The use of a tuning fork and stethoscope to identify fractures

J Athl Train. May-Jun 2009;44(3):272-4. doi: 10.4085/1062-6050-44.3.272.

Abstract

Context: Nonradiographic tests to identify fractures rely on a patient's report of increased pain at the site of injury. These tests can be misleading and produce false-positive or false-negative results because of differences in pain tolerance. A painless technique using a tuning fork and stethoscope to detect fractures has undergone limited review in the athletic training literature.

Objective: To determine if the use of a 128-Hz vibrating tuning fork and stethoscope were effective in identifying fractures.

Design: Cross-sectional study.

Setting: University athletic training room or local orthopaedic center when fractures were suspected.

Patients or other participants: A total of 37 patients (19 males, 18 females) volunteered.

Main outcome measure(s): A diminished or absent sound arising from the injured bone as compared with the uninjured bone represented a positive sign for a fracture. Radiographs interpreted by the attending orthopaedic physician provided the standard for comparison of diagnostic findings.

Results: Sensitivity was 0.83 (10:12), specificity was 0.80 (20:25), positive likelihood ratio was 4.2, negative likelihood ratio was 0.21, and diagnostic accuracy was 81% (30:37).

Conclusions: The tuning fork and stethoscope technique was an effective screening method for a variety of fractures.

Keywords: assessment; auscultation; false-negative results; false-positive results.