What is the weight-bearing status for a patient with a fracture of the pubic ramus (pubic bone)?

From the Guidelines

Weight bearing status for pubic rami fractures should begin with protected weight bearing for 1-2 weeks, followed by progressive weight bearing as tolerated, with the goal of achieving full weight bearing within 4-6 weeks, as supported by the principles of early functional rehabilitation for pelvic ring injuries 1.

Key Considerations for Weight Bearing Status

• The primary goal is to balance bone healing with preventing complications of prolonged immobility.
• Pain is the primary guide for progression; patients should not push through significant pain when bearing weight.
• Initially, patients should use assistive devices like walkers or crutches, with touch-down or partial weight bearing (up to 50% of body weight) on the affected side.
• Physical therapy is recommended to improve mobility and strength, starting with gentle range of motion exercises and progressing to strengthening.

Rationale for Weight Bearing Approach

• Pelvic ring injuries with rotational or vertical instability require surgical fixation to achieve anatomic reduction and stable fixation, which is a prerequisite for early functional rehabilitation 1.
• Stable fracture patterns, such as antero-posterior compression type 1 (APC-I) and lateral compression type 1 (LC-I) injuries, are managed non-operatively, allowing functional rehabilitation and early weight bearing 1.
• The approach to weight bearing for pubic rami fractures is guided by the principles of managing pelvic ring injuries, which prioritize early functional rehabilitation to decrease long-term morbidity, chronic pain, and complications associated with prolonged immobilization 1.

From the Research

Weight Bearing Status After Pubic Rami Fracture

• The weight bearing status after a pubic rami fracture is not explicitly stated in the provided studies 2, 3, 4, 5.
• However, the studies suggest that the treatment strategies for pubic rami fractures typically involve pain management and mobilization 2.
• In some cases, minimally invasive techniques may be used to treat pubic ramus fractures combined with sacroiliac joint complex injuries, which can allow patients to return to their pre-injury jobs and lifestyles 3.
• The outcome of pubic rami fractures with or without concomitant involvement of the posterior ring in elderly patients can be significant, with a high risk of complications and mortality 4.
• The management of pelvic fractures, including pubic rami fractures, typically involves initial stabilization, radiographic evaluation, and classification of the pelvic injury, followed by definitive reduction and fixation of the posterior and anterior pelvic ring to restore stability and allow for mobilization and healing 5.

Factors Influencing Weight Bearing Status

• Age is a significant factor influencing the outcome of pubic rami fractures, with older patients being at higher risk of complications and mortality 2, 4.
• The presence of concomitant posterior ring fractures (cPRF) can also influence the outcome of pubic rami fractures, with patients with cPRF having a higher complication rate 4.
• The ambulatory status of patients with pubic rami fractures is also an important factor, with dependent ambulatory status being a strong predictor of 1-year mortality 4.