The titles and abstracts of all search results were screened by two authors (KM and JD) and full manuscripts for all potential relevant papers were obtained. We selected studies in a two-stage process. The aim of this review was to identify the techniques used to diagnose fractures using a tuning fork and assess all studies of the diagnostic accuracy of tuning fork tests for the presence of fracture. Using a stethoscope to listen to the sound over a bony prominence proximal to the fracture site, the fracture is detected by a reduction in the sound conducted along the bone compared to the unaffected limb. The second method uses a vibrating tuning fork placed over a bony prominence distal to the fracture site. 2 The pain stops or decreases with the removal of the tuning fork. Because the periosteum is heavily innervated, mechanical vibration over a fracture site stimulates the overlying periosteum, causing pain. The first method uses a vibrating tuning fork placed directly over, or closely proximal to the suspected fracture site. Two methods of using tuning forks to detect fracture(s) have been developed. One test which was proposed at least 60 years ago is the use of a tuning fork. Other clinical tests for fracture may then assist in decision making. Although imaging for suspected fractures is generally cheap and readily accessible, there are situations such as remote settings, where imaging is not readily available.
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