Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Radha, Sarkhell; Shenouda, Michael; Hazlerigg, A; Konan, Sujith; Hulme, Alison

doi:10.1155/2013/674732

Cited by 3 publications

(2 citation statements)

References 7 publications

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“…The most common pelvic fracture patterns which can be seen in elderly population above the age of 60 years are pubic ramus fractures. Mrs ABC being in the risk category because of her age of 88 years she even had osteoarthritis which led to pelvic injury (Radha et al, 2013. The presentation for this type of fracture can be seen with the evidence of fall by elderly due to the presence of osteoporotic bone.…”

Section: Process Informationmentioning

confidence: 99%

Levette Jones' Clinical Reasoning Cycle: A Case Study

2021

NJI

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Introduction: The Clinical Reasoning Cycle (CRC) is a tool that helps in making decision that enable nurses to select best care options using a process systematically; it takes many factors into consideration. The CRC by Tracy-Levette Jones stimulates critical thinking in order to deliver appropriate management plan for the patient. This article presents a case study in medical-surgical nursing through a discussion of patient-centred and evidence-based care provisions through a theoretical examination using the CRC of Tracy Levette- Jones (2010). This article will help the nurses both novice and pro cient, to understand implementation of CRC in the clinical areas and in writing the case study for the patient.

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Section: Process Informationmentioning

confidence: 99%

Levette Jones' Clinical Reasoning Cycle: A Case Study

2021

NJI

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“…During recovery, the patient's ability to sit on a wheelchair, walk with crutches, and even have sexual intercourse was improved; therefore, repair and xation of the inferior ramus of pubis-ischium ramus fractures should be given more attention and recommended for traumatic pelvic ring injuries, even in anterior ring fractures that occur during hip replacement surgery. Impressively, following total hip arthroplasty, minimal displacement of the inferior ramus of pubis-ischium ramus fractures and signi cantly displaced acetabular fractures were observed; prosthesis loosening, fracture xation, and hip revision surgery were eventually performed (33,34). We assumed that revision surgery could be avoided if the inferior ramus of the pubisischium ramus fracture is repaired with non-weight-bearing exercises.…”

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Plate Fixation of Inferior Ramus in Pubis-Ischium Ramus Improves Mechanical Stability in Tile B Pelvic Injures: A Cadaveric Biomechanical Analysis and Early Clinical Experience

Pan,

Hu,

et al. 2024

Preprint

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Background Management of inferior ramus of the pubis-ischium ramus remains controversial, and related research is sparse. The main intention of this study is to describe the biomechanical and clinical outcomes of pubis-ischium ramus fractures in Tile B pelvic injuries and to identify the feasibility and necessity of fixation of the inferior ramus of the pubis-ischium ramus. Methods This study comprised two parts: a biomechanical test and a retrospective clinical study. For the biomechanical tests, Tile B-type pelvic injuries were modeled in six cadaver specimens by performing pubis-ischium osteotomies and disruption of the anterior and interosseous sacroiliac ligaments. The superior and/or inferior rami of the pubis-ischium ramus were repaired with reconstruction plates and separated into three groups (A, B, and C). Specimens were placed in the standing position and were loaded axially with two-leg support for three cycles at 500 N. The displacements of sacroiliac joints at osteotomy were measured with Vernier calipers and compared using statistical software. To investigate the clinical outcomes of this technique, 26 patients were retrospectively analyzed and divided into a superior ramus fixation group (Group D) and a combined superior and inferior ramus of the pubis-ischium ramus fixation group (Group E). The main outcome measures were time of operation, blood loss, postoperative radiographic reduction grading, and functional outcomes. Results In the vertical loading test, Group E showed better pelvic ring stability than Group D (P < 0.05). However, the shift of the sacroiliac joints was almost identical among the three groups. In our clinical case series, all fractures in Group E achieved bony union. Group E demonstrated earlier weight-bearing functional exercise (2.54 ± 1.45 vs. 4.77 ± 2.09; P = 0.004), earlier bony union (13.23 ± 2.89 vs. 16.55 ± 3.11; P = 0.013), and better functional outcomes (89.77 ± 7.27 vs. 82.38 ± 8.81; P = 0.028) than Group D. The incidence of sexual dysfunction was significantly lower in Group E than that in Group D (2/13 vs. 7/13; P = 0.039). Bone nonunion occurred in two patients in Group D, and two patients in Group E had heterotopic ossification. None of the patients exhibited wound complications, infections, implant failures, or bone–implant interface failures. Conclusion Fixation of the inferior ramus of a pubis-ischium ramus fracture based on conventional fixation of the anterior pelvic ring is mechanically superior in cadaveric Tile B pelvic injury and shows rapid recovery, good functional outcomes, and low incidence of complications.

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Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter?

Ko,

Lee,

Kim

et al. 2024

Arch Orthop Trauma Surg

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Introduction Periprosthetic fractures in total hip arthroplasty (THA) have been well described and studied. However, there is a lack of reports on ipsilateral pubic ramus fractures during THA due to the rare occurrence of such fractures and ambiguity of symptoms. With the use of postoperative computed tomography (CT) examinations, we have identified that asymptomatic ipsilateral pubic ramus fractures occur frequently during THA. This study aims to evaluate the incidence, location, clinical outcomes, and risk factors of ipsilateral pubic ramus fractures during THA. Methods From May 2022 to March 2023, a single surgeon performed 203 THAs in 183 patients at a single institution. All patients underwent postoperative CT scans three days after THA. The patients with ipsilateral pubic ramus fractures were followed up for a minimum of six months. Basic demographics, osteoporosis, general conditions of the operations, and outcomes of THA were investigated in all patients. Results Twenty-two cases (10.8%) of ipsilateral pubic ramus fractures were identified on postoperative CT scans. All fractures were located near the origin of the superior or inferior pubic ramus. Five fractures were detected on simple postoperative radiographs. The fractures did not cause any further complications at a minimum of six-month postoperative follow-up. Univariate and multivariate analyses did not identify any risk factors associated with these fractures. Conclusions Although the incidence of ipsilateral pubic ramus fractures during THA is high, treatment is not required as they do not cause any significant clinical symptoms or affect the prognosis of THA. However, the possibility of occurrence of these fractures must be explained to the patients before surgery.

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Fractured Inferior Pubic Ramus with Ipsilateral Total Hip Replacement: A Case Report and Review of the Literature

Cited by 3 publications

References 7 publications

Levette Jones' Clinical Reasoning Cycle: A Case Study

Levette Jones' Clinical Reasoning Cycle: A Case Study

Plate Fixation of Inferior Ramus in Pubis-Ischium Ramus Improves Mechanical Stability in Tile B Pelvic Injures: A Cadaveric Biomechanical Analysis and Early Clinical Experience

Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter?

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