Context: Fractures in the elderly are common in primary care settings. In situations such as home visits where diagnostic imaging cannot be performed immediately, history and physical examination are key to suspecting a fracture. Auscultatory percussion is a method for evaluating bone fractures in which the examiner evaluates differences in sound between fractured and intact bones. This evaluation is somewhat subjective. Visualizing the waveform of the percussed sound in a smartphone recording application, for example Voice Memos on the iPhone, is objective and may be effective for examining fractures.
Objective: To examine the difference in the vibration waveform, including the amplitude and range, during auscultatory percussion of fractured versus intact bones among patients with a proximal femoral fracture using a smartphone
Study Design: Observational research
Setting: An acute-care hospital in Ibaraki Prefecture, Japan
Population studied: Participants were hospitalized for a unilateral proximal femoral fracture between November 2019 and March 2020. In order to eliminate other factors associated with the waveform, we excluded cases involving pelvic or patella fractures, artificial materials already placed in the femur, defects beyond the hip joint, and the presence of acute complications such as infections in the pelvis or lower extremities.
Intervention: EH (first author) examined all of the hospitalized patients. A smartphone (iPhone 8 Plus) was placed vertically on the patient’s pubic area with the patient in the supine position. As the examiner, EH standardized the procedure of percussing the patella of the fractured and intact bones manually and with a hammer. The sound was recorded with Voice Memos. Patient age, sex, fracture site and severity, height, weight, leg length, and number of days from the injury to evaluation were recorded.
Outcome Measures: Difference in the vibration waveform during auscultatory percussion of the fractured and intact bones in Voice Memos.
Results: Twenty patients were examined. The mean age was 82.2 years and 80% were female. The fractured side had a smaller amplitude and lower range than the intact side. Acoustic analysis is in progress.
Conclusions: Auscultatory percussion using a smartphone application may be an effective method for assessing proximal femur fractures.