Patellar-Pubic Percussion Test: Difference between revisions

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'''Original Editor '''- [[User:Michael Conaway|Michael Conaway]]  
'''Original Editor '''- [[User:Michael Conaway|Michael Conaway]]  


'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}      
'''Top Contributors''' - {{Special:Contributors/{{FULLPAGENAME}}}}   
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== Purpose<br>  ==
 
== Purpose ==


To identify occult hip fractures.  
To identify occult hip fractures.  
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== Technique  ==
== Technique  ==


[[Image:Patellar-pubic percussion test.JPG|right|300px|Photo: Mike Conaway]]
The Patellar-Pubic Percussion Test is a form of Osteophony or auscultatory percussion which is used in the assessment of bone integrity by analyzing its vibrations through the use of a stethoscope and bony prominence percussion.<ref name="Borgerding et al">Borgerding LJ, Kikillus PJ, Boissonnault WG. Use of the Patellar-Pubic Percussion Test in the Diagnosis and Management of a Patient with a Non-Displaced Hip Fracture. J Manual and Manipulative Therapy.2007;15:E78-E84.</ref>  
 
The Patellar-Pubic Percussion Test is a form of Osteophony or auscultatory percussion which is used in the assessment of bone integrity by analyzing its vibrations through the use of a stethascope and bony prominence percussion.<ref name="Tiru et al">Tiru M, Goh SH, Low BY. Use of percussion as a screening tool in the diagnosis of occult hip fractures. Singapore Med J 2002;43:467-469.</ref>&nbsp; The patient is positioned in supine and the bell of the stethascope is placed on the pubic symphysis, held in place by the patient.&nbsp; The patient's legs are positioned symmetrically and extended while the clinician percusses each patella.&nbsp; The clinician stabilizes the patella, insuring that the leg being tested remains in the neutral position.&nbsp; The clinician compares the sounds from each leg for differences in pitch and loudness.&nbsp; These sounds should be equal in the case of normal bony structure.&nbsp; If there is a bony disruption, the affected side will have a duller, more diminished sound when compared to the unaffected side.<ref name="Borgerding et al">Borgerding LJ, Kikillus PJ, Boissonnault WG. Use of the Patellar-Pubic Percussion Test in the Diagnosis and Management of a Patient with a Non-Displaced Hip Fracture. J Manual and Manipulative Therapy.2007;15:E78-E84.</ref>  
 
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{{#ev:youtube|bZccYojlDvQ|400}} <ref>BJSM Videos. Patellar pubic percussion test, with Mike Reiman. Available from: http://www.youtube.com/watch?v=bZccYojlDvQ [last accessed 25/01/14]</ref>


== Evidence<br> ==
== Sensitivity/Specificity ==
Tiru et al<ref name="Tiru et al">Tiru M, Goh SH, Low BY. Use of percussion as a screening tool in the diagnosis of occult hip fractures. Singapore Med J 2002;43:467-469.</ref> found a sensitivity of .96 and a specificity of .86 for the PPPT in the diagnosis of femoral neck fractures.


{| width="40%" cellspacing="1" cellpadding="1" border="0" align="right" class="FCK__ShowTableBorders"
== Evidence  ==
|-
| align="right" |
| {{#ev:youtube|bZccYojlDvQ|250}} <ref>BJSM Videos. Patellar pubic percussion test, with Mike Reiman. Available from: http://www.youtube.com/watch?v=bZccYojlDvQ [last accessed 25/01/14]</ref>
|}


In the United States hip fractures have a yearly incidence of about 300,000.&nbsp; This number is expected to double or possibly triple by the year 2040.&nbsp; Morbidity and mortality are reported to be as high as 14-36% in the first year after injury.<ref name="Perron et al">Perron AD, Miller MD, Brady WJ. Orthopedic Pitfalls in the ED: Radiographically occult hip fracture. Am J Emerg Med 2002;20:234-237.</ref><ref name="Brunner et al">Brunner LC, Eshilian-Oates L, Duo TY. Hip Fractures in adults.Am Fam Phys 2003;68:537-542.</ref>&nbsp; In 2-10% of those patients that present to the ER with a painful hip after trauma, initial radiographs will not show the occult fracture.<ref name="Lubovsky et al">Lubovsky O, Liebergall M, Mattan Y, Weil Y, Moshieff R. Early diagnosis of occult hip fractures: MRI versus CT scan. Injury Int J Care Injured 2005;36:788-792.</ref>&nbsp; Adams and Yarnold<ref name="Adams et al">Adams SL, Yarnold PR. Clinical use of the patellar pubic percussion sign in hip trauma. Am J Emerg Med 1997;15:173-175.</ref>&nbsp;reported an interrater agreement of 90.2% for the PPPT.&nbsp; In a study of 290 patients with post-traumatic hip pain, inablility to ambulate due to pain and negative radiographs, Tiru et al<ref name="Tiru et al">Tiru M, Goh SH, Low BY. Use of percussion as a screening tool in the diagnosis of occult hip fractures. Singapore Med J 2002;43:467-469.</ref>&nbsp;found a sensitivity of .96 and a specificity of .86 for the PPPT in the diagnosis of femoral neck fractures.
In the United States hip fractures have a yearly incidence of about 300,000.&nbsp; This number is expected to double or possibly triple by the year 2040.&nbsp; Morbidity and mortality are reported to be as high as 14-36% in the first year after injury.<ref name="Perron et al">Perron AD, Miller MD, Brady WJ. Orthopedic Pitfalls in the ED: Radiographically occult hip fracture. Am J Emerg Med 2002;20:234-237.</ref><ref name="Brunner et al">Brunner LC, Eshilian-Oates L, Duo TY. Hip Fractures in adults.Am Fam Phys 2003;68:537-542.</ref> In 2-10% of those patients that present to the ER with a painful hip after trauma, initial radiographs will not show the occult fracture.<ref name="Lubovsky et al">Lubovsky O, Liebergall M, Mattan Y, Weil Y, Moshieff R. Early diagnosis of occult hip fractures: MRI versus CT scan. Injury Int J Care Injured 2005;36:788-792.</ref> Adams et al<ref name="Adams et al">Adams SL, Yarnold PR. Clinical use of the patellar pubic percussion sign in hip trauma. Am J Emerg Med 1997;15:173-175.</ref> reported an interrater agreement of 90.2% for the PPPT.  


== Resources  ==
add any relevant resources here
== Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed])  ==
<div class="researchbox"><rss>http://eutils.ncbi.nlm.nih.gov/entrez/eutils/erss.cgi?rss_guid=1-u-VnOuHrrCiN4uNBhKFassUPc2VzIQL54Pm2oHlxLagOJYxB</rss> </div>
== References  ==
== References  ==
<references />


References will automatically be added here, see [[Adding References|adding references tutorial]]. <references /><br>
[[Category:Assessment]]  
 
[[Category:EIM_Residency_Project]]  
  [[Category:Assessment]] [[Category:EIM_Residency_Project]] [[Category:Hip]] [[Category:Musculoskeletal/Orthopaedics]] [[Category:Special_Tests]]
[[Category:Hip]]  
[[Category:Musculoskeletal/Orthopaedics]]  
[[Category:Special_Tests]]
[[Category:Primary Contact]]
[[Category:Hip - Assessment and Examination]]
[[Category:Hip - Special Tests]]

Latest revision as of 00:47, 3 May 2021

Original Editor - Michael Conaway

Top Contributors - Admin, Michael Conaway, Kim Jackson, Fasuba Ayobami, Laura Ritchie, WikiSysop, Evan Thomas, Kai A. Sigel, Claire Knott, 127.0.0.1 and Tony Lowe

Purpose[edit | edit source]

To identify occult hip fractures.

Photo: Mike Conaway


Technique[edit | edit source]

The Patellar-Pubic Percussion Test is a form of Osteophony or auscultatory percussion which is used in the assessment of bone integrity by analyzing its vibrations through the use of a stethoscope and bony prominence percussion.[1]

[2]

Sensitivity/Specificity[edit | edit source]

Tiru et al[3] found a sensitivity of .96 and a specificity of .86 for the PPPT in the diagnosis of femoral neck fractures.

Evidence[edit | edit source]

In the United States hip fractures have a yearly incidence of about 300,000.  This number is expected to double or possibly triple by the year 2040.  Morbidity and mortality are reported to be as high as 14-36% in the first year after injury.[4][5] In 2-10% of those patients that present to the ER with a painful hip after trauma, initial radiographs will not show the occult fracture.[6] Adams et al[7] reported an interrater agreement of 90.2% for the PPPT.

References[edit | edit source]

  1. ↑ Borgerding LJ, Kikillus PJ, Boissonnault WG. Use of the Patellar-Pubic Percussion Test in the Diagnosis and Management of a Patient with a Non-Displaced Hip Fracture. J Manual and Manipulative Therapy.2007;15:E78-E84.
  2. ↑ BJSM Videos. Patellar pubic percussion test, with Mike Reiman. Available from: http://www.youtube.com/watch?v=bZccYojlDvQ [last accessed 25/01/14]
  3. ↑ Tiru M, Goh SH, Low BY. Use of percussion as a screening tool in the diagnosis of occult hip fractures. Singapore Med J 2002;43:467-469.
  4. ↑ Perron AD, Miller MD, Brady WJ. Orthopedic Pitfalls in the ED: Radiographically occult hip fracture. Am J Emerg Med 2002;20:234-237.
  5. ↑ Brunner LC, Eshilian-Oates L, Duo TY. Hip Fractures in adults.Am Fam Phys 2003;68:537-542.
  6. ↑ Lubovsky O, Liebergall M, Mattan Y, Weil Y, Moshieff R. Early diagnosis of occult hip fractures: MRI versus CT scan. Injury Int J Care Injured 2005;36:788-792.
  7. ↑ Adams SL, Yarnold PR. Clinical use of the patellar pubic percussion sign in hip trauma. Am J Emerg Med 1997;15:173-175.
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