10 The risk of a fall resulting in a serious injury rises proportionately with a person’s age, with older persons more likely to suffer a significant injury subsequent to fall compared with a younger person. One out of every three community dwelling seniors fall once a year, 7, 8, 9 and this number approaches 50% for those persons over the age of 80 years. Among the most common conditions preferentially affecting older persons is injury and disability subsequent to a fall. 4, 5, 6 This predictable and rapid aging of the population has significant implications to field practitioners as it will greatly influence the proportional frequency of those clinical conditions that preferentially affect older patients encountered in private practice. 3 Moreover, according to these studies, the average chiropractic patients were young to middle age adults, although the demographic group most likely to seek chiropractic care was the Baby Boomers, 1, 2, 3 a cohort group who are aging rapidly and causing a profound alteration to traditional pyramid-shaped population pyramids. 3 Additionally, extremity subluxation/joint dysfunction (3.2/4) and sprain of any joint (3.1/4) were commonly seen. 1, 2 The National Board of Chiropractic Examiners (NBCE) reported similar data, with ‘subluxation/ joint dysfunction’ being the condition most routinely seen in practice (3.9 on a scale of 0–4, with 4 being most commonly seen). Based on recent demographic data, two out of three patients who initially present to a chiropractor have either back pain (41–44%) or neck pain (24–25%). The Positive Predictive Value (PPV) was 85.7% and the Negative Predictive Value (NPV) was 87.It is very common for patients to present to a chiropractor’s office with a chief complaint of spinal pain or disability. Using an amplitude ratio of less than 0.45 as indication of fracture, tuning fork test had a sensitivity of 85.7% and specificity of 87.5% in diagnosis of suspected femoral neck fractures when compared with MRI and clinical monitoring. In patients with extracapsular femoral neck fractures, the mean amplitude ratio of 0.16 (s.d:0.1) was significantly lower when compared with intracapsular fractures (0.26 s.d:0.13, p=0.03). The mean amplitude ratio of sound waves in the control group was 0.91(s.d:0.1), and in patients with femoral neck fractures 0.21(s.d:0.12), this differences were statistically significant (p<Ġ.001). There were 48 females and 17 male patients and the mean age of the study population was 82 years (s.d:8.2 yrs) which was similar in all groups. Results: A total of 65 patients were studied which consisted of 25 patients with femoral neck fractures, 20 patients with suspected femoral neck fractures, and 20 patients served as controls without hip pathology. MRI and clinical progression were used as gold standard test to confirm diagnosis. The amplitude ratio was defined as the proportion of the amplitude height between the fracture side and the normal side for femoral neck fractures, between the right and left side for controls, and between the painful hip and normal side for suspected hip fractures. Data was then transferred by an infrared transmitter to a computer with the 3M Littmann sound analysis software to convert the sound to a universally recognised format * (wav) for audio feedback and visual display (phonocardiogram) as amplitude height. Methodology: Sound waves generated by 125 Hz tuning fork was placed on both patella and then stored on the 3M Electronic Stethoscope Model 4000 placed at both anterior superior iliac spines. Objectives: The objective of this study was to assess the reliability of measured sound waves amplitude using the 3M Littmann Sound Analysis Software as a diagnostic tool in suspected femoral neck fractures.
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