Pubic Rami Fracture

1. Pelvis Case # 8

2. 19 yo male p/w pelvic pain and bilateral knee pain s/p MVC, as a restrained passenger hs knees struck the dashboard. History and Physical T 98.7 P 103 BP 117/62 O2 100% Gen: CV: Tachycardic , RR, no m/r/g Pulm : Lungs CTA bilat GU: nml Ext: bilateral hip pain with ROM; bilateral knee contusions (stable)

3. Image

4. Image

5. Review all cortices of “pretzel” If one fracture noted, high index of suspicion for additional fracture as force to circle affects opposite side as well Width of normal symphysis pubis: Children <10 mm Adults <5mm Consider lesions if greater Diagnosis

6. ATLS (ABCs, IOM) Nondisplaced Urgent Orthopedic referral Likely non-operative Displaced Immobilization Emergent Orthopedic referral Assess for GU trauma ED Management

7. Assess Posterior P elvis for frx Assess symphysis pubis for width Concern for possbile Open Book pelvic frx Assess GU for trauma Possible retrograde urethrogram Pearls

8. http:// www.imageinterpretation.co.uk/pelvis.html http:// www.wheelessonline.com/ortho/12846 Simon, Robert, and Scott Sherman. Emergency Orthopedics. New York: McGraw Hill, 2011. 6 th Ed. References