Pubic rami fracture - bilateral

Case contributed by Leonardo Lustosa

Presentation

Motorcycle accident. Polytrauma patient. Pubic symphysis is painful to the touch.

Patient Data

Age: 60 years
Gender: Female
x_ray

The radiograph reveals bilateral pubic rami fractures, both superior and inferior pubic rami are fractured bilaterally, although visualization of the left superior ramus is hampered by a metallic zipper.

The 3D reconstruction of the CT exam allows for better visualization of the bilateral pubic rami fracture. It was confirmed that the left superior pubic ramus is also fractured. The exam revealed a left iliac wing fracture as well.

Case Discussion

Pubic rami fractures are a subgroup of pelvic fractures. Pelvic fractures are related to pelvic trauma with a risk of grave hemorrhage. If a pelvic fracture is suspected, proper physical examination and radiographic studies are extremely important.

The initial radiograph performed on this case was suboptimal, with many metallic artifacts and the transport board difficulting the exam interpretation. The zipper on the patient's pants did not allow for proper assessment of the left superior pubic ramus, which was confirmed by CT.

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