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Introduction: Weight recurrence (WR) affects > 20% of patients following Roux-en-Y gastric bypass (RYGB). Shortening of the common channel (CC) after RYGB (distal bypass) has been proposed for additional weight loss in patients with WR, but results vary, and concerns for vitamin deficiencies/malnutrition exist. Our aim was to determine whether the percentage of bowel bypassed after distal bypass is associated with the amount of postoperative weight loss. Methods: Patients undergoing distal bypass between 2018 and 2022 were reviewed. Small bowel limb lengths before and after distal bypass were measured, and the percentage of bypassed bowel was calculated (= bypassed biliopancreatic limb/total small bowel length). Patients were dichotomized into two groups based on the percentage bypassed bowel (≤ 50% vs. > 50%). Weight loss (measured as excess BMI loss; EBIL%), comorbidities resolution, complications, and nutritional deficiencies were reviewed. Results: Thirty female patients underwent distal bypass during the study period. After distal bypass, the Roux was lengthened to 150 cm (75–175 cm) from 75 cm (20–200 cm), and the CC shortened to 150 cm (100–310 cm) from 510 cm (250–1000 cm). These changes resulted in an increase in the size of the bypassed biliopancreatic limb from 40 cm (15–90 cm) to 330 cm (180–765 cm) and a total alimentary limb (TALL; Roux + CC) shortening from 590 cm (400–1075 cm) to 300 cm (250–400 cm). The group with > 50% bowel bypassed had higher EBIL%. Overall EBIL% was 36.9 ± 14.7%, 53.3 ± 25.6%, and 62.1 ± 36.9% at 0.5, 1, and 2 years, respectively. There were minimal vitamin deficiencies. Diabetes resolved in 100% (n = 3/3), HTN in 67% (n = 10/15), and GERD in 73% (n = 11/15). Complication rate was 23%. No reintervention for malnutrition or vitamin deficiencies was required. Conclusions: Distal bypass effectively leads to considerable weight loss and comorbidity improvement in patients with WR after RYGB, but the amount of weight loss depends on the percentage of bypassed bowel. An exact threshold of bypassed bowel that optimizes weight loss outcomes and simultaneously minimizes the nutritional complications needs to be determined. Meanwhile, close monitoring for vitamin deficiencies is recommended. [ABSTRACT FROM AUTHOR]

Objectives: Long lower limbs relative to body size are thought to be an adaptation to prevent excessive increases in body temperature during running in hot climate. The advantage of long lower limbs relative to body size is usually explained by an increase in body surface area relative to mass; however, the influence of limb length on relative body surface area was shown to be minor. We aimed to experimentally test the effect of relative lower‐limb length (LLL) on body temperature changes during running. Furthermore, we tested the effect of relative LLL on relative body surface area. Materials and Methods: Adult men (n = 37) ran for 40 min on a treadmill, while their core temperature (ingestible thermometer), skin temperature (infrared thermography), and oxygen consumption (indirect calorimetry) were measured. Relative LLL was calculated as residuals from linear regression of LLL on stature. Linear regression was used to test the effect of relative LLL on standardized heat loss (heat loss/heat production), mean body temperature (weighted mean of skin and core temperatures), and body surface area. Results: Relative LLL had a positive effect on standardized heat loss and a negative effect on mean body temperature change during running. Relative LLL had a positive effect on the proportion of body surface area allocated to the lower limbs but not on the relative body surface area. Discussion: The reduced increase in mean body temperature associated with long lower limbs suggests an advantage of relatively long lower limbs for greater endurance and speed during persistence hunting or contemporary running events. [ABSTRACT FROM AUTHOR]

Purpose: The optimal bowel limb lengths for laparoscopic Roux-en-Y gastric bypass (LRYGB) to maximize weight loss while minimizing nutritional deficiencies in severe obesity treatment remain a topic of debate. The multi-center Dutch Common Channel Trial (DUCATI) aims to compare the outcomes of a very long Roux Limb Roux-en-Y gastric bypass (VLRL-LRYGB) with a standard Roux-en-Y gastric bypass (S-LRYGB). Methods: A total of 444 patients were randomly assigned in a 1:1, double-blind manner to undergo either VLRL-RYGB or S-LRYGB. Five-year follow-up data were assessed, concentrating on weight loss, obesity-related medical conditions, complications, re-operations, and malnutrition. Results: Both groups had comparable total alimentary lengths (RL + CC). The VLRL-LRYGB group demonstrated significantly greater %TWL (32.2% vs. 28.6%, p = 0.002) and %EWL (81.2% vs. 70.3%, p = 0.002) at 5 years. Eight (3.6%) patients in the VLRL-LRYGB group versus 2 (0.9%) in the S-LRYGB group (p = 0.055) needed modification surgery for malabsorption. Suboptimal clinical response rate was significantly higher (22.0% vs. 8.3%) in S-LRYGB group. No significant differences for nutrient deficiencies in favor of the S-LRYGB group were found. Conclusion: A 100-cm common channel with a relatively long Roux limb provides superior, sustainable weight loss over 5 years, without significantly increased rate of malabsorption-related re-operations. These results suggest that a longer Roux limb can still ensure adequate micronutrient uptake in the total alimentary tract. These findings should be considered in discussions regarding the optimal Roux-en-Y limb length for severe obesity treatment. [ABSTRACT FROM AUTHOR]

One-anastomosis gastric bypass (OAGB) has gained importance as a simple, safe, and effective operation to treat morbid obesity. We previously found that Roux-en-Y gastric bypass surgery with a long compared with a short biliopancreatic limb (BPL) leads to improved weight loss and glucose tolerance in obese mice. However, it is not known whether a long BPL in OAGB surgery also results in beneficial metabolic outcomes. Five-week-old male C57BL/6J mice fed a high-fat diet (HFD) for 8 weeks underwent OAGB surgery with defined BPL lengths (5.5 cm distally of the duodenojejunal junction for short and 9.5 cm for long BPL), or sham surgery combined with caloric restriction. Weight loss, glucose tolerance, obesity-related comorbidities, endocrine effects, gut microbiota, and bile acids were assessed. Total weight loss was independent of the length of the BPL after OAGB surgery. However, a long BPL was associated with lower glucose-stimulated insulin on day 14, and an improved glucose tolerance on day 35 after surgery. Moreover, a long BPL resulted in reduced total cholesterol, while there were no differences in the resolution of metabolic dysfunction-associated steatotic liver disease (MASLD) and adipose tissue inflammation. Tendencies of an attenuated hypothalamic-pituitary-adrenal (HPA) axis and aldosterone were present in the long BPL group. With both the short and long BPL, we found an increase in primary conjugated bile acids (pronounced in long BPL) along with a loss in bacterial Desulfovibrionaceae and Erysipelotrichaceae and simultaneous increase in Akkermansiaceae, Sutterellaceae, and Enterobacteriaceae. In summary, OAGB surgery with a long compared with a short BPL led to similar weight loss, but improved glucose metabolism, lipid, and endocrine outcomes in obese mice, potentially mediated through changes in gut microbiota and related bile acids. Tailoring the BPL length in humans might help to optimize metabolic outcomes after bariatric surgery. NEW & NOTEWORTHY: Weight loss following OAGB surgery in obese mice was not influenced by BPL length, but a longer BPL was associated with improved metabolic outcomes, including glucose and lipid homeostasis. These changes could be mediated by bile acids upon altered gut microbiota. Further validation of these findings is required through a randomized human study. [ABSTRACT FROM AUTHOR]

Background: Leg length discrepancy following hip arthroplasty causes dissatisfaction to the patient; thus, preoperative planning and implant selection is critical. The purpose of this study was to measure the articular-trochanteric distance (ATD) and femoral neck length (FNL) in our population and compare them to those of 3 of the most used uncemented stems. Methods: In this cross-sectional study, 401 hip radiographs of healthy adults were collected between January and July 2022. The vertical ATD and FNL were measured. A linear regression model was used to identify the relationship between these measurements and age, sex, and height. A logistic regression model was used to assess the matching of native hips with the neck length of the stem. Results: Mean age was 60 years, and 74.56% were women. In 94.3% of hips, the ATD was negative, 3.73% neutral, and 2% positive. In our population, 0.25% of FNL were shorter than POLARSTEM (Smith & Nephew, UK), 10.72% shorter than MetaFix stem (Corin, UK), and 11.97% shorter than Corail stem (DePuy Synthes, USA). In the logistic regression analysis, matching for the POLARSTEM was associated with age but not with sex or height. Conversely, for MetaFix and Corail, stem matching was associated with sex and height. Conclusions: Anthropometric hip measurements vary among individuals, and variables such as age, sex, and height must be considered during preoperative planning and implant selection to avoid leg length discrepancy. Additional studies, including different implants, are required to guide surgeons in selecting a femoral stem that best matches the patient's native hip.

Purpose: The ability of elite breaststroke swimmers to maximize average velocity maintained throughout a race is reportedly mediated by a number of range-of-motion, dryland strength–power, and anthropometric characteristics. The present study aimed to develop a physical profile and evaluate the relationship between dryland strength–power and stroke kinematic variables in elite breaststroke swimmers. Methods: A series of range-of-motion, dryland strength–power, and anthropometric measures were assessed in 11 elite-level breaststroke specialists and used to establish group-based averages and expected variance within an elite breaststroke population. Results: Analysis of the relationships between dryland strength–power parameters and breaststroke kinematics revealed strong associations (r >.7, minimum 95% confidence range of g > 0.80 or < −0.80) most frequently at 100-m and maximal paces. From further analysis of these associations, a series of second-order models of best fit were calculated to describe the relationship between dryland strength–power parameters and propulsive velocity. Five models strongly described the relationship between countermovement jump height, mean pull-up velocity, and average propulsive velocity. Conclusions: These models can be used to assess propulsion effectiveness and act as a catalyst for technique evaluation. It is also recommended that strength and conditioning coaches consider the inclusion of explosive movements, such as countermovement jumps and maximal velocity pull-ups, in dryland training programs designed for sprint breaststroke swimmers. [ABSTRACT FROM AUTHOR]

The present study pursued the investigation of anthropometric asymmetries regarding the length of the upper and lower limbs and the indices of body proportionality and had the following ob-jectives: identifying the differences between the female and male groups, in the 4 age categories (7, 8, 9 and 10 years old), regarding anthropometric parameters and proportionality indicators; also tried to identify the differences in anthropometric parameters and proportionality indicators between the 4 age categories (7 - 10 years old) for each gender (female, respectively male). The study included 727 subjects with the age between 7-10 years, of which 383 (52.7%) female and 344 (47.3%) male, the subjects being divided into four groups according to age (7, 8, 9 and 10 years old groups). The measurements aimed at the following longitudinal anthropometric parameters and the calculation of proportionality ratios: height (cm); the length of the right upper limb (cm - LUL Right); the length of the left upper limb (cm - LUL Left); the length of the right lower limb (cm - LLL Right); the length of the left lower limb (cm - LLL Left); ratio of LUL Right X 100 / LLL Right; ratio of LUL Left x 100 / LLL Left; ratio of LUL Right x 100 / height; ratio of LUL Left x 100 / height; ratio of LLL Right x 100 / height; ratio of LLL_Left x 100/height. Analyzing ccompara-tively the results recorded between the upper and lower right and left segments, we find asym-metry in all samples according to age and gender. The differences between the groups of girls and boys, in all age categories, were statistically significant. The ANOVA analysis reflects statis-tically significant differences between the 4 age groups (7 - 10 years) in all anthropometric evalu-ations. The largest asymmetries between the right and left upper limb were recorded in the age category of 7 years old group; respectively, the largest asymmetries between the lower limbs were recorded in the 10 year old groups depending on gender. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to assess the significance of post-operative change in limb length in medial opening wedge high tibial osteotomy (MOWHTO), and evaluate the correlation between correction angles and changes in limb length. We hypothesize that opening wedge height and correction angles directly correlate to changes in limb length. Methods: The medical records and radiographs of 91 MOWHTO patients were retrospectively evaluated for relevant radiographical parameters both pre- and post-operatively. The exclusion criteria are: (i) concurrent distal femur osteotomy in the same setting, (ii) other previous unilateral lower limb surgeries prior to MOWHTO and (iii) failure to follow-up with post-operative radiographs. A linear regression model was performed and a line of best fit, Pearson's correlation coefficient (r) and coefficient of determination (R2) were computed. Chi-squared test was also performed, and results with P < 0.05 were considered statistically significant. Results: There is a statistically significant increase in post-MOWHTO limb length (Absolute Δ = 4.3 ± 2.86 mm, % Δ = 0.652% ± 0.434%, p < 0.001). There was no significant difference in the limb length change between patients with larger (> 8 mm) and smaller (< 8 mm) opening widths. There was a weakly positive correlation between limb length change versus actual (R2 = 0.140, 95%CI [-0.068, 0.336]) and planned correction angles (R2 = 0.196, 95%CI [-0.012, 0.387]). Conclusion: In conclusion, post-MOWHTO change in limb length is statistically significant, but the clinical significance is minimal. Further studies are required to assess other factors. Development of a reliable mathematical model that predicts post-MOWHTO limb length change would be useful in predicting the anatomical outcomes. Level of evidence: Level III. Retrospective Cohort Study. [ABSTRACT FROM AUTHOR]

Background: Minimizing leg length (LLD) and hip offset (OD) discrepancies is critical for tissue tension and implant longevity in total hip arthroplasty (THA). The direct anterior approach (DAA) helps surgeons recreate these values under fluoroscopy. Several methods to accomplish this have been described, with no consensus on which is superior. This study evaluated the ability to minimize LLD and OD using a surgeon-controlled, adjustable fluoroscopic grid. We hypothesized that this tool would recreate parameters to within 10 mm of the contralateral side. Methods: One hundred eleven primary THAs performed with an adjustable radiopaque grid to equalize leg length and hip offset were retrospectively reviewed. These values were measured on postoperative radiographs and compared to the contralateral hip. Patients were excluded if they had inadequate imaging, revision arthroplasty, preexisting deformities, or underwent approaches other than DAA. Results: Mean age was 59.1 ± 11.1 years, 63.1% of patients were female, and average body mass index was 27.8 ± 7.0. Mean LLD was 3.7 ± 3.0 mm, while mean OD was 4.6 ± 3.6 mm. 95.5% of hips showed LLD < 10 mm, while 93.7% of hips had OD < 10 mm. Furthermore, 76.6% of hips had LLD < 5 mm, while 62.2% of hips had OD < 5 mm. Conclusions: The described technique restored limb length and hip offset during DAA THA. This technique yields consistent results and offers an inexpensive alternative to costly digital software and more cumbersome fixed grid systems.

(The present study pursued the investigation of anthropometric asymmetries regarding the length of the upper and lower limbs and the indices of body proportionality and had the fol-lowing ob-jectives: identifying the differences between the female and male groups, in the 4 age categories (7, 8, 9 and 10 years old), regarding anthropometric parameters and proportionality indicators; also tried to identify the differences in anthropometric parameters and proportional-ity indicators between the 4 age categories (7 - 10 years old) for each gender (female, respectively male). The study included 727 subjects with the age between 7-10 years, of which 383 (52.7%) fe-male and 344 (47.3%) male, the subjects being divided into four groups according to age (7, 8, 9 and 10 years old groups). The measurements aimed at the following longitudinal anthropomet-ric parameters and the calculation of proportionality ratios: height (cm); the length of the right upper limb (cm – LUL Right); the length of the left upper limb (cm – LUL Left); the length of the right lower limb (cm - LLL Right); the length of the left lower limb (cm - LLL Left); ratio of LUL Right X 100 / LLL Right; ratio of LUL Left x 100 / LLL Left; ratio of LUL Right x 100 / height; ratio of LUL Left x 100 / height; ratio of LLL Right x 100 / height; ratio of LLL_Left x 100/ height. Analyzing ccompara-tively the results recorded between the upper and lower right and left segments, we find asym-metry in all samples according to age and gender. The differ-ences between the groups of girls and boys, in all age categories, were statistically significant. The ANOVA analysis reflects statis-tically significant differences between the 4 age groups (7 - 10 years) in all anthropometric evalu-ations. The largest asymmetries between the right and left upper limb were recorded in the age category of 7 years old group; respectively, the largest asymmetries between the lower limbs were recorded in the 10 year old groups depending on gender.

Background: Symptomatic leg length discrepancies (LLDs) are a significant complication after total hip arthroplasty. Many surgeons incorporate an intraoperative anteroposterior pelvis radiograph, to help prevent LLD; however, obtaining a high-quality radiograph is often difficult. The purpose of this study is to evaluate the accuracy and reliability of estimating LLD using different radiographic reference landmarks on suboptimal anteroposterior pelvis radiographs. Material and methods: We obtained 2 pelvis Sawbones models with attached femurs and created a true shortening of the left femur of the experimental model by 7 mm. We then obtained a series of radiographs manipulating each model in standardized increments for a total of 66 different permutations of suboptimal radiographs. Each radiograph was evaluated for LLD by 2 separate orthopedic surgeons using reference lines bisecting the following anatomic landmarks: ischial tuberosities, acetabular teardrops, obturator foramina, sacroiliac joints, and the femoral heads, to the lesser trochanters. The accuracy and reliability of each line were then analyzed. Results: The obturator foramina line yielded the most reliable LLD estimates with an intraclass correlation coefficient of 0.939. This reference line was also the most accurate, with an average difference of 1.5 mm from the true LLD (P < .001), with 95% confidence to be within 1.8 mm. Conclusion: The obturator foramen reference line on an intraoperative radiograph is an accurate and reliable tool that should be utilized by joint replacement surgeons to estimate LLD even if the radiograph is suboptimal. This estimate is reliably reproduced among multiple observers and puts the estimate within 1.8 mm of a true LLD.

Background: Limb length discrepancy (LLD) is a frequent observation in children with birth brachial plexus palsy (BBPP) and a common concern among parents. A common assumption is that the LLD decreases if the child is using the involved limb more. However, there is no literature evidence for this assumption. The present study was conducted to assess the correlation between the functional status of the involved limb and the LLD in children with BBPP. Methods: One hundred consecutive patients (age > 5 years) with unilateral BBPP seen at our institute underwent measurements of limb lengths to assess the LLD. The arm, forearm and hand segments were measured separately. The functional status of the involved limb was assessed using modified House's Scoring system (Scores 0–10). The correlation between limb length and functional status was assessed using the one-way Analysis of Variance (ANOVA) test. Post-hoc analyses were performed as required. Results: A length difference was observed in 98% of the limbs with brachial plexus lesions. The average absolute LLD was 4.6 cm with a standard deviation of 2.5 cm. We found a statistically significant difference in LLD among the patients with a House score of <7 ('Poor function') and 7 and above ('Good function'; p < 0.001) with later indicative of independent use of the involved limb. We found no correlation between age and LLD. More extensive plexus involvement resulted in higher LLD. The maximal relative discrepancy was found in the hand segment of the upper extremity. Conclusions: LLD was seen in most of the patients with BBPP. The functional status of the involved upper limb in BBPP was found to be significantly associated with LLD. Though causation cannot be assumed. We found that children using the involved limb independently tend to have the least LLD. Level of Evidence: Level IV (Therapeutic) [ABSTRACT FROM AUTHOR]

Purpose: To (1) develop a deep-learning (DL) algorithm capable of producing limb-length and knee-alignment measurements, and (2) determine the association between limb-length discrepancy (LLD), coronal-plane alignment, osteoarthritis (OA) severity, and patient-reported knee pain. Methods: A multicenter, prospective patient cohort from the Osteoarthritis Initiative between 2004 and 2015 with full-limb standing radiographs at 12 month follow-up was included. A convolutional neural network was developed to automate measurements of the hip–knee–ankle (HKA) angle, femur, and tibia lengths, and LLD. At 12 month follow-up, patients reported their frequency of knee pain since enrollment and current level of knee pain. Results: A total of 1011 patients (2022 knees, 52.3% female) with an average age of 61.2 ± 9.0 years were included. The algorithm performed 12,312 measurements in 5.4 h. ICC values of HKA and LLD ranged between 0.87 and 1.00 when compared against trained radiologist measurements. Knees producing pain most days of the month were significantly more varus (mean HKA:− 3.9° ± 2.8°) or valgus (mean HKA:2.8° ± 2.3°) compared to knees that did not produce any pain (p < 0.05). In varus knees, those producing pain on most days were part of the shorter limb compared to nonpainful knees (p < 0.05). Baseline Kellgren–Lawrence grade was significantly associated with HKA magnitude, LLD, and pain frequency at 12 month follow-up (p < 0.05 all). Conclusion: A higher frequency of knee pain was associated with more severe coronal plane deformity, with valgus deviation being one degree less than varus on average, suggesting that the knee tolerates less valgus deformation before symptoms become more consistent. Knee pain frequency was also associated with greater LLD and baseline KL grade, suggesting an association between radiographically apparent joint degeneration and pain frequency. Level of evidence: IV case series. [ABSTRACT FROM AUTHOR]

Objectives: The global distribution of human body proportions has long been attributed to thermoregulatory adaptation to climate. However, latitude has been the most common proxy for climate across ecogeographic studies. If thermoregulation was driving post‐cranial evolution, temperature should provide a better explanation for the morphological patterns observed than latitude, which encompasses temperature and other variables, as well as major events in human migration history. We investigate relationships between latitude, temperature, and postcranial form by distinguishing the strength of these potential selective factors from population structure. Materials & Methods: Quantitative genetic multivariate mixed models were used to estimate morphological effects associated with latitude, minimum temperature, and maximum temperature using osteometric data from 31 globally distributed groups, geographically matched genetic data from 54 groups, and geographically matched temperature data. Results: Dimensions reflecting body size (bi‐iliac breadth/femoral head size) show independent evolutionary responses from limb lengths. In models including population history, only dimensions reflecting body size show evidence of response to directional selection. Model results indicate that selection in response to minimum temperature has shaped evolution in body breadth and femoral head size. Models for limb length evolution accounting for population history match results of prior studies, but do not indicate responses to temperature‐driven directional selection. Conclusions: This study highlights the importance of considering multiple potential sources of selection within a multivariate evolutionary model, demonstrating the possible synergistic effects of selective pressures. These results complicate the classic thermoregulatory model of human postcranial evolution and show that factors other than temperature may have shaped post‐cranial evolution in humans. [ABSTRACT FROM AUTHOR]

Abstract Purpose This study aims to assess the significance of post‐operative change in limb length in medial opening wedge high tibial osteotomy (MOWHTO), and evaluate the correlation between correction angles and changes in limb length. We hypothesize that opening wedge height and correction angles directly correlate to changes in limb length. Methods The medical records and radiographs of 91 MOWHTO patients were retrospectively evaluated for relevant radiographical parameters both pre‐ and post‐operatively. The exclusion criteria are: (i) concurrent distal femur osteotomy in the same setting, (ii) other previous unilateral lower limb surgeries prior to MOWHTO and (iii) failure to follow‐up with post‐operative radiographs. A linear regression model was performed and a line of best fit, Pearson's correlation coefficient (r) and coefficient of determination (R2) were computed. Chi‐squared test was also performed, and results with P 8 mm) and smaller (

BackgroundMeasurement of small bowel length is an essential step in performing bariatric surgery. Surgeons need to measure bowel length in order to create alimentary and biliopancreatic limbs. Inaccurate bowel measurement may affect the outcome of surgery. However, it is not clear how accurate the measurement of bowel length is by surgeons.MethodsTwo image quizzes marking certain lengths of jejunum were sent to participants. They were asked to estimate the length of marked bowels in maze quizzes. The Error of estimation, prevalence of significant error (error greater than 30 percent of actual length), and the relationship between different participant characteristics was investigated.ResultsA total of 86 participants answered the questionnaire. The mean error of estimation was 4.62 cm (27%). Twenty-eight participants (33%) had significant errors in estimation of bowel length.ConclusionWhile there are surgeons that can estimate bowel length with decent accuracy, significant errors in estimation of bowel length are not uncommon among surgeons. Surgeons should consider adopting techniques for accurate measurement of the small intestine.

Background: The preferred walk-to-run transition speed (PTS) for healthy adults is approximately 2 m∙s-1, however, PTS is influenced by anthropometric factors. Yet despite known sex differences in anthropometrics, studies have reported no sex differences in PTS.Research Question: Do stature and limb length affect PTS in the same way for both male and female healthy adults?Methods: Thirty-seven (19 female) non-injured adults volunteered for this study. Participants completed a walk-to-run transition protocol, where the treadmill speed was increased from 1.2 m∙s-1 to 2.2 m∙s-1, in increments of 0.1 m∙s-1 every two minutes. An independent t-test compared PTS between sexes. Multiple regression analysis determined the effect of sex and stature and sex and limb length on PTS.Results: Female participants transitioned at a lower PTS than male participants (1.8 (0.2) m∙s-1 versus 1.9 (0.1) m∙s-1; p ≤ 0.026). Sex and stature explained 19% of the variance in PTS, while sex and limb length explained 21% of the variance. Including interactions increased the variance explained by 23% and 2% for sex and stature and sex and limb length, respectively. The significant interaction between sex and stature showed PTS was inversely proportional to stature for male participants but directly proportional for female participants.Significance: These findings suggest that the extent to which stature and limb length influence the preferred transition speed may differ between sexes. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the relationship between the corticospinal tract (CST) and limb length discrepancy (LLD) in patients with hemiplegic cerebral palsy (CP). Using diffusion tensor tractography, a retrospective study on 92 pediatric patients with hemiplegic CP who visited our hospital from May 2017 to the end of 2020 was conducted. Limb length was measured by anthropometry to calculate LLD. The functional level of hemiplegia scale (FxL), modified Ashworth scale, and manual muscle test (MMT) were evaluated for clinical function. Patients were classified into two groups according to the presence or absence of disruption of the affected CST: disruption (A) and preservation (B) groups. Fractional anisotropy (FA) and mean diffusivity (MD) of the affected CSTs were measured and correlated with LLD. The results of the independent t-test and chi-square test did not show significant differences between the two groups, except in the FxL and finger extensor of MMT (p < 0.05). For the LLD, there were no significant differences in total upper, total lower, and foot limb lengths. A significant difference was observed only in hand LLD (p < 0.05) from ANCOVA. Hand LLD was significantly correlated with FA (r = −0.578), MD (r = 0.512), and degree of CST disruption (r = −0.946) from the Pearson correlation test. The results of this study suggested that patients with hemiplegic CP would likely have LLD especially in the hand, and that CST evaluation using diffusion tensor tractography might be helpful in assessing and predicting LLD in hemiplegic CP. [ABSTRACT FROM AUTHOR]

Introduction: In absence of deformity or injury of the contralateral leg, the contralateral leg length is used to plan limb lengthening. Length variability on long-leg weight-bearing radiographs (LLR) can lead to inaccurate deformity correction. The aim of the study was to (1) examine the variability of the measured limb length on LLR and (2) to examine the influence of the position of the magnification device. Materials and methods: The limb lengths of 38 patients during deformity correction with a taylor-spatial-frame were measured retrospectively on 7.3 ± 2.6 (4–13) LLR per patient. The measured length of the untreated limb between LLR were used to determine length variability between LLR in each patient. To answer the secondary aim, we took LLR from a 90 cm validation distance. A magnification device was placed in different positions: at the middle of the 90 cm distance (z-position), 5 cm anterior and 5 cm posterior from the z-position, at the bottom and top of the validation distance as well as 5 cm medial and 15 cm lateral from the z-position. Results: The measured length variability ranged within a patient from 10 to 50 mm. 76% of patients had a measured limb length difference of ≥ 2 cm between taken LLR. Compared to length measurement of the 90 cm test object with the magnification device in the z-position (90.1 cm), positioning the device 5 cm anterior led to smaller (88.6 cm) and 5 cm posterior led to larger measurements (91.7 cm). The measured length with the magnification device at the bottom, top, medial or lateral (90.4; 89.9; 90.2; 89.8 cm) to the object differed not relevantly. Conclusions: High variability of limb length between different LLR within one patient was observed. This can result from different positions of the magnification device in the sagittal plane. These small changes in positioning the device should be avoided to achieve accurate deformity correction and bone lengthening. This should be considered for all length and size measurements on radiographs. [ABSTRACT FROM AUTHOR]

BACKGROUND Few existing studies have examined the relationship between lower extremity bone length and quadriceps strength. PURPOSE/HYPOTHESIS To evaluate the relationship between lower extremity, tibia and femur lengths, and isometric quadriceps strength in patients undergoing knee surgery. The null hypothesis was that there would be no correlation between lower extremity length and isometric quadriceps strength. STUDY DESIGN Cross-sectional study METHODS Patients with full-length weightbearing radiographs that underwent isometric quadriceps strength testing after knee surgery were included. Using full-length weightbearing radiographs, limb length was measured from the ASIS to the medial malleolus; femur length was measured from the center of the femoral head to the joint line; tibia length was measured from the center of the plateau to the center of the plafond. Isometric quadriceps strength was measured using an isokinetic dynamometer. Pearson's correlation coefficient was used to report the correlation between radiographic limb length measurements. A Bonferroni correction was utilized to reduce the probability of a Type 1 error. RESULTS Forty patients (26 males, 14 females) with an average age of 25.8 years were included. The average limb, femur, and tibia lengths were not significantly different between operative and non-operative limbs (p>0.05). At an average of 5.8±2.5 months postoperatively, the peak torque (156.6 vs. 225.1 Nm), average peak torque (151.6 vs. 216.7 Nm), and peak torque to bodyweight (2.01 vs 2.89 Nm/Kg) were significantly greater in the non-surgical limb (p<0.01). Among ligament reconstructions there was a significant negative correlation between both limb length and strength deficit (r= -0.47, p=0.03) and femur length and strength deficit (r= -0.51, p=0.02). The average strength deficit was 29.6% among the entire study population; the average strength deficit was 37.7% among knee ligament reconstructions. For the non-surgical limb, femur length was significantly correlated with peak torque (r = 0.43, p = 0.048). CONCLUSION Femur length was significantly correlated with the isometric quadriceps peak torque for non-surgical limbs. Additionally, femur length and limb length were found to be negatively correlated with quadriceps strength deficit among ligament reconstruction patients. A combination of morphological features and objective performance metrics should be considered when developing individualized rehabilitation and strength programs. [ABSTRACT FROM AUTHOR]

Background and objectives: The differences between computed radiography-based teleoroentgenograms (CR-based teleoroentgenograms) and an EOS® imaging system were evaluated by measuring lower extremity lengths and alignments. Materials and methods: The leg length [L], femur length [F], tibia length [T], and hip–knee–ankle (HKA) angle were measured in 101 patients with lower extremity disease by a CR-based teleoroentgenogram with computed radiography and an EOS®. The additive length of the femoral and tibial segments (F + T) was determined by adding the two length values. Then, the differences among all five parameters between the two techniques were analyzed. The magnification (mm) was calculated by subtracting the length measurements on the EOS® from those in the scanogram. Furthermore, the magnification percentage (%) was calculated by dividing the magnification with the measurements on the EOS®. Results: The magnification errors (mean ± standard deviation), when comparing both right and left sides, were 7.80 ± 1.41%, 7.3 ± 6.01%, 5.16 ± 1.25%, and 6.45 ± 0.94% for L, F, T, and F + T, respectively. For limb length, the CR-based teleoroentgenogram had an average magnification of 6.8% (range, 5.2 to 7.8%) compared to the EOS® imaging. The two groups displayed a statistical difference (p < 0.01), except for the HKA angle. Conclusions: The CR-based teleoroentgenogram had a magnification of about 6.8% compared to the EOS® imaging system in evaluating lower extremity length. Therefore, more attention must be given to CR-based teleoroentgenograms to correct angular deformities. [ABSTRACT FROM AUTHOR]

PurposeThere are over 500 medically related applications (apps) for mobile devices. Very few of these applications undergo testing and peer-review for accuracy. The purpose of this study is to assess the accuracy of limb deformity measurements on the Bone Ninja app compared to PACS and to determine the intra- and inter-observer variability among different orthopaedic practitioners.MethodsFour participants (attending, senior and junior resident, and physician assistant) measured the leg length (LL), the lateral distal femoral angle (LDFA), and the medial proximal tibial angle (MPTA) of 48 limbs (24 patients), twice with both Bone Ninja and PACS. The difference between the measurements obtained with the Bone Ninja app and PACS were measured. We determined the consistency of the intra-observer intra-class correlation coefficient (ICC) for both systems.ResultsThere were no statistical differences in leg length discrepancy (LLD), MPTA, or LDFA measurements between Bone Ninja and PACS (p = 0.96, 0.87, and 0.97, respectively). The intra-observer ICC for the LL, LDFA, and MPTA was similar between Bone Ninja and PACS (0.83, 0.89, and 0.96 vs. 0.96, 0.93, and 0.95, respectively). The inter-observer ICC was similar between Bone Ninja and PACS (0.95, 0.96, and 0.99 vs. 0.99, 0.98, and 0.98, respectively).ConclusionsThis study demonstrates that Bone Ninja is an accurate educational tool for measuring LLD, LDFA, and MPTA. Both systems are reliable instruments for evaluating limb length differences and angles on standing radiographs for pre-operative deformity planning and education. This is the first study to evaluate the accuracy of Bone Ninja compared to the gold standard of PACS.

Introduction: Tailoring limb length in bariatric surgery is a subject of many studies. To acquire the optimal limb length, accurate measurement of the small bowel length is essential. Objective: To assess the intra- and inter-individual variability of laparoscopic bowel length measurement using a hand-over-hand technique with marked graspers. Method: Four bariatric surgeons and four surgical residents performed measurements on cadaver porcine intestine in a laparoscopic box using marked graspers. Each participant performed 10 times a measurement of three different lengths: 150, 180, and 210 cm. Acceptable percentage deviation from the goal lengths was defined as less than 10%, while unacceptable deviations were defined as more than 15%. Results: The bariatric surgeons measured the 150-, 180-, and 210-cm tasks with 4% (CI 0.4, 9), − 6% (CI − 11, − 0.8), and 1% (CI − 4, 6) deviation, respectively. In total, the bariatric surgeons estimated 58 out of 119 times (49%) between the margins of 10% deviation and 36 times (30%) outside the 15% margin. Considerable inter-individual differences were found between the surgeons. The surgical residents underestimated the tasks with 12% (CI − 18, − 6), 16% (CI − 19, − 13), and 18% (CI − 22, − 13), respectively. Conclusion: Bariatric surgeons estimated bowel length with on average less than 10% deviation. However, this still resulted in 30% of the measurements with more than 15% deviation. There were considerable inter-individual differences between the surgeons and residents structurally underestimated the bowel length. Ascertainment of measurement accuracy and adequate training is essential for bariatric procedures in which limb length is of importance. [ABSTRACT FROM AUTHOR]

Purpose: The goal was to compare the reliability of a novel 3D method with the standard 2D technique for lower limb discrepancy (LLD) measurement during pre-operative THA planning. Methods: This prospective study included 100 consecutive patients who underwent THA using 3D planning based on a low-dose CT scan. The LLD was subdivided into three parameters: the intra-articular LLD (IA-LLD), the segmental extra-articular LLD (EA-LLD), and the total LLD (T-LLD). The LLD was assessed with a standard 2D technique on CT scanograms and also with a 3D method. A pelvic reference line (PBL) was determined as the 3D line joining the deepest part of the two great sciatic notches. The IA length was measured from the lesser trochanters (MLT) to the PBL. The EA length was measured from the MLT to the ankle center, and the total length was measured from the ankle center to the PBL. The intra- and inter-observer reliability of the measurements was assessed with the intra-class correlation coefficient (ICC). Results: The intra-observer ICC was higher with the 3D technique for IA-LLD (0.96–0.97 vs. 0.79–0.84), EA-LLD (0.96 vs. 0.78–0.92), and T-LLD (0.99 vs. 0.90–0.97). Inter-observer ICC was also higher with the 3D technique for IA-LLD (0.90–0.94 vs. 0.70–0.84) and EA-LLD (0.93–0.96 vs. 0.80–0.82), but not for T-LLD (0.91–0.94 vs. 0.91–0.94). Conclusion: The presented 3D method has a higher reliability than 2D assessment of LLD during pre-operative THA planning. This article presents the first discussion of measuring LLD from 3D models. As 3D reconstruction becomes both more feasible and less-invasive, this study has interest to the orthopaedic surgeon. [ABSTRACT FROM AUTHOR]

Lack of standardization in the Roux-en-Y gastric bypass (RY-GBP) is quite well established. We all learned the basics of the technique, but a lot of differences do exist in performing each step of the procedure. Based on scientific evidences, coming from an extensive and meticulous review of the literature of the last 20 years, we thus address the different technical steps of the procedure and their importance to try and propose a standardization of RYGBP. A lot of possibilities exist at each and every step of a RYGBP. They influence the postoperative complications, the end weight loss (EWL), weight regain, and resolution of obesity bounded comorbidities. Furthermore, lack of standardization leads to problems regarding comparison of scientific data in the related literature. [ABSTRACT FROM AUTHOR]

Introduction: In order to design the most effective weight loss procedure, the ideal biliopancreatic limb (BPL) and alimentary limb (AL) length in Roux-en-Y gastric bypass (RYGB) have been discussed extensively. Yet, no consensus has been reached. The aim of this study was to compare weight loss after a short and long BPL in patients who underwent a RYGB with a minimum of 4 years follow-up. Methods: This retrospective cohort study consisted of 574 patients who underwent a primary RYGB procedure between March 2015 and January 2017. Patients were divided in two groups based on the surgical procedure performed: a short BPL group (BPL of 50 cm with an AL of 150 cm) and long BPL group (BPL of 150 cm with an AL of 75 cm). The percentage total weight loss (%TWL) between groups was compared up to 4 years after surgery. Secondary outcomes were 30-day postoperative complications and health-related quality of life (RAND-36). Results: The short BPL group consisted of 286 patient and the long BPL group of 288 patients. Follow-up rates of both groups at the first, second, third, and fourth year after surgery were comparable. The long BPL group showed significantly more %TWL compared to the short BP limb group starting at 6 months (p = 0.004) until 4 years after surgery (p < 0.001). Thirty-day complications and health-related quality of life did not differ. Conclusion: The results showed significantly more %TWL in patients receiving a long BPL compared to the short BPL up to 4 years after surgery. [ABSTRACT FROM AUTHOR]

This study investigates the ability of low-intensity pulsed ultrasound (LIPUS) or direct injection of recombinant growth hormone (rGH) to stimulate local growth of long bones. In a randomized controlled animal trial, healthy immature rabbits were allocated to 1 of the following 4 conditions: epiphyseal rGH periosteal injection, transdermal LIPUS, saline periosteal injection, or no treatment. New bone deposition was labeled with calcein at days 1 and 18, and microscopic measurements of growth were conducted by blinded observers. Statistically significant differences in growth were observed between the LIPUS and rGH stimulated legs compared with contralateral control legs (35% p = 0.04 and 41% p = 0.04, respectively); whereas no difference was observed between the 4 control groups (p = 0.37). There was no evidence of physeal bar formation, suggesting that direct injection of rGH and application of LIPUS around the distal femoral physis in rabbits may have a positive effect on microscopic growth without short-term adverse sequelae. [ABSTRACT FROM AUTHOR]

Pecan (Carya illinoinensis) trees were pruned using varying intensities at planting to determine the effect of pruning on trunk development and shoot growth. Data on trunk diameter, number and length of shoots, as well as the total shoot growth were recorded annually from a completely randomized design experiment that assigned 0%, 50%, and 75% pruning of above-ground height to single-trunk transplants. The results suggest that pruning intensity has little effect on trunk diameter. The pruned trees had fewer shoots initially and more growth per shoot, leading to a difference of 7 cm/shoot higher for the 50% pruning group than the control group and to a difference of 11 cm/shoot higher for the 75% pruning group compared with the control group. The total length of all shoots was not significantly different across treatments. Because previous research has sometimes shown that pruning increases tree survival and this research shows that trees can recover from pruning, there is no need to change the current recommendation of pruning seedlings at planting.

Abstract Background It is not exactly known whether guided growth or definitive epiphysiodesis techniques are superior in treating limb length discrepancy (LLD). The purpose of the present study was therefore to find out if definitive epiphysiodesis is associated with more powerful LLD correction than tension band plate epiphysiodesis. Methods Pediatric patients with LLD treated either with tension band plating as a guided growth technique (temporary epiphysiodesis) or a percutaneous drilling technique (definitive epiphysiodesis) around the knee and a minimum follow-up of 12 months were included in this retrospective study. Radiographic measurements were performed by two independent reviewers. The reduction in side difference between preoperative radiographs and last follow-up was calculated and compared between surgical techniques. Results Thirty-eight patients (mean age 13.6 years) were included, 17 treated with temporary and 21 with definitive epiphysiodesis. Average follow-up was at 578 days. The reduction of the LLD in 12 months was 5.7 mm in patients treated with temporary epiphysiodesis and 8.4 mm with definitive epiphysiodesis, respectively (p = 0.22). In both groups, LLD could be statistically significantly reduced after 12 and 24 months. Definitive epiphysiodesis had a lower revision rate (4.8% vs. 17.6%). Intra- and interobserver reliability of the measurements was excellent. Conclusions As in earlier studies supposed, temporary epiphysiodesis with tension band plating seems to correct LLD less powerful compared to definitive percutaneous epiphysiodesis. However, in the present study, the differences of LLD correction were not statistically significant. We do not recommend the use of tension band plates for LLD correction due to inferior correction with higher complication and revision rate.

This study aimed to investigate the relationship between the corticospinal tract (CST) and limb length discrepancy (LLD) in patients with hemiplegic cerebral palsy (CP). Using diffusion tensor tractography, a retrospective study on 92 pediatric patients with hemiplegic CP who visited our hospital from May 2017 to the end of 2020 was conducted. Limb length was measured by anthropometry to calculate LLD. The functional level of hemiplegia scale (FxL), modified Ashworth scale, and manual muscle test (MMT) were evaluated for clinical function. Patients were classified into two groups according to the presence or absence of disruption of the affected CST: disruption (A) and preservation (B) groups. Fractional anisotropy (FA) and mean diffusivity (MD) of the affected CSTs were measured and correlated with LLD. The results of the independent t-test and chi-square test did not show significant differences between the two groups, except in the FxL and finger extensor of MMT (p < 0.05). For the LLD, there were no significant differences in total upper, total lower, and foot limb lengths. A significant difference was observed only in hand LLD (p < 0.05) from ANCOVA. Hand LLD was significantly correlated with FA (r = −0.578), MD (r = 0.512), and degree of CST disruption (r = −0.946) from the Pearson correlation test. The results of this study suggested that patients with hemiplegic CP would likely have LLD especially in the hand, and that CST evaluation using diffusion tensor tractography might be helpful in assessing and predicting LLD in hemiplegic CP.

Aim: Climatic variation has long been regarded as a primary source of morphological variation. However, there is mixed support for the adherence of reptiles to ecogeographical hypotheses, such as Bergmann's rule (body size decreases with temperature) and Allen's rule (limb length increases with temperature). We quantified body and limb morphology among the diverse Australian gecko fauna (4 families, 30 genera, 226 of the 231 described species) to investigate environmental correlates of morphological variation in this radiation. Location: Australia. Major taxa studied: Geckos (Squamata: Gekkota; the families Gekkonidae, Carphodactylidae, Diplodactylidae and Pygopodidae). Methods: We measured 20 external features of ethanol‐preserved museum specimens. We investigated whether principal component axes of morphology were correlated with three key environmental variables, and the microhabitat occupied by each species. Results: Morphology varied greatly among Australian gecko families and genera, although there was a strong phylogenetic signal in morphology. After accounting for phylogeny, morphology was correlated with a species' microhabitat use. Saxicolous species and species with variable microhabitat requirements (i.e., generalists) had larger body dimensions than terrestrial species. Saxicolous species also had longer proportional forelimbs and hindlimbs than terrestrial species. Main conclusions: Our results highlight the importance of phylogeny and microhabitat use in shaping the morphology of Australian geckos. We find little evidence that Australian geckos adhere to Bergmann's rule or Allen's rule, suggesting that these ecogeographical hypotheses provide limited insight into the adaptive potential of lizard species to altered environmental conditions. [ABSTRACT FROM AUTHOR]

Background: Leg length discrepancy following hip arthroplasty causes dissatisfaction to the patient; thus, preoperative planning and implant selection is critical. The purpose of this study was to measure the articular-trochanteric distance (ATD) and femoral neck length (FNL) in our population and compare them to those of 3 of the most used uncemented stems., Methods: In this cross-sectional study, 401 hip radiographs of healthy adults were collected between January and July 2022. The vertical ATD and FNL were measured. A linear regression model was used to identify the relationship between these measurements and age, sex, and height. A logistic regression model was used to assess the matching of native hips with the neck length of the stem., Results: Mean age was 60 years, and 74.56% were women. In 94.3% of hips, the ATD was negative, 3.73% neutral, and 2% positive. In our population, 0.25% of FNL were shorter than POLARSTEM (Smith & Nephew, UK), 10.72% shorter than MetaFix stem (Corin, UK), and 11.97% shorter than Corail stem (DePuy Synthes, USA). In the logistic regression analysis, matching for the POLARSTEM was associated with age but not with sex or height. Conversely, for MetaFix and Corail, stem matching was associated with sex and height., Conclusions: Anthropometric hip measurements vary among individuals, and variables such as age, sex, and height must be considered during preoperative planning and implant selection to avoid leg length discrepancy. Additional studies, including different implants, are required to guide surgeons in selecting a femoral stem that best matches the patient's native hip., (© 2024 The Authors.)

Distantly related mammals (e.g. jerboa, tarsiers, kangaroos) have convergently evolved elongated hindlimbs relative to body size. Limb elongation is hypothesized to make these species more effective jumpers by increasing their kinetic energy output (through greater forces or acceleration distances), thereby increasing take-off velocity and jump distance. This hypothesis, however, has rarely been tested at the population level, where natural selection operates. We examined the relationship between limb length, muscular traits and dynamics using Longshanks mice, which were selectively bred over 22 generations for longer tibiae. Longshanks mice have approximately 15% longer tibiae and 10% longer femora compared with random-bred Control mice from the same genetic background. We collected in vivo measures of locomotor kinematics and force production, in combination with behavioral data and muscle morphology, to examine how changes in bone and muscle structure observed in Longshanks mice affect their hindlimb dynamics during jumping and clambering. Longshanks mice achieved higher mean and maximum lunge-jump heights than Control mice. When jumping to a standardized height (14 cm), Longshanks mice had lower maximum ground reaction forces, prolonged contact times and greater impulses, without significant differences in average force, power or whole-body velocity. While Longshanks mice have longer plantarflexor muscle bodies and tendons than Control mice, there were no consistent differences in muscular cross-sectional area or overall muscle volume; improved lunge-jumping performance in Longshanks mice is not accomplished by simply possessing larger muscles. Independent of other morphological or behavioral changes, our results point to the benefit of longer hindlimbs for performing dynamic locomotion., Competing Interests: Competing interests The authors declare no competing or financial interests., (© 2024. Published by The Company of Biologists Ltd.)

Background and objectives: The differences between computed radiography-based teleoroentgenograms (CR-based teleoroentgenograms) and an EOS® imaging system were evaluated by measuring lower extremity lengths and alignments. Materials and methods: The leg length [L], femur length [F], tibia length [T], and hip–knee–ankle (HKA) angle were measured in 101 patients with lower extremity disease by a CR-based teleoroentgenogram with computed radiography and an EOS®. The additive length of the femoral and tibial segments (F + T) was determined by adding the two length values. Then, the differences among all five parameters between the two techniques were analyzed. The magnification (mm) was calculated by subtracting the length measurements on the EOS® from those in the scanogram. Furthermore, the magnification percentage (%) was calculated by dividing the magnification with the measurements on the EOS®. Results: The magnification errors (mean ± standard deviation), when comparing both right and left sides, were 7.80 ± 1.41%, 7.3 ± 6.01%, 5.16 ± 1.25%, and 6.45 ± 0.94% for L, F, T, and F + T, respectively. For limb length, the CR-based teleoroentgenogram had an average magnification of 6.8% (range, 5.2 to 7.8%) compared to the EOS® imaging. The two groups displayed a statistical difference (p < 0.01), except for the HKA angle. Conclusions: The CR-based teleoroentgenogram had a magnification of about 6.8% compared to the EOS® imaging system in evaluating lower extremity length. Therefore, more attention must be given to CR-based teleoroentgenograms to correct angular deformities.

Purpose: Although the laparoscopic Roux-en-Y Gastric Bypass (LRYGB) is the gold-standard bariatric procedure, it remains uncertain what the optimal bowel limb lengths are to accomplish maximal weight loss while minimizing nutritional deficiencies and related gastro-intestinal complaints. The aim of this randomized controlled multicenter trial is to investigate the effect of significant lengthening of the length of the Roux limb (RL) at the cost of the length of the common channel (CC) while keeping the biliopancreatic limb (BPL) lengths the same on both study arms. Methods: Four hundred forty-four patients were randomized to receive either a Very Long Roux Limb LRYGB (VLRL-LRYGB) (variable RL length, BPL 60 cm, and CC 100 cm) or a Standard LRYGB (S-LRYGB) (RL 150 cm, BPL 60 cm, and a variable CC length). Results at 1-year follow-up for weight loss, effect on obesity-related comorbid conditions, complications, re-operation rate, malnutrition rate, and re-admission rate were investigated. Results: Weight loss at 1-year showed no significant differences for %EWL (84.3% versus 85.3%, p = 0.72) and %TWL (34.2% versus 33.6%, p = 0.359) comparing VLRL-LRYGB versus S-LRYGB. Malabsorption requiring surgical bowel length adjustment was observed in 1.4% in VLRL-LRYGB group versus 0.9% in S-LRYGB group (p = 0.316). Conclusion: Significant lengthening of the RL at the cost of the common channel seems to have no effect on the weight loss at 1-year follow-up, which supports the theory that absorption of nutrients also occurs in the RL. Nevertheless, long-term results of the VLRL-LRYGB have to be awaited to draw final conclusions as part of the discussion towards optimal limb length in LRYGB surgery. [ABSTRACT FROM AUTHOR]

Laparoscopic Roux-en-Y gastric bypass (RYGB) is considered the 'gold standard' for surgical treatment of morbid obesity. It is hypothesised that reducing the length of the common limb positively affects the magnitude and preservation of weight loss but may also impose a risk of malnutrition. The aim of this study was to compare patients' nutrient and vitamin deficiencies in standard RYGB with a very long Roux limb RYGB (VLRL-RYGB). This study was part of the multicentre randomised controlled trial (Dutch Common Channel Trial), including 444 patients undergoing an RYGB or a VLRL-RYGB. Laboratory results, use of multivitamin supplements and reoperations were collected at baseline and 1 year postoperative. Primary outcome measure was nutrient deficiency after 1 year postoperative. Secondary outcome measure was the reoperation rate due to malabsorption. In total, 227 patients underwent RYGB and 196 patients underwent VLRL-RYGB. Most common deficiencies at 1 year postoperative were ferritin (17·2–18·2 %), Fe (23·4–35·6 %), K (7·4–15·2 %), vitamin B12 (9·0–9·9 %) and vitamin D (22·7–34·5 %). Patients undergoing VLRL-RYGB had slightly but significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but significantly higher levels of folic acid and Na. Reoperation rates due to malabsorption were not significantly different between RYGB (2/227, 0·9 %) and VLRL-RYGB (7/196, 3·6 %) (P = 0·088). We concluded that patients undergoing VLRL-RYGB had significantly lower levels of Ca, Fe and vitamin D compared with those undergoing RYGB at 1 year postoperative, but higher levels of folic acid and Na. Reoperation rates did not differ. Close monitoring on nutrient deficiencies should be performed in patients undergoing VLRL-RYGB. [ABSTRACT FROM AUTHOR]

Background: Achieving appropriate limb length and offset in total hip arthroplasty (THA) is challenging. Target limb length and offset may not always mean equal radiographic measurements bilaterally. The goal of this study is to introduce a method for determining as well as achieving target limb length and offset using digital radiographic measurements.Methods: One hundred and two consecutive patients with unilateral hip osteoarthritis undergoing primary THA in the lateral decubitus position were included. Limb length and offset were measured on anterior-posterior pelvic radiographs preoperatively, intraoperatively, and postoperatively. Offset was defined as the length of a line parallel to the inter-teardrop line, extending from the edge of the ischium, at about the lower border of the ipsilateral obturator foramen, to the edge of the femoral cortex, usually at, or just below, the neck resection level. Target limb length was determined for each patient based on patient perception and severity of disease. Target offset equaled the contralateral limb. Using intraoperative digital radiography, adjustments were made until targets were achieved and the hip was stable. Patients were followed for an average of 4.2 years postoperatively.Results: Limb length was within 5 mm of target measurements in 100% of patients and offset was within 5 mm of targets in 97.1%. Target measurements differed by >5 mm from the contralateral side in 2.0% of limb length and 2.9% of offset measurements. There were no significant differences between intraoperative and postoperative limb length (P = .261) or offset (P = .747) measurements. At final follow-up, there were no dislocations or reoperations and average Hip disability and Osteoarthritis Outcome Score for Joint Replacement was 95.78.Conclusion: Target limb length and offset goals can be determined for most patients undergoing THA. Targets are not always equal to the contralateral side. Intraoperative digital radiography can allow surgeons to accurately achieve target limb length and offset to within 5 mm in a homogenous cohort of patients with unilateral hip osteoarthritis with excellent clinical outcomes. [ABSTRACT FROM AUTHOR]

Background: Anthropometric data prove valuable for screening and monitoring various medical conditions. In young infants, however, only weight, length and head circumference are represented in publicly accessible databases. Aim: To characterise length and circumferential measures in pre-term and full-term infants up to 90 days post-natal. Subjects and methods: In eight US medical centres, trained raters recorded humeral, ulnar, femoral, tibial and fibular lengths along with mid-upper arm, mid-thigh, chest, abdominal and neck circumference. Data were pooled by post-menstrual age into 1-week intervals and population curves created using the lambda, mu and sigma (LMS) method. Goodness-of-fit was assessed by examining de-trended quantile-quantile plots, Q statistics and fitted centiles overlaid on empirical centiles. Results: In total, 2097 infants were enrolled in this study with a mean ± SD gestational age and post-natal age of 37.1 ± 3.3 weeks and 27.3 ± 25.3 days, respectively. A re-scale option was used to describe all curves. The resultant models reliably characterised anthropometric measures from 33–52 weeks PMA, with less certainty at the extremes (27–55 weeks). Conclusion: The population curves generated under this investigation expand existing reference data on a comprehensive set of anthropometric traits in infants through the first 90 days post-natal.

Long-term durability after Roux-en-Y gastric bypass is challenging in the super-obese population. Although lengthening of biliopancreatic limb (BPL) is associated with higher rates of weight loss, shortening of common limb (CL) is related to higher risk of malabsorption. In this study, we aimed at evaluating the importance of the total alimentary limb length by creating a 2-m BPL diversion with varying CL lengths. High-volume bariatric center, Norway. Three groups of patients (N = 187) with different limb lengths were included in this retrospective cohort-analysis as follows: group 1 (n = 69; Roux limb = 150 cm, BPL = 60 cm), group 2 (n = 88; BPL = 200 cm, CL = 150 cm), and group 3 (n = 30; BPL = 200 cm, CL = 200 cm). Weight loss, regain, and failure were analyzed along with malabsorption issues. Preoperative body mass index (BMI) was higher in group 2 (58.5, P <.001) and 3 (57.4) versus group 1 (54.6, P =.011). No other clinically significant differences between the groups were noted. Follow-up rate was 95% at year 2, 74% at year 5, and 52% at year 10. At 10-year follow-up, excess weight loss and total weight loss was higher in group 2 (70.4%; 40.3%) and 3 (64.0%; 35.9%) compared with group 1 (55.9%; 29.2%). Excess weight loss failure was higher in group 1 versus 2 (30% versus 8.3%, P <.001). No difference in short- or long-term complications was seen except higher occurrence of internal hernia in distal Roux-en-Y gastric bypass groups (11.4%, 6.7%). Vitamin and mineral deficiencies occurred more frequently the shorter the CL was. Sustainable weight loss in a long-term follow-up is achieved by shortening the total alimentary limb length with a 2-m BPL diversion that should not be attached <200 cm from the ileocecal junction owing to higher rates of internal hernia and vitamin and mineral deficiencies. • Weight loss is determined by the length of the total alimentary limb length • Biliopancreatic diversion is essential for durable long-term results in superobese • Length of the biliopancreatic limb should correspond roughly to one third of the total length of the small bowel • Common channel should not be shortened to less than 200 cm due to higher frequency of malnutrition and internal hernia. [ABSTRACT FROM AUTHOR]

Background: In super-obese patients, rates of weight loss failure and weight regain are high after RYGB. In order to improve weight loss, lengthening of the biliopancreatic limb is vital. In this study, efficacy and safety of two types of RYGB with 2-m BP-limb were assessed in improving weight loss and in the resolution of comorbidities compared with standard RYGB in a long-term follow-up. Methods: This is a retrospective cohort analysis on 671 super-obese patients operated in a 10-year period. Patients were classified into three groups: (1) 155 patients; roux limb 150 cm, BP-limb 60 cm; (2) 230 patients; roux limb 60 cm, BP-limb 200 cm; and (3) 286 patients; roux limb 150 cm, BP-limb 200 cm. EWL, TWL, BMI, failure, weight regain, comorbidity resolution, nutritional status, and complications were assessed. Results: Total alimentary limb length was shortened with 60 cm in group 1 and with 200 cm in groups 2 and 3. EWL, BMI change, and TWL were higher in the 2-m BP-limb groups vs group 1. No differences in complication rates were found, except higher frequency of marginal ulcers in patients with a shorter roux limb. EWL failure was higher in group 1 (10.3%) vs the other groups (4.3%; 5.2%). Group 3 had significantly less weight regain (26.6%). Remission of comorbidities was higher in the 2-m BP-limb groups at expense of nutritional and vitamin deficiencies (3.9%; 5.9%). No difference in hypoalbuminemia was noted. Conclusion: Lengthening of the BP-limb gives significantly higher weight loss, lower rate of EWL failure, and lesser weight regain along with better resolution of obesity-associated comorbidities. [ABSTRACT FROM AUTHOR]