Introdução: A discrepância no comprimento dos membros inferiores (DCMI) está associada a alterações biomecânicas na marcha e a uma grande variedade de desordens ortopédicas, que incluem uma possível sobrecarga do tendão tibial posterior. Neste sentido, hipotetizamos que há associação entre a presença de DCMI e disfunção do TTP. Objetivo: O presente estudo foi realizado para comparar a frequência e a magnitude de DCMI em um grupo com e outro sem disfunção do tendão tibial posterior (DTTP), bem como para relacionar características clínicas com a presença da doença. Modelo do estudo: Estudo caso-controle. Método: O estudo envolveu 118 pacientes com diagnóstico de DTTP atendidos entre janeiro de 2009 e setembro de 2012 e 118 voluntários controles pareados por gênero e raça. Através de escanometria radiográfica ou tomográfica, a frequência da DCMI, assim como a média da DCMI absoluta e a média da DCMI relativa foram comparadas entre os dois grupos. Resultados: A prevalência da DCMI e as médias da DCMI absoluta e da DCMI relativa foram significativamente maiores no grupo de casos (94,9%, 5,64 mm e 7,36% respectivamente) do que no grupo controle (79,7%, 3,28 mm e 4,18% respectivamente) (p<0.001). Conclusões: Os resultados deste estudo demonstram haver uma relação entre a DCMI e a presença de DTTP. Devido a importantes alterações biomecânicas geradas pela DCMI, esta é possivelmente um fator predisponente para o desenvolvimento da DTTP. / Background: Leg length discrepancy (LLD) is associated with a variety of orthopedic disorders and biomechanical gait changes that involve possible overload of the posterior tibial tendon (PTT). In view of the biomechanical disturbances induced by LLD, an association may exist between LLD and PTT dysfunction (PTTD). Purpose: To compare the frequency and magnitude of LLD between subjects with and without PTTD and ascertain whether associations exist between clinical features and presence of dysfunction. Study design: Casecontrol study. Methods: A total of 118 patients with a diagnosis of PTTD were seen between January 2009 and September 2012 and compared to 118 sex- and race-matched volunteers. The frequency of LLD, the mean absolute LLD and the mean relative LLD were measured by conventional (radiographic) or CT scanography and compared between cases and controls. Results: The prevalence of LLD and mean absolute and relative LLD values were significantly greater in the case group (94.9%, 5.64 mm and 7.36% respectively) than in the control group (79.7%, 3.28 mm and 4.18% respectively) (p<0.001). Conclusion: The findings of this study demonstrate a relationship between LLD and PTTD. In light of the major biomechanical changes it induces, LLD may be a predisposing factor for development of PTTD.

Existe uma alta incidência de desigualdade de membros inferiores na população geral, podendo ser do tipo estrutural, onde existe diferença no comprimento de estruturas ósseas, ou funcional, como resultado de alterações mecânicas dos membros inferiores (MMII). A desigualdade pode ainda ser classificada quanto a sua magnitude, sendo discreta, moderada, ou grave. São muitos os métodos antropométricos utilizados para avaliar a desigualdade, entre os mais usados estão os métodos clínicos, como o uso de fita métrica para medir a distância entre duas saliências ósseas. Além destes, os métodos radiográficos também podem ser usados, porém com menor freqüência devido ao custo elevado e exposição à radiação. As desigualdades discretas têm sido associadas especificamente à fratura por estresse, dor lombar e osteoartrite. Quando uma desigualdade está presente em indivíduos cuja sobrecarga mecânica é acentuada pela sua prática profissional, diária ou recreativa, estas desordens podem se manifestar precoce e gravemente. O objetivo deste estudo foi comparar diversas medidas antropométricas de comprimento de MMII usadas na prática clínica com a escanometria em corredores, e estudar a Força Reação do Solo durante a marcha e a corrida de corredores com desigualdade estrutural discreta de membros inferiores. Observou-se que a presença de desigualdade de membros inferiores foi associada à maior incidência de sintomas nos quadris e joelhos nos corredores. As medidas clínicas EIAS/MM (R=0,96; p=0,000), EIAS/ML (R=0,97; p=0,000), Crista/MM (R=0,95; p=0,000) e Umbigo/MM (R=0,92; p=0,000) apresentaram alta correlação com a escanometria. Entretanto, somente a medida clínica Umbigo/MM (0,8 ± 0,6 cm; 0,8 ± 0,5%) detectou desigualdade absoluta e normalizada entre os membros semelhante à escanometria (0,6 ± 0,5 cm; 0,8 ± 0,6%). Observou-se que quanto maior a desigualdade, maior a sobrecarga em ambos MMII, cargas estas capazes de causar em longo prazo desordens ortopédicas. Os sujeitos com desigualdade de 0,5 a 2,0 cm, durante o andar, apresentaram no MI menor maiores valores de Fzmin (0,56 ± 0,08 PC); e maiores valores de Fz2 e PO no MI menor durante o correr (2,48 ± 0,22 PC; 17,18 ± 3,35 PC/s). E os sujeitos com desigualdade de 1,0 a 2,2 cm apresentaram no MI maior uma menor Taxa de Crescimento 1 (9,19 ± 1,49 PC/s) em comparação ao controle (10,44 ± 1,72 PC/s) durante o andar; maiores valores de Fz1 no MI maior (1,70 ± 0,17 PC) em relação ao controle (1,57 ± 0,16PC), e ainda maiores valores de Fz2 e PO no MI menor (2,55 ± 0,22 PC; 17,07 ± 3,31 PC/s) durante o correr. No entanto, os sujeitos com desigualdade discreta de membros inferiores apresentaram a marcha e a corrida simétricas de acordo com os valores obtidos pelo Índice de Simetria Absoluto das variáveis da FRS vertical e horizontal. / There is a high incidence of leg length discrepancy (LLD) in general population, which could be structural, when the difference occurs in bone structures, or functional, as a result of mechanical changes at the lower limbs. The discrepancy can also be classified by its magnitude, being mild, intermediate, or severe. Many anthropometric methods are used to evaluate discrepancy, however the most common are clinical methods, which use a tape to measure the distance between two bone landmarks. Radiographic methods can also be used, although they are characterized by high cost and radiation exposure. Mild LLD has been associated with stress fractures, lower back pain and osteoarthritis. When the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these disorders might appear early and severely. The aim of this study was to compare several anthropometric measurements of LLD used in clinical practice with the scanogram in runners, and to study the ground reaction forces during gait and running in runners with mild and structural LLD. Results demonstrated an association between LLD and higher incidence of symptoms in runners\' hips and knees. Clinical measures ASIS/MM (R=0.96; p=0.000), ASIS/LM (R=0.97; p=0.000), Crest/MM (R=0.95; p=0.000) and Umbilicus/MM (R=0.92; p=0.000) presented high correlation with scanogram. Although, only the clinical measurement Umbilicus/MM (0.8 ± 0.6 cm; 0.8 ± 0.5%) detected absolute and relative discrepancy between lower limbs similar to that detected with scanogram (0.6 ± 0.5 cm; 0.8 ± 0.6%). Results also showed that increasing discrepancy leads to overloads in both lower limbs, which may lead to orthopedic disorders after extended periods. Subjects with mild LLD of 0.5 to 2.0 cm presented higher values of Fzmin (0.56 ± 0.08 BW) at the shorter limb during gait, and higher values of Fz2 and PO at the shorter limb (2.48 ± 0.22 BW; 17.18 ± 3.35 BW/s) during running. Subjects with mild discrepancy of 1.0 to 2.2 cm presented a smaller rate of load 1 (9.19 ± 1.49 BW/s) at the longer limb during gait in comparison to control subjects (10.44 ± 1.72 BW/s), and higher values of Fz1 at the longer limb during running (1.70 ± 0,17BW ) relative to control subjects (1.57 ± 0.16PC). Subjects with mild discrepancy also showed higher values of Fz2 and PO at the shorter limb (2.55 ± 0.22 BW; 17.07 ± 3.31 BW/s). Nevertheless, subjects with mild LLD displayed symmetrical gait and running according to values obtained by Absolute Symmetric Index of vertical and horizontal GRF variables.

Greater trochanteric pain (GTP) is a regional pain syndrome characterized by lateral hip pain and tenderness. Its incidence after total hip arthroplasty (THA) is variable. Bursal inflammation, degenerative changes of the attachment of the gluteal muscles, direct operative trauma and biomechanical disturbance of the operated hip have been discussed as being related to GTP. The diagnosis is purely clinical because radiological and laboratory investigations show no definite pathology. Although most treatment modalities are conservative, some patients may develop refractory complaints leading to surgical intervention. In study I we studied the incidence of GTP in 172 consecutive patients who underwent THA during 2002 at Sundsvall Hospital. Patients with GTP (n=21, incidence 12%) were matched with controls from the same cohort. The THA outcome was assessed using the Western Ontario and McMaster Universities Arthrosis (WOMAC) Index. Trochanteric tenderness was studied using an electronic pressure algometer. We found an association between the occurrence of GTP and postoperative uncorrected lengthening of the operated limb of ≥ one centimetre. The WOMAC index revealed a reduction of the clinical outcome in the GTP group. In Study II we tested the value of using an algometer in the diagnosis of GTP after THA. We measured the pressure-pain threshold (PPT) over the greater trochanter and ilio-tibial band in 18 patients and 18 matched controls. Both groups were evaluated using the visual analogue scale (VAS). We found the algometer to have a good predictive validity and reproducibility. However, there was large inter-individual variability across subjects. The PPT ratio of 0.8 (affected vs. unaffected side) can be used as a cutoff ratio to establish GTP. There was no correlation between PPT measurements and VAS. Because of a low positive predictive value and large inter-individual variability, the pressure algometer has a limited value as a screening tool. In study III we proposed a new surgical treatment for refractory GTP after THA consisting of distal lengthening of the ilio-tibial band (ITB) by Z-plasty under local anaesthesia. This method was used in 12 women between March 2004 and June 2006. The patients were followed up by phone interview 3-4 months postoperatively and by an EQ-5D questionnaire and clinical examination including evaluation with the algometer at 1-3 years postoperatively. We found that the patients‘ quality of life was markedly improved following the operation (EQ-5D = 0.26 preoperatively vs. 0.67 postoperatively; p &lt;0.005). There were no postoperative complications. In study IV we evaluated the accuracy of a commonly used clinical method of LLD measurement (anterior superior iliac spine-medial malleolus) by comparing it to a reliable radiological method (tear drop-lesser trochanter) in 139 patients before and after THA. We found the correlation between the clinical and radiological methods to be weak preoperatively (r=0.21, ICC= 0.33) while the correlation was moderate postoperatively (r= 0.45, ICC=0.62). It is therefore recommended that the radiological method be used to measure leg length discrepancy in patients who undergo THA.

Existe uma alta incidência de desigualdade de membros inferiores na população geral, podendo ser do tipo estrutural, onde existe diferença no comprimento de estruturas ósseas, ou funcional, como resultado de alterações mecânicas dos membros inferiores (MMII). A desigualdade pode ainda ser classificada quanto a sua magnitude, sendo discreta, moderada, ou grave. São muitos os métodos antropométricos utilizados para avaliar a desigualdade, entre os mais usados estão os métodos clínicos, como o uso de fita métrica para medir a distância entre duas saliências ósseas. Além destes, os métodos radiográficos também podem ser usados, porém com menor freqüência devido ao custo elevado e exposição à radiação. As desigualdades discretas têm sido associadas especificamente à fratura por estresse, dor lombar e osteoartrite. Quando uma desigualdade está presente em indivíduos cuja sobrecarga mecânica é acentuada pela sua prática profissional, diária ou recreativa, estas desordens podem se manifestar precoce e gravemente. O objetivo deste estudo foi comparar diversas medidas antropométricas de comprimento de MMII usadas na prática clínica com a escanometria em corredores, e estudar a Força Reação do Solo durante a marcha e a corrida de corredores com desigualdade estrutural discreta de membros inferiores. Observou-se que a presença de desigualdade de membros inferiores foi associada à maior incidência de sintomas nos quadris e joelhos nos corredores. As medidas clínicas EIAS/MM (R=0,96; p=0,000), EIAS/ML (R=0,97; p=0,000), Crista/MM (R=0,95; p=0,000) e Umbigo/MM (R=0,92; p=0,000) apresentaram alta correlação com a escanometria. Entretanto, somente a medida clínica Umbigo/MM (0,8 ± 0,6 cm; 0,8 ± 0,5%) detectou desigualdade absoluta e normalizada entre os membros semelhante à escanometria (0,6 ± 0,5 cm; 0,8 ± 0,6%). Observou-se que quanto maior a desigualdade, maior a sobrecarga em ambos MMII, cargas estas capazes de causar em longo prazo desordens ortopédicas. Os sujeitos com desigualdade de 0,5 a 2,0 cm, durante o andar, apresentaram no MI menor maiores valores de Fzmin (0,56 ± 0,08 PC); e maiores valores de Fz2 e PO no MI menor durante o correr (2,48 ± 0,22 PC; 17,18 ± 3,35 PC/s). E os sujeitos com desigualdade de 1,0 a 2,2 cm apresentaram no MI maior uma menor Taxa de Crescimento 1 (9,19 ± 1,49 PC/s) em comparação ao controle (10,44 ± 1,72 PC/s) durante o andar; maiores valores de Fz1 no MI maior (1,70 ± 0,17 PC) em relação ao controle (1,57 ± 0,16PC), e ainda maiores valores de Fz2 e PO no MI menor (2,55 ± 0,22 PC; 17,07 ± 3,31 PC/s) durante o correr. No entanto, os sujeitos com desigualdade discreta de membros inferiores apresentaram a marcha e a corrida simétricas de acordo com os valores obtidos pelo Índice de Simetria Absoluto das variáveis da FRS vertical e horizontal. / There is a high incidence of leg length discrepancy (LLD) in general population, which could be structural, when the difference occurs in bone structures, or functional, as a result of mechanical changes at the lower limbs. The discrepancy can also be classified by its magnitude, being mild, intermediate, or severe. Many anthropometric methods are used to evaluate discrepancy, however the most common are clinical methods, which use a tape to measure the distance between two bone landmarks. Radiographic methods can also be used, although they are characterized by high cost and radiation exposure. Mild LLD has been associated with stress fractures, lower back pain and osteoarthritis. When the discrepancy occurs in subjects whose mechanical loads are increased by their professional, daily or recreational activities, these disorders might appear early and severely. The aim of this study was to compare several anthropometric measurements of LLD used in clinical practice with the scanogram in runners, and to study the ground reaction forces during gait and running in runners with mild and structural LLD. Results demonstrated an association between LLD and higher incidence of symptoms in runners\' hips and knees. Clinical measures ASIS/MM (R=0.96; p=0.000), ASIS/LM (R=0.97; p=0.000), Crest/MM (R=0.95; p=0.000) and Umbilicus/MM (R=0.92; p=0.000) presented high correlation with scanogram. Although, only the clinical measurement Umbilicus/MM (0.8 ± 0.6 cm; 0.8 ± 0.5%) detected absolute and relative discrepancy between lower limbs similar to that detected with scanogram (0.6 ± 0.5 cm; 0.8 ± 0.6%). Results also showed that increasing discrepancy leads to overloads in both lower limbs, which may lead to orthopedic disorders after extended periods. Subjects with mild LLD of 0.5 to 2.0 cm presented higher values of Fzmin (0.56 ± 0.08 BW) at the shorter limb during gait, and higher values of Fz2 and PO at the shorter limb (2.48 ± 0.22 BW; 17.18 ± 3.35 BW/s) during running. Subjects with mild discrepancy of 1.0 to 2.2 cm presented a smaller rate of load 1 (9.19 ± 1.49 BW/s) at the longer limb during gait in comparison to control subjects (10.44 ± 1.72 BW/s), and higher values of Fz1 at the longer limb during running (1.70 ± 0,17BW ) relative to control subjects (1.57 ± 0.16PC). Subjects with mild discrepancy also showed higher values of Fz2 and PO at the shorter limb (2.55 ± 0.22 BW; 17.07 ± 3.31 BW/s). Nevertheless, subjects with mild LLD displayed symmetrical gait and running according to values obtained by Absolute Symmetric Index of vertical and horizontal GRF variables.

Femoral neck fracture (FNF) is a great challenge for today´s health care and is associated with high mortality and morbidity in the elderly.  In the short term several studies in the literature have demonstrated improved hip function, quality of life and fewer re-operations in elderly patients treated with total hip arthroplasty (THA) instead of internal fixation (IF). There are few reports on the long-term outcome comparing IF and THA. The vast majority of orthopaedic departments in Sweden use the direct lateral (DL) or posteriolateral (PL) approaches for hip arthroplasty. The PL approach has been linked to an increased risk of dislocation of the prosthesis and a higher rate of revision surgery in comparison to the DL approach. There are few reports focusing on radiological risk factors for prosthetic dislocation and patient reported hip function comparing the two surgical approaches for hip arthroplasty in FNF. The randomized controlled trial (RCT) is the gold standard for evaluating medical or surgical interventions. An RCT of high quality has to be internally and externally valid. Internal validity refers to a correct study design to avoid bias skewing the results. External validity (EV) refers to whether the results will be clinically relevant to a definable group of patients and can be extrapolated to the general health care situation. There are only a few reports in the orthopaedic literature focusing on the EV of published studies and none in the field of hip fractures. Study I: This is a RCT of 100 patients with a displaced FNF comparing THA and IF. Follow-up evaluations were performed at three months and 1, 2, 4, 11 and 17 years. It was found that the Harris hip score (HHS) was higher and the rate of reoperations lower for patients treated with THA. Study II: This is a prospective cohort study of 185 hips, comparing the DL and the PL approaches in patients treated with a hemiarthroplasty (HA) for a displaced FNF. Follow-up was after 1 year. There was no difference in patient reported outcome between the groups measured with the HHS and WOMAC index. The PL approach resulted in a higher re-operation rate while the DL approach in a higher incidence of limping. Study III: This is a retrospective cohort study of 373 patients with a cemented bipolar HA using a PL approach for a FNF with a follow-up ranging from 6 months to 7 years. Radiographs and all surgical records were reviewed regarding femoral offset (FO), leg length discrepancy (LLD) and Wiberg angle. Patients with recurrent dislocations had a decreased postoperative FO, LLD and shallower acetabulum on the operated side compared with their controls. Study IV: This is a prospective cohort study of 840 hips comparing patients included in a RCT with those that did not give their informed consent (NC) or did not fulfill the criteria for participating in the trial (MS). Patients in the NC and MS groups had an increased mortality rate in comparison to those included in the study. We did not find any differences in hip function between these groups. The main conclusions of this thesis are: Healthy and lucid elderly patients with good hip function preoperatively, should be treated with THA for a displaced FNF. The DL approach is favourable in treating displaced FNF with HA due to its decreased risk of reoperation but with an identical hip function outcome as the PL approach. Care should be taken to restore the LLD and FO otherwise this may increase the risk of recurrent dislocation of a HA. Our findings suggest that trial participants had a lower mortality rate than non-participants but the functional outcome of non-participants appeared to be satisfactory. This is important to take into consideration when extrapolating study results to a health care system. / Lårbenshalsfrakturer (FNF) är en utmaning för dagens sjukvård och förknippad med hög mortalitet i den äldre befolkningen. FNF orsakas främst av lågenergitrauma efter fall i samma plan hos patienter med benskörhet. Total höftledsprotes (THA) har visat sig ge en bättre höftfunktion, livskvalitet med färre omoperationer hos äldre patienter än sluten reposition samt fixering med skruvar (IF) under de första två-fyra åren efter operation. Få studier har publicerats med långtidsuppföljning av THA jämfört med IF. Vid behandling av felställd FNF med halv höftledsplastik (HA) eller THA finns olika kirurgiska metoder (snittföring) för implantation av protesen. Majoriteten av ortopedkliniker i Sverige använder direkt lateral (DL) eller posteriolateral (PL) snittföring. PL har kopplats till en ökad risk för luxation av protesen (urledsvridning), vilket i sin tur genererat en högre risk för omoperation jämfört med DL. Få studier har utvärderat höftfunktion med avseende på snittföring. Detsamma gäller vilka radiologiska faktorer som påverkar risken förprotesluxation. Det finns olika typer av studiedesigner för utvärdering av medicinska och kirurgiska behandlingsmetoder. Studiedesignen med högst bevisvärde anses vara den randomiserade kontrollerade studien (RCT). För att en RCT skall hålla hög kvalitet krävs intern och extern validitet. Intern validitet syftar på ett korrekt studieupplägg som mäter det som avses och undviker påverkan av icke önskvärda faktorer. Extern validitet (EV) innebär att erhållna resultat från studien är generaliserbara och kan extrapoleras till andra grupper än den studerade. Det inga rapporter i ortopediska litteraturen med fokus på EV med patienter som drabbats av FNF. Studie I: Prospektiv randomiserad studie av 100 patienter med en felställd FNF jämförs THA med IF med avseende på höftfunktion och reoperationer. Uppföljning gjordes efter tre månader samt 1, 2, 4, 11 och 17 år. HHS som mått på höftfunktion var högre och andelen reoperationer lägre för patienter som behandlades med THA. Studie II: Prospektiv kohortstudie med 183 patienter med felställd FNF behandlade med HA och antingen DL eller PL. Vi fann ingen skillnad i patientrapporterad höftfunktion utvärderat med HHS och WOMAC efter 1 år men en ökad förekomst av hälta vid DL. Studie III: Retrospektiv kohortstudie av 373 patienter opererade med en cementerad bipolär HA och PL. Postoperativa röntgenbilder granskades avseende femoral offset (FO), postoperativ benlägdsskillnad (LLD) samt acetabulär Wibergvinkel och relaterades till återkommande protesluxationer. Detta relaterades till återkommande luxationer. Uppföljningstiden varierade mellan 6 månader och 7 år. Patienter med återkommande luxationer hade en minskad postoperativ global FO, förkortad LLD och grundare acetabulum på den opererade sidan jämfört med kontroller. Studie IV: Prospektiv kohortstudie av 840 patienter med felställd FNF där patienter som ingick i en RCT jämförs med de som inte gav sitt samtycke för deltagande eller ej inkluderats i screeningprocessen. De patienterna som inte gav sitt samtycke hade ökad dödlighet, men ingen skillnad i höftfunktion jämfört med deltagare. Slutsatser • Friska och kognitivt vitala äldre patienter med god höftfunktion innan en felställd lårbenshalsfraktur bör behandlas med total höftledsprotes. • DLsnittföring ger ett lika bra patientrapporterad höftfunktion men en ökad förekomst av hälta jämfört med PL snitt vid behandling med halvprotes på grund av en felställd lårbenshalsfraktur. • Ansträngning bör göras för att återställa benlängdsskillnad samtfemoral offset och därigenom minska risken för återkommande luxation. • Våra resultat tyder på att patienter som deltar i en randomiserad studie har lägre dödlighet än patienter som avböjt att delta samt de som missats i screeningprocessen. Det är viktigt att ta hänsyn till när extrapolerar studieresultat till ett hälso-och sjukvårdssystem. Detta bör vägas in i värderingen av studieresultatens externa validitet.

Bei der Behandlung kindlicher Femurfrakturen ist es wichtig die Besonderheiten des kindlichen Knochens zu berücksichtigen. Resultierende Beinlängendifferenzen sowie die psychosoziale Belastung der Kinder stellen Probleme in der Therapie dar. Ziel der vorliegenden Studie war es unter Berücksichtigung dieser Aspekte einen Vergleich konservativer und operativer Therapieverfahren im Verlauf der Jahre herzustellen. Zugrunde gelegt wurden die Daten von 210 Kindern und Jugendlichen, die in dem Zeitraum von 1992 bis 2008 in der Universitätsmedizin Göttingen an einer Femurfraktur behandelt wurden. Als komplikationsarmes und kindgerechtes Verfahren hat sich in den letzten Jahren die Elastisch Stabile Intramedulläre Nagelung (ESIN) immer mehr durchgesetzt. Sie stellt mittlerweile bei Kindern über vier Jahren das Verfahren der Wahl dar. Die Verwendung der Plattenosteosynthese und des Fixateur externe hat deutlich abgenommen und sollte nur noch Spezialindikationen vorbehalten sein. Bei Kindern unter vier Jahren kann ebenfalls die ESIN mit guten Ergebnissen verwendet werden. Eine Alternative stellt in dieser Altersgruppe der Beckenbeingips dar. Die Extensionsverfahren werden auf Grund der vielen Nachteile, vor allem in psychosozialer Hinsicht, so gut wie nicht mehr verwendet.

The objective of this thesis was to determine the association of leg length (LL), a marker of early childhood conditions, with metabolic abnormalities underlying type 2 diabetes. Utilizing data from a population at-risk for diabetes, the associations of LL with i) insulin resistance (IR) and beta-cell dysfunction and ii) a continuous metabolic syndrome risk score (MetScore) were analyzed. Results showed that shorter LL was associated with IR and beta-cell dysfunction, and that the combination of short legs and large waist (a marker of adult obesogenic conditions) was associated with the greatest IR. Height, a marker of overall childhood conditions, was found to be inversely associated with the MetScore. Therefore, both adverse childhood conditions and early-late life mismatched conditions may increase the risk for diabetes through differing pathways. Improving childhood conditions (i.e. nutritionally or economically) may be an important strategy to prevent diabetes.

The objective of this thesis was to determine the association of leg length (LL), a marker of early childhood conditions, with metabolic abnormalities underlying type 2 diabetes. Utilizing data from a population at-risk for diabetes, the associations of LL with i) insulin resistance (IR) and beta-cell dysfunction and ii) a continuous metabolic syndrome risk score (MetScore) were analyzed. Results showed that shorter LL was associated with IR and beta-cell dysfunction, and that the combination of short legs and large waist (a marker of adult obesogenic conditions) was associated with the greatest IR. Height, a marker of overall childhood conditions, was found to be inversely associated with the MetScore. Therefore, both adverse childhood conditions and early-late life mismatched conditions may increase the risk for diabetes through differing pathways. Improving childhood conditions (i.e. nutritionally or economically) may be an important strategy to prevent diabetes.

This master's thesis is focused on determination and analysis of stress and strain in femur with distraction intramedullary nail for treating leg length discrepancy with the method of distraction osteogenesis. Thesis is mainly focused on states after distraction when the callus consolidates. Problem of determining stress and strain is solved by computational modeling using FEM. Detailed description of modeling is included in this thesis, complicated 3D geometry of bone was acquired from segmentation of CT images. Computational model is solve with 4 different types of callus geometry and also material properties of callus are varied. The influence on stress and strain when the middle distal screw is not applied is also analyzed.