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Using Tuning-Fork Tests in Diagnosing Fractures.

Chelsey M Toney1, Kenneth E Games1, Zachary K Winkelmann1

  • 1Department of Applied Medicine and Rehabilitation, Indiana State University, Terre Haute.

Journal of Athletic Training
|July 8, 2016
PubMed
Summary
This summary is machine-generated.

Tuning-fork tests show some value in ruling out fractures but lack strong evidence for confirming them in clinical practice. These tests may be useful in remote areas where advanced diagnostics are unavailable.

Keywords:
sensitivitysound transmissionspecificity

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Area of Science:

  • Orthopedics
  • Diagnostic Accuracy Studies

Background:

  • Fracture diagnosis relies on advanced imaging, which may not be accessible in all settings.
  • Tuning fork tests are a low-cost alternative for assessing potential fractures.

Purpose of the Study:

  • To systematically review the evidence supporting the use of tuning fork tests for diagnosing fractures.
  • To evaluate the diagnostic accuracy of tuning fork tests compared to established reference standards.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases (AMED, CINAHL, EMBASE, MEDLINE, SPORTDiscus, Web of Science).
  • Six primary studies involving 329 patients were included, assessing tuning fork tests against reference standards like MRI, radiography, or bone scans.
  • Data on sensitivity, specificity, and likelihood ratios were extracted and analyzed using the QUADAS-2 tool.

Main Results:

  • The review included six studies with patients aged 7–84 years and fracture prevalence from 10% to 80%.
  • Tuning fork tests demonstrated high sensitivity (75%–92%) but variable specificity (18%–94%).
  • Positive likelihood ratios ranged from 1.1 to 16.5, and negative likelihood ratios ranged from 0.09 to 0.49.

Conclusions:

  • Tuning fork tests show potential for ruling out fractures but lack sufficient evidence for definitive diagnosis in clinical practice.
  • The diagnostic accuracy of tuning fork tests is not robust enough for widespread clinical use.
  • These tests may be a viable option in resource-limited rural or remote settings where advanced diagnostic tools are inaccessible.