From the Guidelines
A healed old right pubic ramus fracture requires no specific treatment, but maintaining bone health through adequate calcium and vitamin D intake, and regular weight-bearing exercise is crucial to prevent future fractures. This type of fracture commonly occurs in elderly individuals from falls or in younger people from high-energy trauma like car accidents 1. According to the EULAR/EORT recommendations, optimal care in the preoperative, operative, and postoperative phases has an important effect on clinical outcome, and limited mobility and a poor quality of life in the postoperative phase may be associated with an elevated risk of future fractures 1.
To maintain bone health, it is recommended to take:
- Calcium: 1000-1200mg daily
- Vitamin D: 600-800 IU daily Regular weight-bearing exercise, as tolerated, is also essential to prevent future fractures. If you experience any persistent pain in the area, over-the-counter pain relievers like acetaminophen (500-1000mg every 6 hours as needed) may help. The healed fracture might appear on X-rays or other imaging studies as a slight irregularity or thickening of the bone, which is normal and represents the body's natural healing process. This finding is typically incidental and shouldn't cause concern unless you're experiencing symptoms. The management of pelvic trauma, including pubic ramus fractures, must consider the physiological and mechanical derangement, and critical and operative decisions can be taken more effectively if both anatomy of injury and its physiological and mechanical effects are considered 1.
From the Research
Healed Old Right Pubic Ramus Fracture
- A healed old right pubic ramus fracture refers to a fracture of the pubic ramus that has undergone the healing process and is no longer actively fractured.
- According to a study published in 2013 2, fractures of the pubic rami due to low energy trauma are common in the elderly, with an incidence of 26 per 100,000 people per year in those aged more than 60 years.
- The study also found that the fracture lines were healed 12 weeks after surgery, and all patients returned to their pre-injury jobs and lifestyles.
Risk Factors for Nonunion
- A study published in 2024 3 found that initial displacement was a risk factor for nonunion in patients with pubic ramus fractures.
- The study also found that conservative treatment is ineffective in some ramus fracture cases with pelvic ring injury, and active treatment is required if the displacement is ≥ 16 mm.
Heterotopic Ossifications
- A study published in 2021 4 found that heterotopic ossifications can occur in the area of the pubic bone after fractures of the anterior pelvic segment.
- The study identified risk factors for heterotopic "spicule" type ossifications, including male sex, severity of injury, unstable type of fracture, concomitant bladder injury, surgical treatment, and the use of massive implants.
Outcomes in Elderly Patients
- A study published in 2020 5 found that isolated pubic ramus fractures are serious adverse events for elderly persons, with an excess mortality, loss of independence, restricted mobility, and decreased quality of life.
- Another study published in 2001 6 found that patients with a fracture of a pubic ramus had a significantly worse survival than an age-matched cohort from the general population, but this was better than patients with a fracture of the hip during the first year after injury.