Symptoms, Signs, and Diagnosis
The usual mechanism of injury is a fall on level ground. Patients present with pain and are unable to walk. Physical examination reveals localized tenderness in the groin and pain on leg movement. The clinical appearance mimics a proximal femoral fracture; diagnosis is made by x-ray. Usually, only a single ramus is fractured, with the pubic ramus breaking twice as often as the ischiatic ramus. Less commonly, two or more rami fracture, either on the same or on opposite sides of the symphysis pubis.
Normally, the pelvis bears weight mainly on the strong bony arches in the ilium, with the pubic and ischiatic rami acting as secondary tie arches. When the pelvis suffers trauma, the rami tend to fracture first, weakening the secondary tie arches but leaving the main iliac weight-bearing arches intact.
Treatment and Prognosis
Hospitalization is usually required because most patients are initially unable to stand or sit without considerable pain. Analgesics and nonsteroidal anti-inflammatory drugs help. To avoid the complications associated with bed confinement, patients should be encouraged to begin full weight-bearing ambulation as soon as possible. Most are able to walk with a walker by 1 wk. Pubic ramus fractures typically heal without causing permanent functional disabilities.
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