Detection of posterior pelvic injuries in fractures of the pubic rami

Background: Fractures of the pubic rami are associated with prolonged pain, bed rest and increased morbidity and mortality. Often no further diagnostic work-up is undertaken and the pubic rami fractures are classified as stable injuries. However, fractured pubic rami seem to be only part of the picture and are often associated with posterior pelvic ring injury. This retrospective study was designed to evaluate the posterior ring for undetected injury in patients diagnosed with pubic rami fractures. Methods: All patients (n = 233) with diagnosed fractures of the pubic rami were retrospectively retrieved. All patients with a CT scan available at time of admission (n = 177) were included in the study. Results: In 28.8% of the cases a fracture of the acetabulum was found additionally to the pubic rami. In cases without obvious other injury of the ap radiograph, an injury of the posterior pelvic ring was found on CT scans in 96.8% of the patients. Most lesions represented transforaminal sacral fractures, avulsion fractures of ligaments or compression fractures of the lateral mass. All patients with dorsal injuries could initially be treated conservatively, nevertheless 30% of them needed operative treatment in the course. Conclusion: Nearly all cases with fractures of the pubic rami do have a lesion elsewhere within the pelvic ring. In patients with prolonged pain and immobility following 'pubic rami fractures' one should be aware that they probably represent an undiagnosed pelvic ring injury and further diagnostic work-up sometimes even surgery - is warranted. (C) 2012 Elsevier Ltd. All rights reserved.