Acute Traumatic Pubic Ramus Fractures

Pubic rami fractures, common in the older person from low energy trauma, significantly impact morbidity through pain, reduced mobility, and increased injury risk. Effective management in the emergency department (ED) is essential for this population, but the lack of standardised guidelines can lead to inconsistent and potentially suboptimal care. This service evaluation aimed to review current management practices for isolated pubic rami fractures in our ED, identifying areas for improvement and guiding future protocol development.

We retrospectively reviewed electronic patient records. Over a twelve-month period (01/03/2023 - 29/02/2024), pelvic X-rays taken in the ED were screened for isolated pubic rami fractures, excluding duplicates and patients under 60. Cases were analysed for presentation, length of stay, management, discharge, and complications.

From 1,135 pelvic X-rays, 42 (3.70%) patients with isolated fractures were included; 35 (83%) were female. Most injuries 37 (88.1%) resulted from falls under 2 metres. Of the patients, 29 (69%) were admitted, 11 (26%) were discharged from the ED (2 of whom were referred to the Silver Trauma outpatient clinic), and 2 (5%) were transferred directly to a rehabilitation unit. Of those admitted, 7 were subsequently transferred to rehabilitation facilities. The median ED length of stay was 12 hours 20 minutes (IQR 10:11-17:44). 4 (13.79%) of the admitted patients died.

Management was largely conservative, yet key outcomes including prolonged ED length of stay, high frailty burden and in-hospital mortality were identified. Standardised guidelines based on these findings could enhance care consistency and improve outcomes for older patients with pubic rami fractures.