Scintigraphic findings in stress fractures.

Forty-two patients suspected of having stress fractures were evaluated by serial roentgenograms and by one total-body scan with detailed views of suspicious areas. Stress fracture was the ultimate clinical diagnosis in twenty-one patients, and in fifteen of them the roentgenograms were normal while the scintigram was positive. The false negative rate for the roentgenograms was 71 per cent. In eleven of the fifteen patients, the roentgenograms eventually became positive. There were five positive scintigrams from causes other than stress fracture, giving a false positive rate for scintigraphy of 24 per cent. The bones with stress fractures included the metatarsals, calcaneus, tibia, femur, and fibula.

Reconstruction of the posterior cruciate ligament: preliminary report of a new procedure.

The integrity of the posterior cruciate ligament is necessary for the stability of the knee. The popliteus tendon is a promising, practical, and anatomical donor for reconstructing the posterior cruciate ligament. The procedure can be performed relatively easily using a posterolateral Henderson incision in association with the standard anteromedial parapatellar approach. We have performed the operation in 2 patients, produced good results at 4 and 6 month follow-up examination.

Standing roentgenograms in spondylolisthesis.

Lateral roentgenograms of 50 patients with spondylolisthesis were made in the recumbent and standing positions and compared. Thirteen (26%) showed an increase in the percentage of displacement on standing. Those patients with demonstrable change appeared to have a higher incidence of severe symptomatology. Apparent spondylolysis on recumbent roentgenograms may change to spondylolisthesis on standing lateral roentgenograms. Degenerative spondylolisthesis may be more apparent on standing lateral roentgenograms.

Treatment of coccidioidomycosis infection of bone with local amphotericin B suction-irrigation. Report of a case.

A 29-year-old man with coccidioidomycosis of the tarsal bones and toxic reactions to intravenous Amphotericin B was treated by surgical curettage and local suction-irrigation system of Amphotericin B. The patient responded to treatment and was free of disease 2 years later. Local suction-irrigation with Amphotericin B may be a valuable adjunct in the treatment of coccidioidomycosis infection of bone.

Electrical activity in muscle pain.

The concept of muscle pain-spasm-pain vicious cycle has been challenged on the basis of inability to find electrical activity in the presence of palpable changes in fibrositic muscle. We produced muscle pain in the wrist extensor and paravertebral muscle groups of seven healthy subjects by injection of hypertonic saline (0.3 ml of 6% NaCl solution). The time course of the integrated muscle action potentials, roughly paralleled the time course of the developed pain in all but one subject for each muscle group. EMG recordings were made on one subject using both surface electrodes with amplifier sensitivity of 10 muV/cm and needle electrodes with an amplifier sensitivity of 100 muV/cm. Sequential recording showed clear evidence of electrical activity from the surface electrode and high sensitivity whereas the combination of the needle electrode with lower sensitivity showed no electrical activity whatever. We conclude that even mild muscle spasm is accompanied by muscular hyperactivity which can be evaluated by appropriate EMG techniques. There appears to be no reason to challenge the widely accepted concept of pain-spasm-pain as stated by Travell, Rinzler and Herman.