Patellar Pubic Percussion Test | Occult Hip Fracture Screening

Hip fractures will usually present clearly with pain in the upper leg and the patient reports adequate trauma during patient history taking, plus a painfully limited range of motion. Plain radiographs easily reveal the site of the fracture and the patient can be managed accordingly. Some fractures though are occult, meaning they don’t appear easily on radiographs, which is what the patellar pubic percussion test assesses for.

In their systematic review from the year 2013, Reiman et al. report a pooled sensitivity of 95% and specificity of 86%. More recently Smeets et al. from 2018 assessed 191 patients with suspected occult hip or pelvic fractures and reported a sensitivity of 85% and specificity of 70% with an inter-observer reliability of 0.7 which is why we give it a high clinical value in the diagnosis of hip related fractures.

To conduct the test you will need a stethoscope. The patient lies in supine position and you will place the bell of the stethoscope on the pelvis lateral to the pubic symphysis on the pubic tubercle of the site you want to examine.
Then tap on the patella and look for a distinct sharp sound which would indicate a negative test.
In case of a positive test possibly indicative of a fracture, the sound would be dull. Compare your findings with the other side

Alternatively, you can use a 128 Hertz tuning fork on the patella or on the femoral condyle.
What you’re examining here is whether the sound is conducted also compared with the other side.

Other common tests to screen for fractures in different body parts are:

• Canadian C-Spine Rules (Cervical Spine)
• Elbow Extension Test (Elbow)
• Caradeniz Wrist Rules (Wrist)
• Supine Sign (Thoracic Spine)
• Closed-Fist Percussion Test (Thoracic Spine)
• Tuning Fork Auscultation Test
• Fulcrum Test (Femur)
• Ottawa Knee Rules (Knee)
• Ottawa Ankle Rules (Ankle & Foot)

Reiman, M. P., Goode, A. P., Hegedus, E. J., Cook, C. E., & Wright, A. A. (2013). Diagnostic accuracy of clinical tests of the hip: a systematic review with meta-analysis. British journal of sports medicine, 47(14), 893-902.

Smeets, S. J. M., Vening, W., Winkes, M. B., Kuijt, G. P., Slooter, G. D., & van Eerten, P. V. (2018). The patellar pubic percussion test (PPPT): A simple bedside tool for suspected occult hip fractures. PERIOPERATIVE CARE OF HIP FRACTURE PATIENTS, 45.