From the Guidelines
The treatment plan for an inferior ramus fracture typically involves conservative management with simple immobilization, as surgery is usually reserved for cases with significant displacement or other complicating factors 1. When managing an inferior ramus fracture, the primary goal is to minimize morbidity, mortality, and improve quality of life.
- Pain control is crucial and can be achieved with acetaminophen 650-1000mg every 6 hours and/or NSAIDs like ibuprofen 400-600mg every 6-8 hours as needed, unless contraindicated.
- Weight-bearing should be limited initially, with progression to partial weight-bearing with assistive devices (crutches or walker) as tolerated over 4-6 weeks.
- Physical therapy should begin within 1-2 weeks to maintain muscle strength and joint mobility.
- Most inferior ramus fractures heal well without surgery in 6-8 weeks due to the stable nature of these fractures and the strong surrounding musculature that limits displacement.
- Surgery is rarely needed unless there is significant displacement, multiple pelvic fractures, or instability, as noted in the American College of Foot and Ankle Surgeons guidelines 1.
- Regular follow-up with orthopedics at 2,6, and 12 weeks is recommended to monitor healing progress with appropriate imaging, such as CT scans, which can provide detailed images of the fracture and surrounding structures 1.
- Patients should be advised that deep vein thrombosis prophylaxis may be necessary depending on mobility status and risk factors.
From the Research
Treatment Options for Inferior Ramus Fractures
- Minimally invasive screw fixation can be an effective treatment option for inferior pubic ramus stress fracture nonunion, as seen in a case report where a 51-year-old female runner was successfully treated with percutaneous screw fixation after 11 months of symptoms and 10 months of nonoperative treatment 2.
- Plate fixation of the inferior ramus of the pubis-ischium ramus can improve mechanical stability in Tile B pelvic injuries, with a cadaveric biomechanical analysis and early clinical experience showing better pelvic ring stability and earlier weight-bearing functional exercise in patients who underwent combined superior and inferior ramus fixation compared to those who underwent only superior ramus fixation 3.
- Intramedullary screw fixation may be a better option than superior ramus plating for unstable lateral compression pelvic ring injuries, with a biomechanical comparison study showing lower average displacement and angulation of the superior and inferior rami osteotomies with retrograde superior ramus screw fixation 4.
Minimally Invasive Treatment
- Minimally invasive treatment can be effective for pubic ramus fractures combined with a sacroiliac joint complex injury, with a study showing satisfactory efficacy and low complication rates in 15 patients treated with this technique 5.
- Minimally invasive treatment options can provide satisfactory outcomes for patients with inferior ramus fractures, with studies showing successful treatment of stress fracture nonunion and improved mechanical stability in pelvic injuries 2, 3.
Pain Management
- Pain management strategies for fractures, including inferior ramus fractures, can involve multimodal pain control, with the use of NSAIDs, regional anesthesia, and other techniques to manage pain and improve outcomes 6.
- The management of pain associated with fractures is complex and multifactorial, requiring nuanced clinical judgment and individualized treatment plans 6.