![]() This study aims to assess whether the tuning fork can increase the diagnostic accuracy of the Ottawa ankle rules when used on twisting ankle injuries by multiple operators in multiple emergency care settings.Ī mixed methods study conducted in two phases was undertaken. Although the rules are said to have reduced the number of ankle x-rays requested the frequency of fractures in the population still receiving x-rays is only 15% nationally. each image was 1×2 inches in size.Ī used flouroscope is a good x ray option to consider if you want to spend a few grand on extremity images.īeyound that its in the 30k+ range for an entry level used veteranary DR system.Ankle injuries account for 8% of all minor injuries attending emergency departments in the United Kingdom and the Ottawa ankle rules were introduced to assess the need for x-ray in the early 1990s (Stiell et al 1992). I have used 6 images from a dental hand held digital unit to get an ankle film. * there are times and places where a patient has to walk out on a fracture. ![]() The few times I tried it it seemed obvious on big obvious fractures and less so on the hard to find little fractures we are talking about. Probably just opened myself up for some internal medicine joke re surgical secialty services not knowing what a stethoscope is etc…. While I have read about it, I have not used auscultation extensively in the clinic or in the field so I have limited experience to draw from on that technique………. Remmber to test with and without vibration to see if its the vibration that hurts vs the pressure of the tool. This is a good adjunctive test for the im not sure fractures that are out there in austere settings. Most fractures are obvious from the exam. The intensity is more consistant from side to side making it superior for auscultation (will try to dig up the reference on that). If you take a sonnicare or equivilant tooth brush and cut off the brush you can use this as the vibration source as well as a tuning fork. ![]() A diagnostic ultrasound can also be used to try to image the bone for fractures. An ultrasound tool as used in PT for deep tissue work can also light up a fracture with pain. Its an adjunctive test that is not alwase reliable or focal. Its a usefull tool in stress fractures of the foot or tibia. Pain from vibration from a tuning fork strongly suggests a fracture. The tuning fork or ‘ultrasonic’ tooth brush are good adjunctive tools. Different bones take different time frames to heal. If it still hurts 3-10 days later then splint cast or protect it for 6 weeks on average. If in doubt splint it for 3-10 days and make it non wt bearing*, if its pain free then it was likely not broken or is reasonably stable, gentle progression of activities as tolerated avoiding impact for a few more weeks. Palpate gently along the bone feeling for pain or step off, percuss gently then firmly to find the point of most pain. Most fractures can be picked up on by the usual pain swelling or deformity issues. Also, the references from the article cite several other papers that also investigated this technique, which you can review at your leisure. Update: Updated to better reflect the article quoted. Practice so that you know what normal sounds like afterwards, abnormal is quite obvious. But there it is.Īssignment #1: find a tuning fork (they are very cheap on Amazon, and much cheaper than an Xray machine) and actually do this. ![]() I know, I know, I’m breaking my rule about citing data. I’ve not formally tested or published that last bit. My hypothesis is that causes the broken ends of the bone to vibrate against one another, and this caused worsening pain at the fracture site. My patients never complained of dramatically increased pain, just noticeable increased pain, so I did not feel as if I tortured them. My experience with this is that occasionally the vibration of the tuning fork caused increased pain at the site of the break the article above claims this is “painless”.
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