Anteroposterior radiograph of the pelvis of a 79-year-old woman following a fall reveals left-sided superior and inferior pubic rami fracture.
A 79-year-old woman comes to the emergency department complaining of left-sided hip pain after a fall 3 days previously. She resides at a nursing home and tripped while walking to the bathroom. Anteroposterior radiograph of the pelvis reveals left-sided superior and inferior pubic rami fracture.
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The pelvis is made of 3 bones: the ilium, ischium, and pubis. The pubis, or superior and inferior pubic rami, acts as an anchoring point for the hip adductor muscles. The rectus abdominus muscles also attach on the superior portion of the pubis. The right and left superior and inferior pubic rami are joined together by a disc of fibrocartilage called the symphysis pubis.
Fractures of the superior and inferior pubic rami generally occur as a result of a low-trauma fall in elderly people with poor bone quality. The pelvis is a ring-like structure, and most injuries to one side of the ring are considered stable. Such fractures include iliac wing fractures, sacral fractures, and unilateral superior and inferior pubic rami fractures. Superior and inferior pubic rami fractures can cause significant pain with hip motion and ambulation and often require hospital admission for pain control and inability to ambulate.
Stable pelvic fractures can be treated with weight bearing as tolerated and the use of a walker or other assistive device for gait support. Those with stable fractures should be advised to mobilize early and often to avoid complications such as venous thromboembolism and skin breakdown. Superior and inferior pubic rami fractures typically heal in 6 to 8 weeks, at which time patients can often discontinue using a walker or cane.1,2
In unstable pelvic fractures, the pelvic ring is disrupted in at least 2 places. Unstable fractures may include anterior-posterior compression fractures in which the sacroiliac joint and symphysis pubis are disrupted, lateral compression fractures in which the hemipelvis is pushed inward, and vertical shear fractures in which part of the hemipelvis is shifted upward.2
Dagan Cloutier, MPAS, PA-C, practices in a multispecialty orthopedic group in the southern New Hampshire region and is editor-in-chief of the Journal of Orthopedics for Physician Assistants (JOPA).
Weatherford B. Pelvic ring fractures. http://www.orthobullets.com/trauma/1030/pelvic-ring-fractures Accessed October 25, 2016.
Koval KJ, Zuckerman JD. Handbook of Fractures. 4th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2010.