Abstracts Posters SICOT-SOF meeting Gothenburg 2010 _2_

Poster
Topic: Trauma - Hip
Abstract number: 25619
CHILDHOOD PUBIC RAMI FRACTURES: NOT SO BENIGN AFTER ALL
Devendra MAHADEVAN, Ajit GARDE, Edward CRAWFURD
Northampton General Hospital, Northampton (UNITED KINGDOM)
Pubic rami fractures are classified as benign injuries but we present an unusual case
of childhood fracture malunion resulting in delayed morbidity in adulthood. The
patient presented to us 30 years following the injury and we describe the symptoms
and management of this rare problem.A 42 year old presented with delayed
symptoms of impingement and rotational hip deformity following this injury in
childhood. The fracture had healed without operative intervention and the only
morbidity till then was a failed vaginal childbirth. At presentation, she had an
internally rotated right leg and impingement to external rotation of the hip. She
walked with an in-toeing gait. The hip joint had significant pain on attempted external
rotation. Radiographs of the pelvis showed malunited superior and inferior pubic rami
fractures with a large exostosis centred over the ischial tuberosity. The bony
prominence encroached on the posterior aspect of the femur and restricted the
normal arc of hip movement. The exostosis was excised surgically which restored a
full range of hip movement. Unfortunately her exostosis had recurred requiring two
further debridements. Following her most recent surgery, the patient was given 5
doses of external beam radiotherapy to reduce the recurrence of her exostosis. She
remains symptom free for 18 months. As children continue to grow and develop,
simple fractures of the pelvis can have significant delayed complications. Long-term
review of these injuries is advocated to detect these potential morbidities early.
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