An initial radiograph preformed in the emergency department revealed a left
pubic rami fracture (Figure 1).
37) With weightbearing, the superior
pubic rami and the pubic symphysis act as a compression strut, linking the femur to the posterior pelvic structures and spine, with the centers of rotation being near the pubic symphysis.
He struck a tree while driving home from work and sustained multiple injuries including traumatic ventral hernia, traumatic left testicular hematoma, open bilateral superior and inferior
pubic rami fractures, scalp laceration, nasal bone fractures, and bilateral occipital condyle fractures.
Plain radiographs revealed symmetric fracture zones in both of her superior
pubic rami and inner margins of the femoral neck (Figure 1).
Special investigations included normal blood work and a normal CXR; a whole-body bone scintigraphy study demonstrated multiple osteoblastic metastases in the skull, ribs, both scapulae, the superior and inferior
pubic rami on the left, both femurs and the proximal two-thirds of the right humerus (Fig.
2) revealed extensive pelvic fractures with displaced bilateral superior and inferior
pubic rami fractures and bilateral posterior ring crescent fractures.
The rectus abdominis was incised anteriorly longitudinally, the linea alba was split, and, though both heads of the rectus were elevated from the pubic symphysis, their attachments were maintained to the anterior aspects of the superior
pubic rami.
Various pelvic and hip fractures, including
pubic rami fractures, intratrochanteric fractures, and dashboard fractures are shown.
Since the initial description of a "double vertical" fracture as a combination of
pubic rami fractures and a fracture of the iliac wing by French surgeon Joseph Malgaigne in his 1859 atlas of traumatology, pelvic fractures have received a considerable amount of attention in the orthopaedic literature, having to do with their complexity and associated morbidity and mortality.
Pubic diastasis, localized
pubic rami fractures, or more complex pelvic fractures may be associated with urethral disruption.
There was prominent descent of the bladder base below the level of the inferior
pubic rami, suggesting moderate pelvic floor laxity (Figure 3).
Stress fracture of the
pubic rami following total hip arthroplasty is one possible etiology and is very uncommon.
