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Objective sound wave amplitude measurement generated by a tuning fork. An analysis of its use as a diagnostic tool in suspected femoral neck fractures

      Abstract

      Introduction

      Hip injuries are becoming a more common problem as the elderly population increases and their management represents a significant proportion of health care costs. Diagnosis of a fracture based on clinical assessment and plain films is not always conclusive and further investigations for such occult fractures, such as magnetic resonance imaging (MRI), are sometimes required which are expensive and may be difficult to access. Disruption to the conduction of a sound wave travelling through a fractured bone is a concept that has been used to diagnose fractures.

      Patients and methods

      In our study we used a tuning fork with frequency of 128 Hz to objectively measure the reduction in sound amplitude in fractured and non-fractured hips. We looked at the feasibility of using this test as a diagnostic tool for neck of femur fractures.

      Results

      A total of 20 patients was included in the study, using MRI scan as the standard for comparison of diagnostic findings. Informed consent was obtained from the patients. There was a significant difference in the amplitude reduction of the sound waves when comparing normal to fractured hips. This was 0.9 in normal hips, compared to 0.31 and 0.18 in intra-capsular and extra-capsular fractures, respectively. Our test was 80% accurate at diagnosing neck of femur fractures.

      Conclusion

      In conclusion this test may be used as a diagnostic test or screening tool in the assessment of occult hip fractures.

      Keywords

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      References

        • Agarwal N.
        • Reyes J.D.
        • Westerman D.A.
        • Cayten G.C.
        Factors affecting DRG 210 (hip fracture) reimbursement.
        J Trauma. 1986; 26: 426-431
        • Pandey R.
        • McNally E.
        • Ali A.
        • Bulstrode C.
        The role of MRI in the diagnosis of occult hip fractures.
        Injury. 1998; 29: 61-63
        • Hossain M.
        • Barwick C.
        • Sinha A.K.
        • Andrew J.G.
        Is magnetic resonance imaging (MRI) necessary to exclude occult hip fracture?.
        Injury. 2007; 38: 1204-1208
        • Cannon J.
        • Silvestri S.
        • Munro M.
        Imaging choices in occult hip fracture.
        J Emer Med. 2009; 37: 144-152
        • Frihagen F.
        • Nordsletten L.
        • Tariq R.
        • Madsen J.E.
        MRI diagnosis of occult hip fractures.
        Acta Orthop. 2005; 76: 524-530
        • Chana R.
        • Noorani A.
        • Ashwood N.
        • Chatterji U.
        • Healy J.
        • Baird P.
        The role of MRI in the diagnosis of proximal femoral fractures in the elderly.
        Injury. 2006; 37: 185-189
        • File P.
        • Wood J.P.
        • Kreplick L.W.
        Diagnosis of hip fracture by the auscultatory percussion technique.
        Am J Emerg Med. 1998; 16: 173-176
        • Carter M.C.
        A reliable sign of fractures of the hip or pelvis.
        N Engl J Med. 1981; 305: 1220
        • Bache J.B.
        • Cross A.B.
        The Barford test. A useful diagnostic sign in fractures of the femoral neck.
        Practitioner. 1984; 228: 305-308
        • Misurya R.K.
        • Khare A.
        • Mallick A.
        • Sural A.
        • Vishwakarma G.K.
        Use of tuning fork in diagnostic auscultation of fractures.
        Injury. 1987; 18: 63-64
        • Keogh S.P.
        • Shafi A.
        • Wijetunge D.B.
        Comparison of Ottawa ankle rules and current local guidelines for use of radiography in acute ankle injuries.
        J Coll Edinb. 1998; : 341-343