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1.  The Use of a Tuning Fork and Stethoscope to Identify Fractures 
Journal of Athletic Training  2009;44(3):272-274.
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.
PMCID: PMC2681212  PMID: 19478839
false-negative results; false-positive results; assessment; auscultation

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