Hip Orthopaedic Test: Patellar-Pubic Percussion Test

The PPPT is a simple bedside diagnostic tool that is sensitive in detecting clinically straight forward hip fractures as well as occult hip fractures. The PPPT can support decision-making for additional radiological examinations in case of potential occult pelvis or hip fractures.

Procedure for performing the Patellar-Pubic Percussion Test:

1. Have the patient lie flat on their back on an examination table, with their legs extended.
2. Locate the patella (kneecap) on the affected side.
3. Locate the pubic symphysis (the joint where the two sides of the pelvis meet) and place one hand over it.
4. Using the other hand, tap gently but firmly on the patella, while keeping the knee extended.
5. Observe the patient's reaction: If the patient feels pain or discomfort in the hip during the tapping.
6. Repeat the test on the other knee.
7. To increase the sensitivity of the test, the clinician may try to elicit pain by using a tuning fork over the area.

As with any physical examination test, the results should be interpreted in conjunction with other assessment findings and patient history, and a definitive diagnosis may require further imaging or diagnostic testing.

References:

1. Smeets, S.J.M., Vening, W., Winkes, M.B. et al. The patellar pubic percussion test: a simple bedside tool for suspected occult hip fractures. International Orthopaedics (SICOT) 42, 2521–2524 (2018). https://doi.org/10.1007/s00264-018-4036-2