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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. |