title: Validation of tuning fork test in stress fractures and its comparison with radionuclide bone scan.
abstract: BACKGROUND
  Stress fractures are quite common both in athletes and military recruits. The purpose of the study was to evaluate the efficacy of tuning fork in stress fractures by comparing it with three phase bone scan.
  
  
  METHODS
  The current study examined 55 subjects whose age ranged 18-28 years. X-rays of all the subjects were unremarkable. After history and clinical examination tuning fork test (TFT) was performed on each case by placing 128 Hertz vibrating tuning fork on the site of pain (underlying bony surface) of tibia or fibula. Each case was scanned using triple phase bone scintigraphy.
  
  
  RESULTS
  Fifty-five patients had a total of 67 stress fractures, out of which 53 were picked up by TFT. Sensitivity of TFT was found to be 79% and specificity of 63%. Positive and negative predictive values were 88% and 46% respectively.
  
  
  CONCLUSIONS
  Tuning fork test is a simple and easy approach of diagnosing stress fractures which can be performed even by athletics and military trainers. Management should be initiated in patients who have history of stress related below-knee pain and positive tuning fork test without waiting for bone scintigraphy. For complicated cases the bone scan is the gold standard for diagnosis.
authors.forename: Syeda Tatheer
authors.initials: ST
authors.lastname: Fatima
authors.forename: Asif
authors.initials: A
authors.lastname: Jeilani
authors.lastname: Mazhar-ud-Duha
authors.forename: Nadeem Zia
authors.initials: NZ
authors.lastname: Abbasi
authors.forename: Amjad Aziz
authors.initials: AA
authors.lastname: Khan
authors.forename: Kamran
authors.initials: K
authors.lastname: Khan
authors.forename: Abdul Samad
authors.initials: AS
authors.lastname: Sheikh
authors.forename: Furqan
authors.initials: F
authors.lastname: Ali
authors.forename: Khalid Hussain
authors.initials: KH
authors.lastname: Memon
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015775:Fractures, Stress / Q000175:diagnosis* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D011877:Radionuclide Imaging; D012680:Sensitivity and Specificity