Staan op twee benen

Rede, uitgesproken bij de aanvaarding van het ambt van gewoon hoogleraar in de Orthopaedie aan de Medische Faculteit Rotterdam op woensdag 26 april 1972 Inaugurele rede Medische Faculteit Rotterda

Sub‐phenotyping Metabolic Disorders Using Body Composition: An Individualized, Nonparametric Approach Utilizing Large Data Sets

Objective This study performed individual-centric, data-driven calculations of propensity for coronary heart disease (CHD) and type 2 diabetes (T2D), utilizing magnetic resonance imaging-acquired body composition measurements, for sub-phenotyping of obesity and nonalcoholic fatty liver disease (NAFLD). Methods A total of 10,019 participants from the UK Biobank imaging substudy were included and analyzed for visceral and abdominal subcutaneous adipose tissue, muscle fat infiltration, and liver fat. An adaption of the k-nearest neighbors algorithm was applied to the imaging variable space to calculate individualized CHD and T2D propensity and explore metabolic sub-phenotyping within obesity and NAFLD. Results The ranges of CHD and T2D propensity for the whole cohort were 1.3% to 58.0% and 0.6% to 42.0%, respectively. The diagnostic performance, area under the receiver operating characteristic curve (95% CI), using disease propensities for CHD and T2D detection was 0.75 (0.73-0.77) and 0.79 (0.77-0.81). Exploring individualized disease propensity, CHD phenotypes, T2D phenotypes, comorbid phenotypes, and metabolically healthy phenotypes were found within obesity and NAFLD. Conclusions The adaptive k-nearest neighbors algorithm allowed an individual-centric assessment of each individual’s metabolic phenotype moving beyond discrete categorizations of body composition. Within obesity and NAFLD, this may help in identifying which comorbidities a patient may develop and consequently enable optimization of treatment

Failure of tibial bone grafting for femoral head necrosis

We treated 20 hips with femoral head necrosis in 16 patients using the Phemister tibial bone grafting procedure. After a mean follow-up of 3 years, the Harris hip score had improved in 15 out of 18 hips, however without radiographic improvement. In 2 hips, an arthrodesis and an arthroplasty were per-formed. We concluded that the aim of our treatment was not achieved

Chronic instability of the foot and foot geometry: A radiographic study

Multiple factors are involved in chronic lateral instability of the ankle. The geometry of the foot may be of importance. A cavovarus foot may predispose to lateral ligament injuries. In the present study, standardized lateral X-rays were obtained of the feet of patients with chronic instability and of a control group. Four parameters were used: (1) the tarsal index as described by Benink; (2) the talocalcaneal angle; (3) the talometatarsal angle; and (4) the calcaneal angle. No relationship between lateral instability of the foot and foot geometry was found. The talocalcaneal angle as defined in this study was found to be a less appropriate parameter in measuring the longitudinal foot arch

Bilateral locked facets in the thoracic spine

Two cases of traumatic bilateral locked facets in the thoracic spine are reported. Both patients had only minor neurological signs. They both made a full neurological recovery after surgical reduction of the locked facets. Bilateral locked facets are very uncommon in the thoracic spine. the diagnosis should be considered in any patient with a fracture-dislocation of the thoracic spine. In these cases additional lateral tomographs are required. Early open reduction of bilateral locked facets and internal fixation are mandatory

Widespread erosion on high plateaus during recent glaciations in Scandinavia

Glaciers create some of Earth’s steepest topography; yet, many areas that were repeatedly overridden by ice sheets in the last few million years include extensive plateaus. The distinct geomorphic contrast between plateaus and the glacial troughs that dissect them has sustained two long-held hypotheses: first, that ice sheets perform insignificant erosion beyond glacial troughs, and, second, that the plateaus represent ancient pre-glacial landforms bearing information of tectonic and geomorphic history prior to Pliocene–Pleistocene global cooling (~3.5 Myr ago). Here we show that the Fennoscandian ice sheets drove widespread erosion across plateaus far beyond glacial troughs. We apply inverse modelling to 118 new cosmogenic 10Be and 26Al measurements to quantify ice sheet erosion on the plateaus fringing the Sognefjorden glacial trough in western Norway. Our findings demonstrate substantial modification of the pre-glacial landscape during the Quaternary, and that glacial erosion of plateaus is important when estimating the global sediment flux to the oceans

Rotational deformities after femoral shaft fractures in childhood: A retrospective study 27-32 years after the accident

Fifty femoral shaft fractures sustained in childhood and for the most part treated conservatively were studied in retrospect 27-32 years after the accident, with special reference to rotational deformity. Femoral rotation was measured by means of so-called anteversion X-rays according to Dunn-Rippstein, and the same radiological examination was carried out in a control group of 100 adult volunteers. the L/R differences in femoral rotation were studied in the patient group in comparison with the control group. Persistent rotational dislocation was found in only one case, and had had no demonstrable untoward consequences. the established view that rotational dislocation is incapable of spontaneous correction is refuted with the aid of clinical and experimental data from the literature and personal observations. It is concluded that, in the patients studied, good results have been obtained by the conventional traction methods of Bryant and Russel. the use of the so-called Weber Bock to replace these methods is therefore not recommended

Two year cumulative incidence of trunk abnormalities in a schoolpopulation in Rotterdam, the Netherlands

We conducted a study of the 2 year cumulative incidence of trunk abnormalities in a cohort of 3,071 11 year old children (1,621 boys, 1,450 girls). The following data were recorded: height, weight, signs of puberty and menarche. Trunk abnormality was assessed in the erect child (asymmetry of shoulders and waistline, imbalance of the trunk, scoliosis, lordosis, kyphosis, swayback and flexibility) and by the forward bending test (FBT) (rib hump or lumbar prominence, persisting scoliosis, kyphosis and deviant lateral aspect). A normal FBT both at baseline and at follow-up was found in 84% of the boys and in 79% of the girls. The 2 year cumulative incidence of an abnormal FBT was 10% in boys and 13% in girls

Weight bearing after arthrodesis of the first metatarsophalangeal joint: A randomized study of 61 cases

We performed a prospective randomized study of 61 cases of arthrodesis of the first metatarsophalangeal joint in 56 patients. In the first group, full weight bearing was allowed after 2-4 days and in the second group at 4 weeks. Radiographic union of the arthrodesis in the two groups did not differ