The Patellar-Pubic Percussion Test is a bedside screening test that compares sound transmission through the femur and pelvis. A reduced or altered sound on the symptomatic side may increase suspicion of a fracture or bony disruption, but the test should not replace imaging or urgent referral when fracture is suspected. Because the most commonly cited diagnostic accuracy evidence appears older than 2020, this article does not list older sensitivity or specificity values.
An older adult presents after a fall and reports hip pain with difficulty weight bearing. Initial movement is limited by pain, and there is concern about possible fracture. The Patellar-Pubic Percussion Test may be used as a quick adjunctive screen, but it should never delay imaging or referral when clinical suspicion is high.
Hip fracture assessment is safety-critical. A negative bedside test should not reassure the professional when the history, pain and weight-bearing status remain concerning.
Test name: Patellar-Pubic Percussion Test
Also known as: PPPT
Body region: Hip, femur and pelvis
Purpose: Assess sound transmission through the femur and pelvis
Commonly associated with: Suspected hip fracture, femoral fracture or occult fracture screening
Positive finding: Diminished, altered or asymmetric percussion sound compared with the other side
Negative finding: Similar sound transmission bilaterally
Best used with: History, trauma mechanism, weight-bearing status, pain location, imaging referral and medical assessment
Key limitation: Should not replace imaging or urgent medical review
The Patellar-Pubic Percussion Test assesses sound transmission through bone. The examiner places a stethoscope over the pubic symphysis and taps the patella. Sound quality is compared between sides.
The principle is that bony disruption may alter sound transmission. However, the test is only an adjunctive screening tool.
It may be used when fracture is suspected and a quick comparison of sound transmission is desired.
It may help guide urgency of further assessment, but it should not replace imaging.
The test assesses side-to-side sound transmission through the femur and pelvis. It does not directly visualise bone and does not confirm fracture.
This test may be relevant in clients with traumatic hip pain, older adults after a fall, clients unable to weight bear or cases where occult fracture is being considered.
Use only when it is safe to position the client and when the result will not delay appropriate medical assessment.
Do not use as a replacement for imaging. Be cautious with severe pain, obvious deformity, inability to tolerate position, suspected acute fracture, major trauma or unstable medical status.
Stethoscope
Pain scale
Measurz recording workflow
Referral or escalation notes where appropriate
Position the client supine if tolerated.
The legs are relaxed and supported.
Stand beside the client.
Place the stethoscope diaphragm over the pubic symphysis.
Keep the client still and comfortable.
Gently tap the patella on one side, then the other, using comparable force.
Ask the client to remain relaxed and report pain.
A positive test is an asymmetric, reduced, dull or altered sound on the symptomatic side compared with the other side.
A negative test is similar sound transmission bilaterally.
Stop if the client has pain, distress, guarding or cannot tolerate the position.
Do not use repeated tapping. Do not delay imaging or urgent assessment when fracture is suspected.
A positive test may increase suspicion of bony disruption when the clinical context suggests fracture. It does not confirm fracture.
A negative test does not exclude fracture, particularly when the client has trauma history, inability to weight bear, severe pain, older age or other red flags.
The safest interpretation is to use the result as an adjunct to history, pain behaviour, weight-bearing status and imaging decision-making.
The most commonly cited diagnostic accuracy evidence for the Patellar-Pubic Percussion Test appears to come from studies older than 2020. Because you requested references from 2020 and above only, older sensitivity and specificity values are not listed here.
High-quality 2020+ diagnostic accuracy evidence for the exact PPPT appears limited. Therefore, no sensitivity, specificity or likelihood ratio values are included.
Current 2020+ reliability evidence for the exact PPPT appears limited. Reliability may be affected by examiner tapping force, stethoscope position, ambient noise, client body position and subjective interpretation of sound quality.
Common errors include tapping with inconsistent force, using the test instead of imaging, interpreting a negative result as clearance, not comparing sides, failing to record pain and performing the test despite obvious need for urgent referral.
Limitations include subjective sound interpretation, limited current evidence, poor applicability when the client cannot tolerate positioning and safety concerns in suspected fracture presentations.
Use PPPT only as an adjunctive screening tool. When fracture suspicion is high, prioritise medical assessment and imaging.
Record test name, side tested, result, pain score, symptom location, sound quality, comparison side, client position, tapping method, confidence in result, irritability, reason for stopping and referral or escalation notes.
Add weight-bearing status, trauma mechanism, pain location, hip ROM tolerance and whether further assessment was recommended.
Hip Quadrant Test
Fulcrum Test
Straight Leg Raise Test
Hip Range of Motion Tests
Gait Assessment
Balance Assessment
It assesses sound transmission through the femur and pelvis.
No. It may support suspicion but does not confirm fracture.
No. A negative result does not exclude fracture when history or symptoms remain concerning.
Yes, when clinical suspicion is high, imaging or medical assessment should not be delayed.
PPPT is an adjunctive bedside screening test.
A positive result may increase suspicion of bony disruption.
A negative result does not exclude fracture.
Do not use this test to replace imaging or urgent medical review.
Record sound quality, side, pain and referral reasoning.
American Family Physician. (2024). Bone stress injuries: Diagnosis and management. American Family Physician.
Malek, I. A., & colleagues. (2024). Diagnostic evaluation of stress injuries of the hip using MR imaging. Magnetic Resonance Imaging Clinics of North America. Needs verification.
