![]() These results are in agreement with those of Misurya et al, 5 Bache and Cross, 6 Colwell and Berg, 7 and Peltier 8 in supporting the tuning fork test as a useful aid in identifying fractures. The only false-negative results that were identified occurred in patients with avulsion and buckle fractures. 1, 3, 4 Misurya et al 5 and Bache and Cross 6 explained that sound waves from the tuning fork are transmitted easily in non-transverse fractures because enough of the bone remains in contact. 7 Avulsion and buckle fractures, by definition, leave the bone injured but intact and, therefore, sound is not commonly affected. 5 –, 7 In a complete fracture, sound conduction is interrupted by the separated cortical surfaces of the bone. In a transverse fracture, space created by the fracture is sufficient 1, 3, 4 to decrease the sound the tuning fork produces and, thus, the sound is diminished as compared with the uninjured body part, resulting in a positive test. The tuning fork evaluation method was highly successful on transverse fractures (n = 10) but not as accurate on avulsion (n = 1) and buckle (n = 1) type fractures. After the test, radiographs were taken and interpreted by the attending orthopaedic physician to confirm or rule out the presence of a fracture. Diminished or absent sound from the injured limb as compared with the uninjured limb constituted a positive result. For example, if the fibula was the injured bone, the vibrating tuning fork was placed on the distal tip of the lateral malleolus and the stethoscope's conical bell was placed on the fibular head ( Figure). I listened for a clear tone created by the tuning fork in the uninjured bone and compared it with the sound arising from the injured bone. I then listened to the sound arising from the bone via the stethoscope for approximately 6 to 8 seconds. I struck the tuning fork against a rubber pad and then placed the vibrating tuning fork on the bone distal to the injury site. The tuning fork was placed on the bone distal to the suspected fracture, and the stethoscope's conical bell was placed proximal to the injury site on the same bone. The test was performed on the uninjured limb first. The procedure was conducted as described by Misurya et al, 6 except that the conical bell of a stethoscope was used instead of a pediatric stethoscope. The author administered the tuning fork test to all participants. My purpose was to assess the diagnostic accuracy of a tuning fork and stethoscope technique in detecting fractures in patients presented to an athletic training room and orthopaedic clinic. Bache and Cross 6 reported 87% accuracy in detecting femoral neck fractures. In particular, Misurya et al 5 and Bache and Cross 6 used a stethoscope and tuning fork in diagnosing fractures of the tibia and femoral neck and shaft. Other authors 6 –, 9 have noted favorable results when using auscultation for detecting fractures. Misurya et al 5 showed that a tuning fork and a pediatric stethoscope allowed fractures to be detected in 94% of patients. Colwell and Berg 7 used percussion and a stethoscope to evaluate patients for clavicle, femur, tibia, and fibula fractures, reporting a success rate of 88%. 5 –, 9 Carter 9 used percussion and a stethoscope to examine possible fractures and found that the sound produced by percussion in the injured body part was reduced in “pitch and volume” when compared with the uninjured body part. 2 Percussion with auscultation has been presented as a means of identifying fractures. Research on fracture testing in the athletic training literature is limited. Yet the findings on these tests can be affected by individual pain tolerances, leading to false-negative or false-positive results. ![]() Percussion and squeeze tests, 1 –, 4 which elicit pain indicative of a fracture, have been recommended. ![]() ![]() However, identifying fractures in the absence of radiographic evaluation represents a unique challenge. Through interviews, observation, and the completion of special tests, the extent of many injuries can be determined and decisions made regarding referral and treatment plans. Injury evaluation is a central component of clinical practice for athletic trainers. However, this method should only be used in conjunction with a thorough assessment and sound clinical judgment. During a field evaluation, a tuning fork and stethoscope can be useful in evaluating potential fractures. ![]()
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