Can tuning forks replace bone scans for identification of tibial stress fractures?
PURPOSE: To compare the performance of the tuning fork test (TFT) with nuclear scintigraphy for the identification of tibial stress fractures. METHODS: Fifty-two patients with a history and physical examination suggestive of tibial stress fracture underwent a TFT followed by a bone scan. The TFT was performed by applying a 128-Hz tuning fork to the anterior surface of the bared tibia. If the patient reported a marked exacerbation or reproduction of shin pain in a localized area of the tibia, the TFT was considered positive. All patients also underwent a bilateral lower-extremity bone scan. RESULTS: The sensitivity and specificity of the tuning fork test were 75 and 67%, respectively. The positive and negative predictive values were 77 and 63%, respectively. The positive and negative likelihood ratios with 95% confidence intervals were 2.33 (1.17-4.60) and 0.34 (0.16-0.71), respectively. CONCLUSION: The tuning fork test is not sensitive enough to rule out a stress fracture on the basis
