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Case 5

16 yo/old female presents to a DC office complaining of severe left groin discomfort after a 4 wheeler type accident. Presents with a severe left sided limp. No prior history of trauma, surgery, carcinoma or corticosteroid/opioid regimen.



What do you see? (scroll to the second image& mouse over)

Carefully, compare the right normal superior pubic ramus to the left.
A small cortical infraction is seen at the midportion of the left superior pubic ramus. This was confirmed 6 hours later by a follow-up study.


      High superior pubic ramus fractures – superior & lateral to the ilio-ischial line have a poorer prognosis than fractures medial to this line. (1)  This fracture should resolve with conservative care.

1. All superior pubic ramus fractures are NOT created equal. Can. J. Surg. 2004 Dec; 47(6): 422-425.
2. Dahnert W. Radiology Review Manual. Lippincott & Wilkins (2011)