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Introduction: Proximal humeral fracture is a common cause of morbidity in the elderly and poses a challenge for the orthopedic surgeon. Open reduction and internal fixation (ORIF) with a locking plate is associated with high rate of secondary implant-related complications (IRC). Early implant removal could potentially reduce the risk of IRC and further improve the outcome in relatively asymptomatic patients. The purpose of this study was to evaluate the clinical and radiologic outcomes following implant removal. Methods: A total of 56 patients with an average age of 63 ± 13 years and a mean follow-up of 29 months were evaluated retrospectively following removal of a locking plate in the proximal humerus. Postoperative functional outcomes were evaluated with the Constant-Score, Subjective shoulder value and Quick-DASH score. Results: Early implant removal resulted in high functional outcomes with 96% of the patients reporting an improvement of their shoulder function following implant removal. No intraoperative complications were reported. Avascular necrosis (AVN) of the humeral head occurred in 12.5% of the patients, but no secondary screw cut-out was reported. Conclusion: Early implant removal might be a safe option to avoid secondary IRC with significant subjective functional improvement also in asymptomatic patients. Although early implant removal cannot reverse the process of AVN, it could potentially prevent secondary IRC and subsequent glenohumeral cartilage destruction.

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Usually, multiple drug therapy is necessary to handle high blood glucose levels. Our business manager ate as much as before his diagnosis but he modified the contents of his diet so that the lifestyle intervention was not hard for him. General recommendations for lifestyle modification usually include: more exercise, reduced sugar and monosaccharides, and less alcohol and nicotine. With the knowledge of the effects of specific dietary ingredients, it might be possible to modify a regular diet in such a way as to benefit people with type 2 diabetes, to substantially improve quality of life.

associated with length of stay. These factors can be translated to improvements of our daily practice to provide a fast-track programme. Methods: We retrospectively reviewed all patients' records who received a Coonrad-Morrey total elbow arthroplasty in the period from January 1st 2012 to December 31st 2017. From these records, indications, demographic information and complications were derived. Length of stay was calculated from the hospital administration. Results: In total 118 patients receiving 119 Coonrad Morrey total elbow arthroplasties were included with a mean length of stay of 5 days (range 2-23) for the whole group. After introduction of functional discharge criteria in August 2017 mean length of stay declined from 6.4 days to 3.6 days. Reasons for prolonged stay were six times persistent wound leakage, five times blistering of the skin (of whom two superficial surgical site infections requiring antibiotics), three times awaiting cultures, two awaiting rehabilitation, two cases of pneumonia and one evacuation of a hematoma, performed in one of thirteen ulnaropathies. Conclusions: Omitting a cast and splint as regular post-operative treatment reduced the length of stay significantly without leading to more complications. Introduction of functional discharge criteria lowered the length of stay further to 3.6 days without any complications.