A pubic ramus fracture describes a type of crack or break in a person’s pelvis. Pubic ramus fractures are not typically life threatening and typically heal well. However, this kind of fracture can be serious for older people.

A person’s pelvis is a set of bones connecting their trunk to their lower limbs. The pelvis supports a person’s spine, allowing them to walk. The pelvis also helps protect some of the reproductive, digestive, and urinary organs. Pelvic bones include a person’s two hip bones and a pubis bone. A person’s pubic ramus is in a section of their pubis bone.

In this article, we discuss the causes, symptoms, and treatment options for a pubic ramus fracture.

A person’s pubic rami are a group of bones in their lower pelvis. A pubic ramus fracture refers to a break in one of these bones. Depending on where the fracture occurs, a doctor may classify it as a superior or inferior pubic ramus fracture.

There are many potential causes of pubic ramus fractures.

High energy trauma accidents, such as motor accidents, may cause complex pelvic injuries.

However, low energy trauma accidents may also cause people to sustain a pubic ramus fracture. These accidents can involve slips, or small falls from standing height.

Stress fractures can also occur following excessive mechanical stress from a sudden increase in activity, training intensity, or training volume.

Some health conditions may increase a person’s risk of a pubic ramus fracture. For example, conditions that affect bone, such as osteoporosis and osteomalacia, can increase the risk of bone fractures. Additionally, certain medications or treatments, such as radiotherapy, can also weaken bone and increase the risk of fractures.

Older adults are at higher risk of pelvic ramus fractures. Older females are more at risk of pelvic ramus fractures than older males. Most older people with pubic ramus fractures sustain them because of a fall or repeated falls. These falls tend to be from a standing position.

Pelvic fractures are almost always painful. Other symptoms of a pubic ramus fracture can include swelling and bruising in a person’s hip area.

The pelvis plays an important role in movement, which means a person will typically experience discomfort if they:

  • move their hip
  • attempt to walk
  • put weight on their leg

The pelvic bones are close to a person’s internal organs and major blood vessels. As such, people with pelvic fractures may have extensive internal injuries or bleeding.

Doctors can use various imaging methods to diagnose a person’s pubic ramus fracture. If people feel pelvic pain after a fall, doctors will check for suspected fractures using scans.

Some people may then need a different scan type to help doctors look for other injuries. Examples include:

  • X-rays: Doctors use X-rays to check for pelvic fractures first.
  • Computed tomography (CT) scans: CT scans allow doctors to determine the pattern and extent of a person’s fractures in more detail.
  • Magnetic resonance imaging (MRI) scans: MRI scans may allow doctors to detect fractures or injuries not visible using an X-ray or CT scan.

Pubic ramus fractures in older people often require hospital admission. However, for these fractures, an operation is typically not needed. Doctors will prescribe treatment options, including:

  • physical therapy programs
  • pain medication
  • pain therapy, using non-medication-based options to manage a person’s pain
  • walking, or walking with a mobility aid

Doctors may recommend that people walk with a mobility aid, such as crutches or a walker, until their bones heal. A person can typically fully bear their own weight after 3 months. Some people may still need to use a cane or other walking aid for a longer time.

A person’s physical therapy program can include:

  • Bed exercises: These exercises include several types of knee, hip, and foot stretches. People exercise their legs while lying down in bed.
  • Chair exercises: These exercises strengthen a person’s knees, hips, and feet muscles. When sitting down in a chair, people straighten, lift, and move their legs upward.
  • Standing exercises: These movements exercise a person’s hips and feet. They include leg lifts, squats, and leg raises. People perform these exercises standing up but holding onto a support in front of them.

Pubic ramus fractures normally take 6–8 weeks to heal. People can usually walk as they typically would during their recovery, but they should avoid twisting their legs. Movement and mobility are important in helping a person heal. A 2020 study notes that most people are typically mobile a year after the fracture.

Some pubic ramus fractures may require surgery.

Surgical options generally include plating or screw fixation surgery. In both options, surgeons operate to attach plates or screws directly to a person’s affected bones. These plates or screws are typically titanium or surgical-grade stainless steel. They hold a person’s bones in the correct place until their bones heal naturally.

Click here to learn more about hip fracture recovery.

People can fracture their pubic ramus due to high impact trauma, falls, or repetitive strain. While the fracture is typically painful, pubic ramus fractures do not usually cause permanent health conditions or disabilities.

For most pubic ramus fractures, treatment options include physical therapy and medications to allow the bone to heal naturally. However, some fractures may require surgery. It may take up to 8 weeks to recover from a pubic ramus fracture. Most people typically regain mobility within a year.