Does implant removal of superior clavicle plate osteosynthesis affect the functional outcome: a prospective trial.

BACKGROUND: Elective implant removal (IR) accounts for up to 30% of all orthopaedic surgeries. While there is general acceptance about the need of implant removal for obvious reasons, such as infections or implant failure, little is known about the beneficial aspects in cases of minor reasons such as patients' wish for IR. Therefore, we initiated this study to define patients' benefit of elective implant removal following plate osteosynthesis of displaced clavicle fractures. PATIENTS AND METHODS: Prospective evaluation of patients was conducted before implant removal and 6 weeks postoperative. Subjective and objective criteria included pain rating on a visual analogue scale (VAS) and active range of motion (ROM) pre- and 6 weeks postoperative. Functional scoring included Constant-Murley Score, DASH (Disabilities of Arm, Shoulder and Hand Score), MSQ (Munich Shoulder Questionnaire) and SPADI (Shoulder Pain and Disability Index). RESULTS: 37 patients were prospectively enrolled in this study and implant removal was performed after 16 ± 6.1 months. No re-fractures nor other complications were detected during routine follow up. Functional outcome increased through all scores (Constant score 73.3 ± 14.6 preoperative to 87.4 ± 12.0 postoperative (p = 0.000), MSQ 85.0 ± 7.3 preoperative to 91.8 ± 9.0 postoperative (p = 0.005), DASH Score 7.4 ± 8.2 preoperative to 5.7 ± 9.5 postoperative (p = 0.414), SPADI 93.4 ± 6.6 preoperative to 94.0 ± 10.1 postoperative (p = 0.734). CONCLUSIONS: Discomfort during daily activities or performing sports as well as limited range of motion were the main reasons for patients' wish for implant removal. We found increased functional outcome parameters and decreased irritation after implant removal. Therefore we suggest implant removal in case of patients' wish and completed fracture consolidation. TRIAL REGISTRATION: Trial registration no: NCT04343118, Retrospective registered: www.clinicaltrials.gov .

Longevity and sustainability of tropical and subtropical restored seagrass beds among Atlantic, Pacific, and Indian Oceans.

Seagrass longevity up to 47 years in well-restored, well-sited seagrass restorations are demonstrated from 253 trials at 83 regional sites in tropical and subtropical portions of three oceans (Atlantic, Pacific, Indian Oceans). These trials include over 3.04 million planted units into 306.3 ha. Approximately 12% of the total global tropical restored seagrass by Van Katwijk, Thorhaug et al. (2016) calculations from 1786 trials are included. Almost all projects herein reviewed persisted since date of planting except several cases with harsh anthropogenic impact or forceful natural events in first post-planting months. The oldest tropical/subtropical restoration continually observed is 47 yrs, many are 35 yrs. An array of observed and/or measured restored services accompanied these. This review may provide informational background for government resource managers, legislators, scientists, and citizens concerning tropical/subtropical seagrass longevity. This data from these trials may substantiate future seagrass restoration investments. Public outreach, national & regional government training,and outreach occurred, needing continuation.