Clinical use of the patellar-pubic percussion sign in hip trauma

Stephen L. Adams*, Paul R. Yarnold

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

12 Scopus citations

Abstract

To assess the reliability and validity of osteophony (patellar-pubic percussion [PPP] test) as a physical diagnostic sign in the evaluation of hip trauma, a prospective study was undertaken of 41 consecutive patients presenting to the emergency department with a history of hip trauma necessitating radiographic examination. Fifteen of 19 (78.9%) patients who presented with a history of hip trauma and a fracture on radiograph were found to have had an abnormal PPP sign by at least one of two raters (P < .0001). Only 1 of 22 (4.6%) patients without evidence of fracture (eg, contusion) had an abnormal PPP sign. This patient had diffuse Paget's disease. Nine of 10 (90%) patients who had trochanteric fractures had an abnormal PPP sign (P < .02). Overall reliability of the PPP sign based on two observers was 90.2% (P < .0001). In those patients with radiographic evidence of fracture, interrater reliability was 84.2% (P < .0001). For patients in whom physicians agreed on the PPP sign, the PPP test resulted in a 0% false- positive error and a 25% false-negative error. For patients in whom either physician noted an abnormal PPP sign, the PPP test resulted in a 4.6% false- positive error and a 21.1% false-negative error. The presence of an abnormal PPP sign in the evaluation of hip trauma is associated with evidence of fracture or other bony abnormality on radiograph.

Original languageEnglish (US)
Pages (from-to)173-175
Number of pages3
JournalAmerican Journal of Emergency Medicine
Volume15
Issue number2
DOIs
StatePublished - Jan 1 1997

Keywords

  • Hip trauma
  • osteophony
  • patellar-pubic percussion sign
  • physical examination

ASJC Scopus subject areas

  • Emergency Medicine

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