Pelvic Fracture : Superior and Inferior Rami Fracture 골반 골절: 치골 상하지 골절의 이해

Описание: A fracture involving the superior and inferior rami of the pubic bone is a type of pelvic fracture. The pelvis is a ring-like structure of bones at the base of the spine, composed of three major parts: the ilium, ischium, and pubis. The pubic bone, or pubis, has two branches (rami) - the superior ramus and the inferior ramus - that connect to the ilium and ischium, respectively. These fractures can occur due to high-energy impacts, such as those from motor vehicle accidents or falls from significant heights, but they can also happen due to lower energy mechanisms, especially in older adults with osteoporosis.

Signs and Symptoms
Pain: Located in the groin, hip, or lower abdomen, which may worsen with leg movements.
Swelling and Bruising: Visible swelling and bruising may appear around the site of the injury.
Difficulty Walking: Patients may have trouble standing or walking due to pain.
Potential Urological Issues: Because of the proximity to the bladder and urethra, there may be urinary difficulties in some cases.

Diagnosis
Diagnosis of a pubic ramus fracture typically involves a combination of physical examination and imaging studies:
Physical Exam: The doctor will look for signs of pain, swelling, and bruising in the pelvic area.
X-rays: These are the primary imaging technique used to identify fractures in the pelvis.
CT Scan: For more complex fractures or to assess for associated injuries, a CT scan may be more informative.

Treatment
Treatment depends on the severity of the fracture and whether it's part of a more complex pelvic fracture:

Non-Operative Treatment: Most isolated pubic ramus fractures can be treated non-surgically with rest, pain management, and gradual return to weight-bearing activities as tolerated. Crutches or a walker may be necessary initially to reduce weight-bearing on the injured side.

Operative Treatment: Surgery is rarely needed for isolated pubic ramus fractures unless they are part of a more complex pelvic fracture with instability. In such cases, surgical intervention may be required to stabilize the pelvic ring.

Recovery
Pain Management: Pain typically improves within the first few weeks, and pain management strategies may include medications and physical therapy.
Mobilization: Early mobilization is encouraged to prevent complications such as deep vein thrombosis (DVT) and to promote healing. Weight-bearing as tolerated is often recommended, guided by the patient's pain levels and overall stability of the pelvic ring.
Physical Therapy: Rehabilitation exercises help restore strength and mobility. The duration of recovery can vary, with most patients achieving significant improvement within 6 to 12 weeks.

Monitoring for Complications
While isolated pubic ramus fractures typically have a good prognosis, it's important to monitor for potential complications, including:
Nonunion: Rarely, the fracture may not heal properly, leading to persistent pain.
Associated Injuries: Especially in high-energy traumas, other pelvic injuries or internal organ damage may be present.

It's crucial for patients with suspected pubic ramus fractures to seek medical evaluation to ensure appropriate management and to address any associated injuries.