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| '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] | | '''Lead Editors''' - Your name will be added here if you are a lead editor on this page. [[Physiopedia:Editors|Read more.]] |
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| == Purpose<br> == | | == Purpose<br> == |
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| To identify occult hip fractures.
| | == Technique<br> == |
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| == Technique<br> ==
| | == Evidence<br> == |
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| 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> The patient is positioned in supine and the bell of the stethascope is placed on the pubic symphysis, held in place by the patient. The patient's legs are positioned symmetrically and extended while the clinician percusses each patella. The clinician stabilizes the patella, insuring that the leg being tested remains in the neutral position. The clinician compares the sounds from each leg for differences in pitch and loudness. These sounds should be equal in the case of normal bony structure. 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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| == Evidence<br> == | |
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| 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.<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 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> reported an interrater agreement of 90.2% for the PPPT. 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> found a sensitivity of .96 and a specificityof .86 for the PPPT in the diagnosis of femoral neck fractures.
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| == Resources == | | == Resources == |
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| == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == | | == Recent Related Research (from [http://www.ncbi.nlm.nih.gov/pubmed/ Pubmed]) == |
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| <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> </div> | | <rss>Feed goes here!!|charset=UTF-8|short|max=10</rss> |
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| == References == | | == References == |
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