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Biomedical subjects

R E Leach

Publications and source records attributed to R E Leach.

At least 91 records · Page 5Linked to original sources
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Pitfalls of proximal tibial osteotomy.

Proximal tibial osteotomy for degenerative genu varus and valgus has an excellent success rate with proper patient selection and technical proficiency. The following are some infrequently recognized pitfalls. Excessive bone loss prevents two plateau weight-bearing after osteotomy, introduces a "teeter effect," and is therefore a contraindication. Patellofemoral arthritis may produce symptoms, particularly on stair climbing and necessitate secondary surgery. Varus and planning indicates postoperative articular surface obliquity in excess of 10 to 15 degrees another type of reconstruction is indicated. Secure fixation, closing wedge osteotomy, and non-displacement of the d-stal fragment prevent loss of correction. Peroneal nerve palsy may be avoided by careful surgical technique and postoperative dressings. Cracking the apical cortex and visualization of the plateau fragment will usually prevent fracture.

Arthritis↗
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Bigger is better?

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Adult↗
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Tsunami.

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Biomechanical Phenomena↗
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What are we to think?

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Conflict of Interest↗
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Achilles tendinitis.

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Achilles Tendon↗
PubMedDate not supplied

Surgical management of Achilles tendinitis.

Inflammation of the Achilles tendon and its contiguous structures is one of the most common overuse problems seen in runners. There are actually several etiologies. Involvement of the tendon itself is secondary to areas of mucinoid or fibrotic degeneration, or may be a result of a partial rupture. The sheath (or mesotenon) may also become chronically inflammed. Retrocalcaneal bursitis seems to be a separate entity with hypertrophy and fibrosis of the bursa usually occurring in conjunction with a prominent posterior superior angle of the os calcis. The vast majority of patients can be successfully treated nonoperatively; however, there is a group of patients who are refractory to nonoperative management who would like to continue running, particularly if they are competitive. A retrospective review of 45 surgical cases in 37 patients was performed. All but two of these patients were competitive long-distance runners. There were 24 cases of Achilles tendinitis and/or tenosynovitis, 14 cases with retrocalcaneal bursitis, and 7 with a combination of both. Mean followup was 3 years (range, 1 1/2 to 8 years). Overall there were 87% satisfactory results. Ninety-two percent of the patients with involvement with the tendon and/or sheath had a satisfactory outcome as compared with 71% of patients with retrocalcaneal bursitis. Passive dorsiflexion in the 29 unilateral cases improved from a mean of 17 degrees preoperatively to a mean of 25 degrees postoperatively. We feel that surgery offers a solution for highly motivated runners with chronic posterior heel pain who would like to continue running when conservative measures have failed.

Achilles Tendon↗
PubMedDate not supplied

Peroneal nerve entrapment in runners.

In a practice involving large groups of athletes, seven runners and one soccer player with peroneal nerve compression neuropathy secondary to exercise have been found. Running incited pain, numbness and tingling to varying degrees in all patients, and examination after running revealed muscle weakness and a positive percussion test as the nerve winds around the fibular neck. Nerve conduction velocity studies confirmed the diagnosis in the five patients on whom the test was performed; other studies served primarily to exclude other causes of pain. All patients were treated surgically by neurolysis of the peroneal nerve as it travels under the sharp fibrous edge of the peroneus longus origin. Seven of eight had excellent results and returned to their previous level of physical exertion without further symptoms. We think entrapment of the peroneal nerve at the fibular neck is a more common entity than previously recognized, and it should be considered in the differential diagnosis of exertional lateral leg pain.

Adult↗