• Brett A Matzek, Phillip T Fivecoat, and Reis B Ritz.
• Department of Emergency Medicine, Carl R. Darnall Army Medical Center, Fort Hood, TX. Electronic address: brett.a.matzek@us.army.mil.
• Wilderness Environ Med. 2014 Mar 1; 25 (1): 99-102.

BackgroundFracture diagnosis in the austere environment where radiographic tests are not available can be a challenge. In the past, a diagnostic technique has been described using a tuning fork and stethoscope to assess decreased sound conduction in the fractured extremity. In this study, we evaluate the use of a cellular phone's vibrate function and a stethoscope to limit equipment carried by expeditionary practitioners.ObjectiveThe purpose of this study was to evaluate the accuracy of fracture diagnosis using a cellular phone and stethoscope.MethodsThis is a pilot study to assess the usefulness of the above technique before clinical implementation. In 3 cadavers, we created fractures of the humerus and femur. Twenty-seven emergency medicine residents and an attending physician performed the diagnostic technique.ResultsOverall, the use of the cellular phone and stethoscope resulted in a sensitivity of 73% (95% confidence interval [CI]: 0.64 to 0.81) and a specificity of 83% (95% CI: 0.77 to 0.88), with a positive predicted value of 68% (95% CI: 0.59 to 0.77) and a negative predicted value of 86% (95% CI: 0.81 to 0.90). Positive likelihood ratio was 4.3, and negative likelihood ratio was 0.32.ConclusionsThe use of a cellular phone and stethoscope may be a useful tool for the diagnosis of fractures in the austere environment. However, further study is needed to validate these findings in the clinical environment.Published by Wilderness Medical Society on behalf of Wilderness Medical Society.

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