results: 5 patients experienced radial nerve sensory disorder, and one patients developed carpal tunnel syndrome. All neurological symptoms resolved spontaneously, and these neurological complications were categorized as mild. Further, 3 patients developed trigger finger at the A1 pulley and needed triamcinolone injections for symptomatic relief. There were no tendinous complications around the implanted hardware. All tendinous complications were categorized as moderate complications and resolved with steroid injection therapy. Among skeletal complications, 1 case of postoperative volar displacement resolved with good functional outcome without the need for corrective osteotomy. This was considered a mild complication. The total complication rate was 19.2%. All complications were categorized as mild or moderate, and no patients experienced severe complications that needed further surgery such as hardware removal.

Conclusions: Intramedullary fixation for distal radius fractures was free from tendinous complications such as tenosynovitis and tendon ruptures around the implant, which are frequently caused by volar locking plate fixation. However, this less invasive technique could not avoid common complications such as trigger finger and carpal tunnel syndrome associated with distal radius fractures.

Background: Limited research exists investigating the association between diabetes and glycemic control on complications following elective hand surgery. The goal of this research was to assess the incidence of complications within 30 days of elective hand surgery in a large population of diabetic patients compared to a population of non-diabetics. Furthermore, we sought to examine the relationship of glycemic control, as measured by HbA1c, and postoperative complications.

Methods: We performed a retrospective review of electronic medical records at our institution of all patients who underwent elective hand, forearm, or elbow surgery from the dates of January 1^st, 2008 to December 31^st, 2017. Patients were categorized as diabetic or non-diabetic and most recent HbA1c was documented. Multivariable analysis was employed to compare the incidence of surgical complications within 30 days between the diabetics and non-diabetic populations, adjusting for baseline patient characteristics.

Results: A total of 3,261 patients met the inclusion criteria. There were 646 (20%) diabetic patients and 2,615 (80%) non-diabetic patients. No difference was found in the overall rate of complications between the cohort of diabetic and non-diabetic patients. Additionally, statistical analysis found no difference in the complication rate between insulin and non-insulin controlled diabetics. Rates of complications were stratified based on HbA1c level and statistical analysis found no increased risk of complications with increased hemoglobin A1c value.

Conclusions: In our present study we were not able to demonstrate any significant difference in the 30 day complication rates between and non-diabetics undergoing elective hand surgery. This study attempted to aid in risk stratification of diabetic patients by evaluating preoperative glycemic indices in the form of HbA1c.

The best treatment for mallet fingers is still a matter of debate. Numerous splints with different designs to keep the distal interphalangeal (DIP) joint in extension have been described in literature. The outcomes of splint treatment are generally good with occasional reports of minor skin complications. Percutaneous Kirschner-wire pinning of the DIP joint for closed tendinous mallet finger represents a alternative treatment modality that reliably immobilises the joint and does not need much patient compliance or use of an external splint. We report a rare but devastating complication of percutaneous pinning of the DIP joint for closed tendinous mallet finger.

Level of Evidence: Level V (Therapeutic)

Background: We aim to evaluate the impact of advanced age and sex on postoperative complications and radiographic outcomes after open reduction with internal fixation of distal radius fractures (DRF).

Methods: We conducted a retrospective chart review, including all patients who underwent open reduction with internal fixation of a DRF between 2012 and 2018 at a single level 1 trauma centre. We recorded patient age, sex, fracture classification (Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association [AO/OTA]), time from injury to surgical date, surgical duration, diabetes status, tobacco use, illicit drug use, history of osteoporosis, use of adjuvants, fixation type, postoperative radiographic restoration of normal parameters and early complications including loss of reduction within 30 days postoperatively. Advanced age was defined as age greater than 60 years.

Results: A total of 521 patients underwent operative treatment – 264 males and 257 females. Males were twice as likely (23.5% vs. 10.1%; p < 0.0001) to sustain a type C3 fracture and be treated with a wrist spanning plate (5.3% vs. 0; p < 0.0001). A larger percentage of elderly patients undergoing operative treatment of DRF were female (20.2% vs. 5.7%; p < 0.0001) and females were more likely to carry a pre-injury diagnosis of osteoporosis (9.3% vs. 0%; p < 0.0001). And 100% of the elderly patients received were treated with a volar plate. The overall early loss of reduction was 7.5%. The overall complication rate was 8.2%. No differences in early postoperative complications were identified between sexes or age groups. Neither female sex nor advanced age was found to have increased risk of postoperative complications or early loss of reduction. Similar postoperative radiographic parameter measurements were obtained across groups as well.

Conclusions: Our results support the idea that operative treatment of unstable DRF in elderly patients and women is a reasonable treatment option without significant increases in early postoperative complications.

Level of Evidence: Level III (Therapeutic III)

Systemic lupus erythematosus (SLE) is an autoimmune disease with involvement of multiple systems. Despite the therapeutic advances in the past few decades, refractory SLE causing organ damage and life-threatening complications still poses a therapeutic challenge. Therapeutic plasma exchange is considered as one of the rescue therapies used in refractory SLE. However, the level of evidence supporting its use is low. This article reviews the current evidence of the application of plasmapheresis in the treatment of SLE.

Coronavirus disease 2019 (COVID-19) was one of the most important infections in the past few years. Although most cases of COVID-19 are mild, serious complications may arise. The multisystem inflammatory syndrome (MIS) is a rare but severe, yet poorly understood complication of COVID-19. It was first described in childhood patients with COVID-19 (MIS-C) but is increasingly reported in adults. MIS-A may lead to diagnostic and therapeutic dilemma as its manifestations may mimic a flare of the underlying disease and the use of immunosuppressive therapy may further increase the risk of other infective complications in these patients. However, MIS-A has rarely been reported in patients with pre-existing autoimmune conditions. We hereby present a patient with systemic lupus erythematosus who developed severe MIS-A 6 weeks after a recent SARS-CoV-2 infection.

Endoprosthetic reconstruction using a custom-made metallic megaendoprosthesis is one of the common modalities for the limb salvage operation. The new promising advance of material science, design and fabrication of the endoprosthesis enable an immediate rehabilitation program and provide a durable and functional limb. Thus a successful limb reconstruction is possible in the well-selected patients. In addition to the endoprosthesis-related increased stress, a limited soft tissue support and constraint after limb salvage procedure usually results in an increased incidence of complications, especially in the long term survivors. Some patients may even need revision of the endoprosthesis and, at times, amputation.

The complications after oncological endoprosthectic reconstructions usually occur more frequent than the conventional primary total joint arthroplasty. Considering the characteristics of the surgical procedure and the high demands on the implants, such a relatively high frequency of complications is not unexpected. The common complications include wound necrosis, aseptic loosening, fatigue fracture, local osteolysis, joint contracture, dislodgement/dislocation, nerve or vascular injury, rotational deformity, leg length discrepancy, infection, periprosthectic fracture, etc. Some complications are encountered with other modality of limb salvage procedure, whereas the other endoprosthesis-related complications are endoprosthetic-unique and not uncommon. The major causes of such a relatively high endoprosthesis-related complications include (1) extensive excision of soft tissue, leading to change of biomechanical ergonomics, little soft tissue constraints or support for a long replacement segments, and decreased local defense to infection, (2) increased stress on the implants due to higher activity level in the youthful active individuals, relatively narrower medullary canals with less cancellous bone for fixation, (3) special needs for the stability resulting an increased mechanical constraints placed directly within the endoprosthesis, thus raising the local stress transferred to the prosthesis, and to the prosthesis-bone interface, (4) poor immunological, hematological, or nutritional status resulting from chronic oncologic diseases or chemotherapy. It in turn accelerates the wear processes of the components, induces the wear particulate disease and local osteolysis, as well as to cause the aseptic loosening eventually. Early detection and early correction of minor complications has an important role of preventing the major complications, thus reduces the necessity of reoperation, and at times, amputation. We will review these complications in this article.

Diagnostic and management challenges after radical prostatectomy pertain to both cancer recurrence and management of complications. The risk of cancer recurrence after radical prostatectomy can be estimated using nomograms based on validated prognostic factors. Follow-up can then be tailored to a patient's risk. The diagnosis of recurrence after radical prostatectomy is made when the PSA is greater than 0.2ng/ml. After recurrence, the great dilemma is to determine whether the recurrence is localised or systemic. This can be determined by a variety of imaging modalities and examination of prostatectomy pathologic characteristics and PSA kinetics. Management of a recurrence can be expectant, or using salvage radiotherapy, or androgen ablation therapy, depending on the likelihood of localised disease, patient health and expectations.

Management of complications of radical prostatectomy can be difficult. The risk of incontinence is determined by patient age, ability to perform a nerve-sparing operation, likelihood of developing anastomotic contracture and surgical experience. Management of post-operative incontinence focuses primarily on pelvic floor exercises. Surgical avenues include injection with periurethral bulking agents, slings and artificial sphincter placement. Erectile dysfunction after radical prostatectomy is also common and depends on pre-surgery erectile function, degree of nerve sparing and surgeon's experience. Following surgery, early penile rehabilitation with intra-cavernosal injections and PDE5 inhibitors have been shown to improve the return of erectile function.

Much has been learnt about severe acute respiratory syndrome Coronavirus 2 (SARS-CoV-2) since the beginning of the Coronavirus disease 2019 (COVID-19) pandemic, including its clinical manifestations, diagnosis, and management. Unlike its zoonotic predecessor SARS-CoV which was largely a symptomatic disease where fever was a hallmark, a significant proportion of SARS-CoV-2 infections can be asymptomatic (40%), while severe disease (requiring oxygen supplementation or ventilatory support) occurs in approximately 20%, and mortality in about 2% of infected patients. Extra-pulmonary COVID-19 manifestations are also more protean, compared to SARS. Supportive care is the mainstay of treatment for most patients, but for those who progress to severe COVID-19, antivirals such as remdesivir and immunomodulatory treatment (such as corticosteroids or the JAK-inhibitor, baricitinib) may improve outcomes. While further advances in the management of COVID-19 are anticipated (including novel therapies), prevention of infection through public health measures (including vaccination), will remain as vital facets in confronting this pandemic.

Control of blood sugar is a very important factor in the management of all diabetics. Medications are needed in addition to dietary restrictions and regular exercise. Type 1 and Type 2 diabetes are described — the most common being Type 2. The various types of medications prescribed are also elaborated. Capillary glucose monitoring and HbA1C monitoring are important for good diabetic management. Good glycaemic control prevents complications of diabetes from developing, including nephropathy, retinopathy, neuropathy and vasculopathy.

Charcot joint disease (CJD) or neuropathic joint of the foot is a spectrum of disease ranging from mild changes that can only be identified on radiological examination to gross deformities of the foot that are easily detected on both clinical and radiological examination. The pathology starts from the loss of protective sensation which leads to gradual damage and disruption of the joints and surrounding bones. Early diagnosis and treatment is critical to a successful outcome. Treatment of CJD is primarily non-operative. Treatment consists of two phases: an acute phase treated by immobilisation and reduction of stress, and a post-acute phase treated by wearing custom-made footwear which offers protection and support including total contact casting, modified ankle foot arthoses (AFOs), pneumatic walking brace and bivalved cast. Biphosphonates have been recently advocated. Operative treatment is indicated when there is symptom of instability or a deep-seated infection as a complication of neuropathic ulcers. It includes mid-foot fusions, hind-foot fusions, triple arthrodesis, sub-talar joint fusions and ankle fusions. A-frame external fixation for ankle fusion has been shown to give encouraging results. Others prefer using retrograde (intra-medullary) femoral nail (size 9) with interlocking screws.

The following sections are included:

• INTRODUCTION

• AIMS, ADVANTAGES AND DISADVANTAGES OF LAMINOPLASTY

• INDICATIONS AND CONTRAINDICATIONS FOR LAMINOPLASTY

• TECHNIQUES OF LAMINOPLASTY AND THE SUPPLEMENTARY PROCEDURES
  • Unilateral Hinge Laminoplasty
  • Procedures Supplementary to Laminoplasty

• POSTOPERATIVE MANAGEMENTS AFTER LAMINOPLASTY

• RESULTS AND OUTCOME
  • Neurological Results
  • Roentgenographic Outcome
  • Long-Term Results (Fig. 8)
  • Complications

• REFERENCES