title: Vertebral compression fractures--new clinical signs to aid diagnosis.
abstract: BACKGROUND
  Acute osteoporotic vertebral compression fractures are common and usually managed conservatively. However, a significant number will remain symptomatic, causing significant pain with considerable associated morbidity and mortality. These fractures can be effectively treated with cement augmentation. However, it is impossible to distinguish between an acute and a chronic healed fracture on plain radiographs. The definitive investigation is a magnetic resonance scan. The aim of this paper is to describe and evaluate two new clinical signs to help in the diagnosis of symptomatic fractures. A prospective study of 83 patients with suspected acute osteoporotic vertebral compression fractures was carried out. All patients had a full clinical assessment, which included closed-fist percussion of their spine and asking the patient to lie supine on the examination couch. All patients had a MRI scan.
  
  
  RESULTS
  The closed-fist percussion sign had a sensitivity of 87.5% and a specificity of 90%. The supine sign had a sensitivity of 81.25% and a specificity of 93.33%.
  
  
  CONCLUSIONS
  These tests will enable the practitioner to predict more accurately which patients have an acute fracture, guiding referral for further imaging.
authors.affiliation: Spinal Deformity Unit, The Royal National Orthopaedic Hospital, Stanmore, UK. jameslangdon@doctors.org.uk
authors.forename: James
authors.initials: J
authors.lastname: Langdon
authors.forename: Adam
authors.initials: A
authors.lastname: Way
authors.forename: Samuel
authors.initials: S
authors.lastname: Heaton
authors.forename: Jason
authors.initials: J
authors.lastname: Bernard
authors.forename: Sean
authors.initials: S
authors.lastname: Molloy
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D050815:Fractures, Compression / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D010024:Osteoporosis / Q000150:complications; D010474:Percussion / Q000379:methods; D010808:Physical Examination / Q000379:methods; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D016103:Spinal Fractures / Q000175:diagnosis* / Q000209:etiology; D016683:Supine Position