![]() This may be particularly relevant in situations where radiological facilities are not readily available (expedition medicine) or where access to these has to be prioritised (major incidents, natural catastrophes). This study suggests that additional tuning fork testing of "Ottawa positive" patients may lead to a marked reduction in ankle radiographs, with consequently reduced radiation exposure and journey time. The data were significant, with p = 0.014 (TLM) and p<0.001 (DFS). ![]() Hold the tuning fork by the stem, not the prongs. The tuning fork vibrates at a set frequency after being struck on the heel of the hand and is used to assess vibratory sensation and hearing (air conduction and bone conduction). ![]() The associated positive and negative likelihood ratios were 2.59 and 0 (TLM), and 22 and 0 (DFS), respectively. Tuning forks, typically aluminum, consist of a stem (handle) and two prongs that form a U -shaped fork ( Figure 4-13 ). Sensitivity and specificity were calculated as 100% and 61%, respectively, for tuning fork testing on the tip of the lateral malleolus (TLM), and as 100% and 95%, respectively, for testing on the distal fibula shaft (DFS). The observed prevalence of ankle fractures was 5 of 49 (10%). The tuning fork test findings were compared with formal reports of plain ankle radiographs using simple cross-table analysis. A prospective pilot study was carried out, in which a single trained investigator examined all patients with already "Ottawa positive" findings for possible lateral malleolus injury by applying a tuning fork (C(o) 128 Hz). The aim of this study was to determine the suitability of tuning fork testing in combination with existing Ottawa guidance for increasing the specificity in detecting fractures of the lateral malleolus. This is at the cost of a mean specificity of around only 32%. The Ottawa ankle rules are a clinical instrument calibrated towards a high sensitivity in order not to miss any fractures of the ankle or mid-foot. ![]()
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