Breaking a bone in the pelvis, such as sustaining a pubic rami fracture, can be an incredibly painful and disruptive experience. While many of these fractures are stable and heal without surgery, their impact, particularly on older adults, can be severe and long-lasting. The question of how serious a pubic rami fracture is depends heavily on the individual's age, the cause of the injury, and whether other parts of the pelvic ring are damaged.

Here, the personal injury team at JMW explains the causes, treatment and long-term effects of pelvic fractures involving the pubic rami, including the circumstances in which you might be entitled to compensation if you sustain a pubic ramus fracture due to someone else's negligence.

What Is a Pubic Rami Fracture?

The pelvis is a strong ring of bones located at the base of the spine. It is made up of three main hip bones: the ilium, the ischium and the pubis. The pelvis protects abdominal organs, such as the bladder and intestines, and serves as an anchor for the powerful muscles of the legs and abdomen.

The pubic bone is at the front of the pelvis. It has two parts, or 'rami', that extend outwards:

• The superior pubic ramus
• The inferior pubic ramus

A pubic ramus fracture is a break in one or both of these sections of the pelvic bone. Because the pelvis is a ring structure, a break in one part can sometimes be associated with a second break elsewhere in the ring.

Common Causes of Pubic Rami Fractures

Fractures of the pelvis can occur in several ways, and are typically categorised by the amount of force involved.

Low-energy trauma

For many, especially older adults, a pubic rami fracture results from low-energy trauma. This is most commonly a fall from a standing position, and even a minor fall can be enough to cause one of these painful pelvic fractures. They are more common in older adults, particularly those with conditions affecting bone density, as conditions like osteoporosis or osteomalacia that weaken bones significantly increase the risk of these fragility fractures.

High-energy trauma

High-energy trauma from incidents like road traffic collisions or a fall from a significant height can cause severe and complex pelvic fractures. These events can lead to multiple breaks in the pelvic ring, resulting in unstable pelvic fractures. These are far more serious injuries, often associated with damage to internal organs, major blood vessels, and significant internal bleeding.

Stress fractures

A pubic ramus can also develop a stress fracture. This type of injury is not caused by a single traumatic event but by repetitive mechanical stress. It is more common in athletes, such as long-distance runners, who suddenly increase their training intensity or volume.

How Serious Are Pubic Ramus Fractures?

Most isolated pubic ramus fractures are considered stable fractures. This means there is only one break in the pelvic ring, and the broken ends of the bone are aligned and not displaced. While extremely painful, these stable pelvic fractures usually do not require surgery.

However, the seriousness of these pelvic fractures should not be underestimated, especially in elderly patients.

Hidden instability

A significant concern with pubic rami fractures is the potential for an associated, undiagnosed fracture in the posterior pelvic ring, often the sacrum (the bone at the base of the spine). Diagnosing this often requires advanced imaging like a CT or MRI scan. An unstable fracture is more complex and may require surgical treatment.

Impact on older adults

For older people, even stable pelvic fractures are considered serious events with numerous potentially significant impacts:

• Loss of Independence: The pain and impaired mobility from a pubic ramus fracture can be devastating, with many requiring temporary or permanent admission to a nursing home.
• Complications: Prolonged immobility during recovery increases the risk of serious complications like deep vein thrombosis, pneumonia, and urinary tract infections. This often leads to an extended hospital admission.
• Increased mortality: As a result of the factors above, elderly patients who sustain a pubic ramus fracture are at an elevated mortality rate.

Complications from high-energy fractures

In cases of high-energy trauma, the pelvic fractures themselves are part of a larger, more critical set of injuries. Complications can include:

• Severe bleeding: The pelvis has a rich blood supply, and fractures can damage blood vessels, leading to life-threatening internal haemorrhage.
• Internal injuries: The force of the impact can damage the bladder, bowel, and other organs the pelvis protects.
• Nerve damage: Nerves running through the pelvic area can be stretched or torn.

Treatment and Recovery

Treatment for pelvic fractures depends entirely on the stability and severity of the break.

Non-surgical treatment

Most stable, isolated pubic ramus fractures are treated conservatively, without surgery. The focus is on pain management and early mobilisation.

• Pain relief: Managing pain is the first priority. Healthcare professionals will prescribe medication to relieve pain and make movement possible.
• Mobility: Once pain is controlled, patients are encouraged to start walking, bearing weight as pain allows. Movement is crucial for healing and preventing complications like a blood clot. A walking aid, such as a walker or crutches, is usually necessary for up to three months.
• Physiotherapy: A physiotherapist will provide a programme of exercises to restore strength, flexibility, and range of motion in the hip and legs. This is essential for regaining full function.

The healing time for the bone itself is typically six to eight weeks. However, a full return to previous activity levels often takes two to three months. Some people may experience a limp for several months if the surrounding muscles were damaged.

Surgical treatment

Surgery is required for unstable pelvic fractures, where there are two or more breaks in the pelvic ring or where the bones are significantly displaced. The goal of surgery is to restore the normal alignment of the pelvis and hold the bones in the proper position while they heal.

• External fixation: This involves inserting metal pins through the skin and into the pelvic bone. These pins are connected to a stabilising frame on the outer surface of the body. This is often a temporary measure used to stabilise a critically injured person.
• Skeletal traction: This method uses a system of pulleys and weights attached to pins in the leg bones. The pins gently pull the bones, helping to realign the fractured pelvis.
• Internal fixation: Open Reduction and Internal Fixation is a procedure where a surgeon repositions the broken bones and fixes them in place with surgical screws and metal plates.

Recovery from surgical treatment is longer and more intensive, often requiring an extended hospital stay and a more gradual return to weight bearing.

Long-Term Effects of a Pubic Rami Fracture

While many people with stable pelvic fractures make a full recovery, long-term effects can be a significant concern.

• Chronic pain and reduced mobility: For some, especially older adults, pain and stiffness can persist long after the fracture has healed, impacting their quality of life.
• Loss of independence: As mentioned, a pubic rami fracture can be a life-changing event for elderly patients, leading to a permanent need for a mobility aid or residential care.
• Increased risk of future fractures: Sustaining a fracture can lead to underlying bone weakness, increasing the risk of subsequent fractures, such as proximal femur fractures (broken hips).

Making a Personal Injury Claim

If you have sustained a pubic ramus fracture in an accident that was not your fault, you may be able to make a claim for compensation. These injuries can result from various incidents, including:

• Slips, trips, and falls in public places (such as those caused by a poorly maintained pavement or a wet floor in a shop)
• Accidents at work
• Road traffic accidents

To make a successful claim, our solicitors will help you gather all the necessary evidence, such as accident reports, witness statements and medical records, to show that another party’s negligence caused your injuries.

How Is Compensation Calculated for Pelvic Fractures?

Compensation for a personal injury claim is divided into two parts: general damages and special damages.

General damages

This is an award for the pain you have experienced and the impact the injury has had on your quality of life. This also encompasses loss of amenity, which refers to the effect of the injury on your ability to enjoy your daily life, hobbies and independence.

Special damages

This part of your compensation covers all the financial losses and expenses you have incurred as a direct result of the accident and your pubic ramus fracture. It is calculated based on documented evidence and can include:

• Loss of earnings: This includes both past and future loss of income if you are unable to return to your job.
• Medical expenses: Costs for prescriptions, private physiotherapy, or any necessary medical equipment.
• Care costs: Compensation for professional care or assistance provided by family and friends.
• Travel expenses: Costs for travelling to and from medical appointments.
• Home and vehicle adaptations: If your injury results in a long-term disability.

For an estimate of how much you might be able to claim, use JMW’s Personal Injury Claims Calculator tool.