Objective To assess the sensitivity of two musculoskeletal tests as primary examination for on site use.

Methods I searched through electronic search engines for articles ranging from 2000 to 2010. I used the key words: ankle injuries, ankle examination, ankle assessment and tuning fork.

Data synthesis Ankle injuries are a common injury in sport accounting for 15–45% of all sport injuries. 85% of all ankle injuries concern the lateral ankle complex. However differential diagnosis suggests the examination of fractures such as at the malleolus, fifth metatarsal, navicular, anterior calcaneus process and at the midtarsal bones. During sport events in the misfortune incidence of an ankle injury physicians are required to assess their athletes. However according to each games rules and situation they are required to assess in shortest time possible.

Ottawa ankle rules (OAR) have been suggested to have a high sensitivity to detect to assess fractures (Northrup et al 2005; Papacostas et al 2001). Papacostas et al (2001) examined 122 patients and found 100% sensitivity for maleolar and midfoot fractures when applied the OAR. Leddy et al (2002) found 100% sensitivity in 217 patients applying the OAR-Buffalo modification. Moore (2009) found high sensitivity (n=10) using a tuning fork for the detection of transverse fractures. Further is suggested that the use of a tuning fork is an fast and reliable method to assess possible fractures (Moore 2009).

Conclusion We believe that the combination of those two tools can provide a clear and fast initial evaluation during an event. Nevertheless in a clinical or on site setting can further increase reliability for assessing fractures where x-ray is not available. However, further investigation is required regarding the reliability of the tuning fork in assessing fractures, reliability of the examiner and time required to complete the progressive examination.