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International Orthopaedics

, Volume 42, Issue 11, pp 2521–2524 | Cite as

The patellar pubic percussion test: a simple bedside tool for suspected occult hip fractures

  • Stef Jozef Marie Smeets
  • Wouter Vening
  • Michiel Bernard Winkes
  • Gerrit Paulus Kuijt
  • Gerrit Dirk Slooter
  • Percival Victor van Eerten
Original Paper

Abstract

Purpose

Patellar finger tapping produces a typical sound that can be detected by a stethoscope positioned on the pubic bone (patellar pubic percussion test (PPPT)). Characteristics of this sound are determined by continuity of bone between patella and pelvis. We hypothesized that a PPPT was able to detect overt hip fractures and occult hip fractures that may not be determined by a standard radiological examination.

Methods

Two independent observers performed a PPPT in patients with a suspected hip or pelvic fracture, just before a conventional radiograph (X-ray) was performed. The PPPT test was scored as negative (similar to contralateral side) or positive (different). Patients with a positive PPPT but with a negative X-ray underwent an additional CT scan.

Results

One hundred and ninety-one patients with suspected hip or pelvic fracture were included. A total of 161 patients (84%) were diagnosed with a fracture (hip, n = 142; pelvic, n = 19). An 85% sensitivity, a 70% specificity, a 0.94 positive predictive value, and a 0.47 negative predictive value of the PTTT were calculated. The inter-observer reliability (kappa) was 0.7. Eleven CT scans as indicated by a mismatch between PPPT (positive) and X-ray (no fracture) identified eight fractures (73%). A multivariate analysis demonstrated that a painful passive movement and the PPPT predicted a hip fracture.

Conclusion

The PPPT is a simple bedside diagnostic tool that is sensitive in detecting clinically straight forward hip fractures as well as occult hip fractures. The PPPT can support decision-making for additional radiological examinations in case of potential occult pelvis or hip fractures.

Keywords

Patellar pubic percussion test (PPPT) Occult hip fracture 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

264_2018_4036_MOESM1_ESM.mov (8.1 mb)
ESM 1 (MOV 8278 kb)

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  1. 1.Máxima Medical CenterVeldhovenThe Netherlands
  2. 2.RijnstateArnhemThe Netherlands

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