title: The use of a tuning fork and stethoscope to identify fractures.
abstract: BACKGROUND
  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.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  University athletic training room or local orthopaedic center when fractures were suspected.
  
  
  METHODS
  A total of 37 patients (19 males, 18 females) volunteered.
  
  
  METHODS
  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.
authors.affiliation: Radford University, Radford, VA, USA. mbmoore@radford.edu
authors.forename: Michael Bryan
authors.initials: MB
authors.lastname: Moore