Are ipsilateral proximal femur and pubic rami fractures mutually exclusive in acute trauma?

To determine whether proximal femur and pubic rami fractures are mutually exclusive in acute trauma.

Pelvic/hip radiographs of consecutive adult patients presenting to ER with acute trauma at a tertiary, university hospital between January 1 and December 31, 2020, were retrospectively reviewed for proximal femur and/or pubic ramus fractures. The number of fractures, fracture location, age and gender were recorded. Cases with concomitant pubic rami and proximal femoral fractures were identified. Electronic records confirmed the history of trauma and mechanism of injury (low energy or high energy). Continuous data variables were summarized using descriptive statistics of mean, range and standard deviation. Categorical variables were summarized as count and percentages with proportions compared using Chi-square test.

A total of 1967 patients were included (826 male, 1141 female; mean age 69 years [range 18-119, SD 22]). There were 633 fractures in 624 patients, 125 pubic ramus (19.7% of total, 68.8% females) and 508 proximal femur (80.3% of total, 67.9% females). Injury mechanism was predominantly low energy for both pubic ramus (53%) and proximal femur (91%) fractures. The incidence of concomitant pubic ramus and proximal femur fractures was 1.4% (9/624). Of these 9 cases, two subgroups emerged: (1) 3 middle-aged patients of age 44-62 years, with high energy mechanism, all with subtrochanteric proximal femur fracture, and (2) 6 elderly patients, all age > 90 years, with low energy mechanism, with femoral neck or intertrochanteric proximal femur fracture.

Proximal femur and pubic ramus fractures are not mutually exclusive, although their coexistence is rare.