The improved predictive values, both positive and negative, of using c-TnI can improve our diagnostic capabilities when symptoms suggest acute myocardial infarction, and this improved capability can save lives through early intervention. Unfortunately, we are not readily discarding the older, less specific tests as the newer, more specific types become available. As budget restraints increase, clinical tools are regaining attractiveness. Some years ago, Carter 2 published in a letter to the editor a simple clinical method to diagnose bone fractures of the femur and pelvis, based on physical laws of sound transmission. I undertook an investigation to prospectively evaluate the feasibility and validity of the auscultatory technique in 102 consecutive cases of bone fractures.
Bone is a better sound transmitter than muscle or fatty tissue and dampens sound transmission less.
To evaluate possible fractures of various tubular bones, the stethoscope is positioned in close proximity to the suspected fracture. Distal to the suspected region, sounds are elicited by tapping a fingernail or fingertip against prominent bony structures, the fingernails or the toenails of the patient. The elicited sounds are then compared with the same procedure on an anatomically comparable region. After defining the suspected fracture region by means of this test, results were noted on a chart. Then, radiographs were reviewed in order to confirm or falsify the test results.