As an Athletic Trainer, one of the things that I take a lot of pride in is trying to provide those in my care with the most accurate information possible so that they can make the best decisions regarding their own health.
So in light of that, a study entitled The Use of a Tuning Fork and Stethoscope to Identify Fractures in the latest edition of the Journal of Athletic Training was of particular interest.
The study assessed the accuracy of using a stethoscope and tuning fork to help assess the probability of a fracture.
If you are working in a high school or other setting and may not have immediate access to x-ray facilities, this technique may be able to help make your assessment a little more accurate.
Thirty seven people with suspected fractures less than 7 days old were the subjects for this study.
The author used a 128 -Hz tuning fork, a standard stethoscope (conical bell), and an x-ray machine to confirm the findings. The author used the technique on the uninjured limb first and then repeated on the injured limb. The tuning fork was placed on the bone distal to the fracture and the stethoscope was placed proximal to the fracture.
Overall here is a breakdown of the results when assessing 37 potential fractures using the stethoscope and tuning fork method described in the study:
- 10 of the suspected fractures were assessed as positive for a fracture and were confirmed as a fracture
- 20 of the suspected fractures were assessed as negative for a fracture and were confirmed as a non-fracture
- 5 of the suspected fractures were assessed as positive for a fracture but were confirmed as a non-fracture
- 2 of the suspected fractures were assessed as non-fractures but were confirmed as a fracture
Utilizing this method, transverse fractures were the most easily detected. Of the two false negative assessments, one fracture was buckle fracture and one was an avulsion fracture.
All in all, 30 of the 37 (81%) potential fractures were accurately assessed using a tuning fork and stethoscope. Previous studies show accuracies of this methodology at 87% and 94%. Those previous studies assessed fractures of the femur and tibia. This study noted tested a wider range of potential fracture sites.
In this study, I found it particularly interesting that 100% of the potential fractures assessed for the phalanges of the foot (6), phalanges of the hand (6), and metacarpals (3) were assessed correctly.
Overall, this study provides some additional information that we as athletic trainers can keep in our “box of tools”. This information is probably of the highest value to those covering high school and club or recreational events.
The author properly summarizes at the end that a tuning fork and stethoscope cannot and should not be used in isolation when a fracture is suspected. Thorough evaluation and sound clinical judgment must be employed.
In closing, this study does validate the use of this methodology when assessing potential fractures. If this technique can help you to provide better information to your athletes and their parents, the it should be added to your toolbox.
Especially for those potential fractures that are assessed as positive, the reliability of this study gives you some additional firepower if you will to try and convince someone who may be more unwilling to seek additional care.
At the end of the day, this technique should be able to enhance your decision making process so that those in your care can receive the best assessment information possible.
What are your thoughts? Have you ever used this technique before and what have the results been? Feel free to share your experiences with the group.
Photo Credit by Biology Big Brother
