Pubic Rami Fracture: Pathogenesis and clinical findings
Authors: Kaela Schill Reviewers:
M. Patrick Pankow, Tara Shannon, Alyssa Federico, Dr. Linda Mrkonjic* * MD at time of publication
High energy impact
Osteoporosis (most common)
Bone loses calcium, becoming less dense weaker and more susceptible to fracture (See Osteoporosis: pathogenesis and clinical findings slide)
Athletic injury in skeletally immature athletes (e.g., soccer, gymnastics)
Open growth plates are weak and more susceptible to injury
Lateral compression or vertical shear fracture
Mild to moderate osteoporosis
Fragility pubic rami fracture from low-energy impact (e.g., falls from standing, falls in the bathtub)
Severe osteoporosis
Spontaneous pubic rami fracture
Sudden, forceful contraction of the hamstring muscles (e.g. sudden change of direction, sudden stop)
Hamstring pulls a piece of the ischial tuberosity from the pelvis boneàpubic rami avulsion fracture
(Posterior pelvic rim fracture
requires CT to diagnose and is often missed)
Missed or delayed diagnosis due to incomplete workup
Pubic Rami Fracture
Fracture of the anterior pelvic ring, can be the superior and/or inferior pubic rami
Co-existing posterior pelvic ring fracture (e.g. acetabulum, sacrum)
Fracture on both sides of pelvis
Unstable pelvis
Blood vessels in and surrounding the bone rupture during injury
Blood accumulates under the skin
Bruising around fracture site
Inflammatory response to injury
Recruitment of white blood cells and fluid to the area
Swelling around fracture site
Irritation at superior/inferior pubic rami muscle attachment sites (groin and hip abductor muscles)
Pain in groin near fracture site
↑ Displacement and incomplete healing of the posterior and anterior pelvic ring fracture
↑ Morbidity and mortality
↑ Disuse osteoporosis ex: lower limbs, pelvis, and back
↑ Muscle stiffness ex: lower limbs, pelvis, and back
↑ Joint stiffness ex: lower limbs, pelvis, and back
Fracture hematoma in pubic rami
Hematoma distends the periosteum, irritating nerves in the area
Moving/walking further irritates nerves in the area
Moving and walking ↑ pain àinadequate movement
↓ Mobility (to avoid pain)
Antalgic gait (stance phase of walking is shortened relative to swing phase)
Legend:
Pathophysiology
Mechanism
Sign/Symptom/Lab Finding
Complications
Published December 4, 2022 on www.thecalgaryguide.com