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Abstract: Pubic bone fractures are relatively common in daily life and mainly occur during traffic injuries due to violent impact resulting in fracture of the pubic branch, which has a thin diameter and is prone to fracture when subjected to external forces. In this case, after a traffic accident, an X-ray was taken and the fracture of the inferior pubic branch was confirmed, with local pain and swelling and limitation of movement with subcutaneous bruising, and the symptoms were gradually relieved after external fixation with a pelvic fixation belt and with bed rest.
Basic information】Male, 58 years old
Disease Type】Pubic fracture
Hospital】Harbin First Hospital
Date of consultation】July 2021
Treatment plan】Conservative treatment (external fixation with pelvic fixation belt) + medication (ibuprofen extended-release capsule)
Treatment period】7 days of inpatient treatment, 1 month of outpatient follow-up
Treatment effect】Fracture repositioning and fixation, pain relief
I. Initial consultation
The patient is 58-year-old Master Hai, who suffered a simple fracture of the infrapubic branch after a traffic accident with a direct impact on the pubic bone, and it was a unilateral infrapubic branch fracture, which was confirmed by x-ray. The pain was mainly concentrated in the inguinal region and perineum with pain in the adductor muscle, which was a stable fracture. Therefore, the patient was advised to take conservative treatment with pelvic band immobilization and bed rest until the pain was relieved. This fracture does not require surgical treatment, which would be more traumatic and would affect the speed of recovery. The fracture site of the pubic branch is rich in blood supply, so conservative treatment can ensure relative local stability and rapid fracture repair. Moreover, the pelvic ring remains intact and the fracture ends are not severely dislocated in patients with pubic inferior limb fractures.
II. Treatment history
The patient had a simple infrapubic branch fracture without a fracture mass protruding freely under the skin of the perineum; therefore, no manipulative repositioning was required, and the pelvis was fixed with a pelvic fixation band while the patient rested in bed for 2-4 weeks and could leave bed once the pain symptoms were relieved. The patient had moderate pain symptoms for 2 weeks after the injury and the symptoms were controlled with oral ibuprofen extended-release capsules. Due to continuous bed rest, the pubic fracture site was not stimulated, so the patient had no painful symptoms during turning at night. During the recovery process, the hip joint activities were strictly restricted to avoid painful symptoms caused by pulling the adductor muscle, to prevent displacement of the fracture end, and to promote smooth healing of the fracture.
III. Treatment effect
After 7 days of hospitalization, the patient’s fracture site of the inferior pubic branch gradually healed, and the repeat radiograph confirmed that the fracture line was blurred and continuous bone scabs passed through the fracture end, and the patient’s local pain and swelling and restricted activity symptoms gradually improved, so the patient was discharged. At this time, the patient can start to sit up in bed, resume standing at the bedside without inducing pain, and gradually resume normal weight-bearing walking.
IV. Notes
We are glad that the patient gradually regains normal mobility, but we still need to advise the patient that he should not participate in strenuous exercise within 3 months, otherwise it may significantly slow down the healing of the fracture or even occur deformed healing of the fracture, and once the fracture heals deformed and protrudes from the subcutaneous tissue, it will affect the later sitting and riding movements. Exercise should be gradual to avoid excessive straining of the internal muscles leading to sports injuries or even straining the fracture site, resulting in non-healing fractures. In daily life, calcium can be supplemented regularly, such as taking calcium carbonate tablets orally, increasing the intake of yogurt or milk, or getting sunlight from time to time to supplement vitamin D by receiving sunlight to promote calcium absorption, strengthen bone density, and prevent local fractures from occurring again.
V. Personal insight
Most pubic bone fractures occur in traffic accidents, causing simple subpubic branch fractures in mild cases and pelvic ring disruption in severe cases, therefore, patients should pay attention to traffic injuries in their daily life. Mild pubic fracture does not cause serious injury to other parts of the body, while if a severe displacement of pubic fracture occurs, it may damage the urethra or bladder, leading to clinical consequences such as severe hematuria caused by urethral rupture or even anuria or severe peritonitis, so attention should be paid to enhance local protection. If you find a pubic bone fracture, you should seek medical attention in time and cooperate with the doctor to complete the necessary treatment as well as rehabilitation exercises.