Patellar-Pubic Percussion Test

Original Editor - Michael Conaway

Top Contributors - Kim Jackson

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]


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: [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.