Pubic and Ischial Ramus Fractures

Pubic ramus fractures are usually caused by a fall on level ground. The pubic and ischial rami on one or both sides of the symphysis pubis may be fractured. Normally, the pelvis bears weight mainly on the strong bony arches in the ilium, with the pubic and ischial rami acting as secondary tie arches. When trauma to the pelvis occurs, the rami tend to fracture first, leaving the iliac arches intact. Patients present with groin pain that may prevent them from walking. However, because the rami are not needed for structural support for walking, weight bearing need not be restricted when the pain eases. The clinical appearance mimics that of a proximal femoral fracture. Localized tenderness in the groin and pain during leg movement suggest the diagnosis; x-rays confirm it. In the presence of osteopenia, an undisplaced pubic ramus fracture may be difficult to diagnose; the fracture can become radiologically visible with callus formation.

Prognosis and Treatment

Pubic ramus fractures typically heal without causing permanent functional disabilities. Most patients feel considerable pain when standing or sitting and should be admitted to a hospital or skilled nursing care facility for monitoring of Hct and vital signs. Analgesics and nonsteroidal anti-inflammatory drugs help relieve pain. To avoid the complications associated with bed rest, patients should begin to walk, bearing weight fully, as soon as possible. Most can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.