Pubik ramus kırığı

Özet

Pubik üst veya alt ramus kırığı yüksek enerjili travmada halka deformitesinin ön bileşeni, ileri yaşta ise düşük enerjili kırılganlık hasarının görünen ilk bulgusu olabilir. BT, kortikal hattı ve deplasmanı gösterirken asıl kritik eğitim noktası, sakrum ve SI eklemdeki eşlikçi posterior halka yaralanmasını aramaktır. Retropubik hematom, mesane komşuluğunu ve ek yumuşak doku bulgularını aynı incelemede görünür kılar. Kırığı izole kabul etmek, eşlik eden instabil halka hasarının veya pelvik organ yaralanmasının gözden kaçmasına neden olabilir.

Faz ve pencere

Kemik algoritması tanısal

Pubik ramus kırıkları BT'de gösterilebilir; asetabuluma uzanım pelvis BT'siyle değerlendirilebilir.

Kontrastsız tanısal

Kontrastsız BT kemik hattını ve retropubik hematomun kaba dansitesini gösterebilir; mesane duvarı, damar hasarı veya aktif kanama için kontrastlı travma değerlendirmesinin yerini tutmaz.

Önerilen pencereler: Kemik (G 1800 / M 400), Batın (G 400 / M 50), Yumuşak doku (G 400 / M 40).

BT bulguları

• Alt ramus kırığında asetabuluma uzanımı dışlamak için pelvis BT'si değerlendirilebilir.
• Kırığın asetabuluma uzanımı BT ile değerlendirilmelidir.
• Aynı tarafta veya karşı tarafta ikinci ramus kırığı; halka ön segmentinin tek ya da çift taraflı etkilenmesi
• Sakral ala, SI eklem veya iliak kemikte posterior halka eşlikçisi
• Retropubik/ekstraperitoneal hematomun mesane ön ve yan duvarlarıyla ilişkisi
• Mesane kontur düzensizliği, intravezikal kemik fragmanı veya çevre sıvı gibi eşlik eden organ bulguları

Ölçütler ve sınıflamalar

Rommens-Hofmann FFP

Kırılganlık bağlamında yalnız tek taraflı anterior ramus kırığı Ia, bilateral anterior ramus kırığı Ib olarak adlandırılır; posterior halka lezyonu eklenirse sınıf II-IV paternin tamamına göre belirlenir.

Normalde

Kırık hattının asetabuluma uzanımını pelvis BT'sinde değerlendir.

Ayırıcı tanı

Pubik kemik avulsiyonu

bağ, tendon veya kapsülün beklenen yapışma bölgesine komşu küçük bir kemik fragmanı ile karakterizedir; kronik olgular enfeksiyon veya tümörü taklit edebilir.

Asetabulum ön kolon kırığı

hat iliopubik hatta doğru ilerleyerek asetabular eklem yüzüne ulaşır; yalnız obturator halkayla sınırlı değildir.

Metastatik pubik lezyon

metastatik hastalık pubik ramusta veya asetabulumda görülebilir.

Tuzaklar

• Ön halka kırığını izole raporlama; her iki sakral ala, foraminalar, SI eklemler ve posterior iliak kemikte ikinci yaralanma ara.
• Parasempfiziyer kırığı asetabular uzanım sanma; hattı koronal rekonstrüksiyonda eklem yüzüne kadar takip et.
• Retropubik hematomu mesane dışı serbest sıvıdan ayır; mesanenin ekstraperitoneal ön-yan komşuluğundaki yoğunluk artışını kemik fragmanıyla birlikte incele.
• Osteoporotik kemikte posterior pelvisin gizli ve deplase olmayan kırıkları BT'de saptanamayabilir; bu kırıkların gösterilmesi için MR gerekebilir.

Kendini dene

1. BT'de pubik üst ramus kırığı görülüyor. Pelvik halkanın tamamını değerlendirirken özellikle hangi arka halka bölgelerini incelemelidir?

   • Sakral ala ve SI eklem
   • Femur başı foveası
   • Lomber faset eklemler
   • İliopsoas tendonu
   Cevabı göster

   Sakral ala ve SI eklem. Pubik ramus kırığına posterior halka yaralanması eşlik edebilir; pelvis BT'sinde posterior halkayı da değerlendirin. Bu nedenle özellikle sakrum ve sakroiliak eklemleri inceleyin.

2. S1'deki FFP örneğinde pubik ramus kırığına eşlik eden posterior halka kırığı hangisidir?

   • Sakral ala kırığı
   • Femur boyun kırığı
   • İliopsoas tendon yırtığı
   • Lomber faset kırığı
   Cevabı göster

   Sakral ala kırığı. Kaynakta üst ve alt pubik ramus kırıklarıyla birlikte eşlik eden, deplase olmayan Zone 1 sakral ala kırığı bildirilmiştir.

İlgili konular

• Pelvis kırılganlık kırıkları
• İliak kanat kırığı

Kaynaklar

Bu sayfadaki 34 cümle ve 2 quiz sorusu aşağıdaki kaynaklardan alıntılarla otomatik olarak karşılaştırıldı; 10 cümle bu karşılaştırmada düzeltildi (2026-10-09).

1. Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literaturepmc.ncbi.nlm.nih.gov
2. Ophthalmic manifestations of atypical IgD multiple myeloma.pubmed.ncbi.nlm.nih.gov
3. Psoas abscess secondary to haematoma after a fall causing multiple osteoporotic fractures.pubmed.ncbi.nlm.nih.gov
4. What characteristics indicate concomitant posterior pelvic injury in pubic ramus fractures in the elderly?pubmed.ncbi.nlm.nih.gov
5. PHOSPHATURIC MESENCHYMAL HEEL TUMOR PRESENTING WITH TUMOR-INDUCED OSTEOMALACIA.pubmed.ncbi.nlm.nih.gov
6. Percutaneous screw fixation assisted by hollow pedicle finder for superior pubic ramus fractures.pubmed.ncbi.nlm.nih.gov
7. Ipsilateral pubic ramus fracture during total hip arthroplasty is not rare: does it matter?pubmed.ncbi.nlm.nih.gov
8. Fractured inferior pubic ramus with ipsilateral total hip replacement: a case report and review of the literature.pubmed.ncbi.nlm.nih.gov
9. A correlation study of ischiocavernosus muscle injury with different types of pelvic fractures and erectile dysfunction after pelvic fracture.pubmed.ncbi.nlm.nih.gov
10. Life-threatening hemorrhage from the corona mortis treated with balloon-assisted coiling technique.pubmed.ncbi.nlm.nih.gov
11. Integrity of the pectineal ligament in MRI correlates with radiographic superior pubic ramus fracture displacement.pubmed.ncbi.nlm.nih.gov
12. Corona mortis artery avulsion due to a stable pubic ramus fracture.pubmed.ncbi.nlm.nih.gov
13. Massive haemorrhage from the internal iliac artery following a low energy superior pubic ramus fracture in a 73-year-old man.pubmed.ncbi.nlm.nih.gov
14. Delayed presentation of hypovolemic shock after a simple pubic ramus fracture.pubmed.ncbi.nlm.nih.gov
15. Contributions of Pubic Rami Fracture Morphology and Fixation to Pelvic Ring Stability in Type 1 Lateral Compression Injuries: A Biomechanical Cadaveric Study.pubmed.ncbi.nlm.nih.gov
16. Trans-symphyseal fixation for complex anterior pelvic fractures: a novel technique guide and case series.pubmed.ncbi.nlm.nih.gov
17. Acceptable outcomes after anterior subcutaneous pelvic Internal Fixation (INFIX) for Fragility Fractures of the Pelvis (FFP) type III in elderly patients: a retrospective study.pubmed.ncbi.nlm.nih.gov
18. Evaluating the necessity of edema-sensitive imaging in assessing fragility fractures of the pelvis: a retrospective cohort study utilizing the OF Pelvis Classification and Score.pubmed.ncbi.nlm.nih.gov
19. Biomechanical stability evaluation of isolated straddle fracture using finite element analysis.pubmed.ncbi.nlm.nih.gov
20. Robot-assisted closed reduction and navigated fixation for pelvic ring injuries: a focused narrative review of a reduction-fixation-audit framework.pubmed.ncbi.nlm.nih.gov
21. Clinical Outcomes of Sacral Alar-Iliac Screw Fixation for Pelvic Ring Fractures: A Retrospective Case Series.pubmed.ncbi.nlm.nih.gov
22. Explosive Weapons Trauma Care Collective (EXTRACCT) Blast Injury Clinical Practice Guideline: Genito-Urinary Trauma.pubmed.ncbi.nlm.nih.gov
23. Differentiating Between Obturator and Inferior Epigastric Arterial Injury in Traumatic Pelvic Hemorrhage: A Case Report.pubmed.ncbi.nlm.nih.gov
24. A Case Report of a Vertical Zone III Sacral Fracture Due to Acute Lower Extremity Hyperabduction While Windsurfing.pubmed.ncbi.nlm.nih.gov
25. Occult bladder injury in low displacement anterior-posterior compression pelvic fractures type I: a retrospective analysis of incidence and predictors.pubmed.ncbi.nlm.nih.gov
26. Osteitis Pubis in Athletes in the Era of Pubic-Related Groin Pain: Contemporary Concepts in Diagnosis, Rehabilitation, and Surgical Decision-Making.pubmed.ncbi.nlm.nih.gov
27. The Impact of CT Imaging on the Diagnosis of Fragility Fractures of the Pelvis: An Observational Prospective Multicenter Study.pubmed.ncbi.nlm.nih.gov
28. Surgical management of severely displaced IPRF: operative technique, indications, and preliminary clinical outcomes.pubmed.ncbi.nlm.nih.gov
29. Intraoperative Fluoroscopy for Minimally Invasive Periacetabular Osteotomy: A Standardized Step-By-Step Operative Technique.pubmed.ncbi.nlm.nih.gov
30. Minimally invasive stabilisation of anterior pelvic ring injuries through anterior infix versus percutaneous anterior retrograde pubic screw: a prospective comparative cohort study.pubmed.ncbi.nlm.nih.gov
31. New Insight in Pediatric Orthopedic Oncology: The Use of a Xeno-Hybrid Bone Substitute in Loss of Bone Tissue After Oncological Resections, a Case Series.pubmed.ncbi.nlm.nih.gov
32. Evaluation of cannulated compression headless screws as an alternative implant for superior pubic ramus fracture fixation: a biomechanical study.pubmed.ncbi.nlm.nih.gov
33. Effects of types and degrees of ankylosing spondylitis hip structural damages on post-total hip arthroplasty outcome measurements.pubmed.ncbi.nlm.nih.gov
34. Isolated Unilateral Posterior Sacroiliac Dislocation With an Intact Anterior Pelvic Ring: Case Report of an Unusual Injury Pattern.pubmed.ncbi.nlm.nih.gov
35. Staged management of a Tile C3 pelvic ring injury with bilateral sacroiliac disruption and T-shaped sacral fracture.pubmed.ncbi.nlm.nih.gov
36. Knowledge gaps in high-energy sacral fracture treatment and management.pubmed.ncbi.nlm.nih.gov
37. Urethral Injuries: Diagnostic and Management Strategies for Critical Care and Trauma Clinicians.pubmed.ncbi.nlm.nih.gov
38. The role of imaging in pelvic exenteration for gynecological cancers.pubmed.ncbi.nlm.nih.gov
39. A contemporary review of adult bladder trauma.pubmed.ncbi.nlm.nih.gov
40. Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report.pubmed.ncbi.nlm.nih.gov
41. Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients.pubmed.ncbi.nlm.nih.gov
42. Inverse association between sarcopenia and displacement in the early phase of fragility fractures of the pelvis.pubmed.ncbi.nlm.nih.gov
43. The Unique Features of Pediatric Sports Injuries: The Hip.pubmed.ncbi.nlm.nih.gov
44. Periostitis of the Pubic Symphysis in Inguinal and Femoral Hernia: An Uninterpreted Source of Chronic Groin Pain.pubmed.ncbi.nlm.nih.gov
45. Hip Sideline Emergencies and Hip Injuries in Elite Athletes.pubmed.ncbi.nlm.nih.gov
46. Xanthogranulomatous Osteomyelitis as a Bone Tumor Mimic: A Systematic Review of Pre-biopsy Diagnostic Clues and Management Decision Points.pubmed.ncbi.nlm.nih.gov
47. An Unusual Presentation of Philadelphia Chromosome Positive B-Cell Acute Lymphoblastic Leukemia With Isolated Osteolytic Lesions at Diagnosis: A Case Report.pubmed.ncbi.nlm.nih.gov
48. Imaging of ewing sarcoma: an updated analysis including presenting features, prognostic imaging biomarkers, and treatment response assessment.pubmed.ncbi.nlm.nih.gov
49. Clinical impact of early postoperative routine radiology in isolated pelvic injuries: a retrospective study.pubmed.ncbi.nlm.nih.gov
50. Modified Stoppa Approach for ORIF of a Paediatric Transverse Acetabular Fracture: Case Report and Systematic Review of Internal Fixation in Children.pubmed.ncbi.nlm.nih.gov
51. Limitations of CT-based planning in anterior pelvic ring fixation: a study of fluoroscopy-guided pubic ramus screws.pubmed.ncbi.nlm.nih.gov
52. Postpartum pelvic stress fractures with subsequent forefoot overload injury: A case report.pubmed.ncbi.nlm.nih.gov
53. An Exceptionally Uncommon Hip Injury: Femoral Neck Fracture Dislocation with Abductor Avulsion: A Case Report.pubmed.ncbi.nlm.nih.gov
54. Disease- and Treatment-related Complication on F-18-Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in Oncology Practice: A Pictorial Review.pubmed.ncbi.nlm.nih.gov
55. Fracture of the greater trochanter of the femur in 17 cats: imaging, clinical features and concurrent injuries.pubmed.ncbi.nlm.nih.gov
56. Magnetic Resonance Imaging in the Evaluation of Avulsion Injuries of the Pelvis and Hip in Adolescent Professional Footballers: A Case Series.pubmed.ncbi.nlm.nih.gov
57. High-resolution ultrasound in the evaluation of the adult hip.pubmed.ncbi.nlm.nih.gov
58. Pivotal role of the synovioentheseal complex in the imaging of arthritis and rheumatic diseasespubmed.ncbi.nlm.nih.gov
59. Sports Hernias: A Comprehensive Review for Clinicians.pubmed.ncbi.nlm.nih.gov
60. Paget's disease of bone with superimposed osseous metastasis from lung carcinoma: A case report.pubmed.ncbi.nlm.nih.gov
61. Morphology-Guided Surgical Management of Complex Traumatic Hip Fracture-Dislocations and Acetabular Fractures: A Six-Case Series Illustrating Morphology-Based Surgical Approaches.pubmed.ncbi.nlm.nih.gov
62. Musculoskeletal Hydatid Cyst around Pelvis: A Case Report and Review of Literature.pubmed.ncbi.nlm.nih.gov
63. Acetabular superior wall fractures: a distinct acetabular fracture entity.pubmed.ncbi.nlm.nih.gov
64. Algorithms in acetabular fracture classifications.pubmed.ncbi.nlm.nih.gov
65. Digital measurement and safety parameter analysis of the infra-acetabular screw pathway.pubmed.ncbi.nlm.nih.gov
66. Fluoroscopy-assisted identification of the individual optimal antegrade entry point of the anterior column fixation corridor in pelvic and acetabular surgery: a novel perspective.pubmed.ncbi.nlm.nih.gov
67. Biomechanical analysis of iliosacral and transiliac-transsacral screw combinations for fixation of undisplaced Denis II vertical shear fractures in dysmorphic sacrum.pubmed.ncbi.nlm.nih.gov
68. Avulsion injuries: an update on radiologic findings.pubmed.ncbi.nlm.nih.gov
69. Pubic Symphysis Stress Reaction and Pelvic Girdle Myositis Following Robotic-Assisted Inguinal Hernia Repair: A Case Report and Brief Review of the Literature.pubmed.ncbi.nlm.nih.gov
70. Osteitis pubis after laparoscopic totally extraperitoneal inguinal hernia repair: An uncommon complication - Report of two cases.pubmed.ncbi.nlm.nih.gov
71. Combined Post-traumatic Pseudoaneurysms of the Superior Gluteal and Aberrant Obturator Arteries: A Case Report.pubmed.ncbi.nlm.nih.gov
72. Traumatic testicular dislocation with pelvic fracture in a 17 year old adolescent: A case report.pubmed.ncbi.nlm.nih.gov
73. Iliopubic rami morphology and its vascular relationships in percutaneous retrograde fixation.pubmed.ncbi.nlm.nih.gov
74. Total laparoscopic closed reduction and internal fixation for AO/OTA B2.1 pelvic fracture: A case report and literature review.pubmed.ncbi.nlm.nih.gov
75. Superior border of the arcuate line: Three dimension reconstruction and digital measurements of the fixation route for pelvic and acetabular fractures.pubmed.ncbi.nlm.nih.gov
76. Plating of the Pelvis and Acetabulum via the Laparoscopic Technique: An Alternative Method for ORIF.pubmed.ncbi.nlm.nih.gov
77. Special contoured pelvic brim reconstruction titanium plate combined with trans-plate buttress screws (quadrilateral screws) for acetabular fractures with quadrilateral plate involvement through the anterior ilioinguinal approach.pubmed.ncbi.nlm.nih.gov
78. Fragility Fractures of the Pelvis and Sacrum: Current Trends in Literature.pubmed.ncbi.nlm.nih.gov
79. Pelvic heterotopic ossification causing bladder compression: a rare post-traumatic case report.pubmed.ncbi.nlm.nih.gov
80. Open reduction and internal fixation versus percutaneous multiple-trajectory screw fixation for unstable pelvic fractures with severe polytrauma: a prospective study.pubmed.ncbi.nlm.nih.gov
81. Biomechanical comparison of two fixation constructs for displaced quadrilateral surface acetabular fractures: a finite elements analysis.pubmed.ncbi.nlm.nih.gov
82. Total hip arthroplasty in acetabular fractures.pubmed.ncbi.nlm.nih.gov
83. Percutaneous fixation of acetabular fractures.pubmed.ncbi.nlm.nih.gov
84. Case Report: Life-saving external hemipelvectomy after missed external iliac artery occlusion in severe pelvic trauma.pubmed.ncbi.nlm.nih.gov
85. Comprehensive Management of Different Types of Pelvic Fractures Through Multiple Disciplines: A Case Series.pubmed.ncbi.nlm.nih.gov
86. Design of novel plate for fixation of anterior pelvic ring injury: a digital anatomy study and finite element analysis.pubmed.ncbi.nlm.nih.gov
87. A Didactic Ultrasound Manual for identifying lumbar Plexus Peripheral Nerves in the lower limb: Lower Abdominal Wall, Groin and Thigh.pubmed.ncbi.nlm.nih.gov
88. Axial Spondyloarthritis: Mimics and Pitfalls of Imaging Assessment.pubmed.ncbi.nlm.nih.gov
89. Review for the generalist: evaluation of pediatric hip pain.pubmed.ncbi.nlm.nih.gov
90. MRI of total hip arthroplasty: technical aspects and imaging findings.pubmed.ncbi.nlm.nih.gov
91. Chronic pelvic insufficiency fractures and their treatment.pubmed.ncbi.nlm.nih.gov
92. Clinical pathways for fragility fractures of the pelvic ring: personal experience and review of the literature.pubmed.ncbi.nlm.nih.gov
93. Case Report: Total hip arthroplasty via the direct anterior approach using a cementless revision stem without corrective osteotomy for fibrous dysplasia.pubmed.ncbi.nlm.nih.gov
94. Development of a pelvic musculoskeletal model based on statistical shape modelling for estimating sacroiliac and pubic joint reaction forces in females.pubmed.ncbi.nlm.nih.gov
95. 3D-Printed Cut Guides and Custom Prostheses for Pelvic Reconstruction in Bone Sarcoma Patients: Complications, Survival Rates, and Functional Outcomes.pubmed.ncbi.nlm.nih.gov
96. CT/MRI-based finite element model construction and biomechanical analysis of acetabular quadrilateral fractures.pubmed.ncbi.nlm.nih.gov
97. Management and Outcomes of Anterior Hip Dislocation with Multiple Comminuted Fractures from a Vehicular Crush Injury in a 44-Year-Old Woman.pubmed.ncbi.nlm.nih.gov
98. Periacetabular osteotomy to treat residual dysplasia in adolescents and young adults: indications, complications, results.pubmed.ncbi.nlm.nih.gov
99. Neglected intrapelvic dislocation of femoral head.pubmed.ncbi.nlm.nih.gov
100. Surgical resection of malignant tumors at the ischial tuberosity: a new surgical incision design and clinical experience.pubmed.ncbi.nlm.nih.gov
101. The Role of MRI in Groin Pain Syndrome in Athletes.pubmed.ncbi.nlm.nih.gov
102. Compression Osteosynthesis Without Iliac Crest Osteotomy Through the Anterior Iliac Approach for Incomplete High Anterior Column Fractures of the Acetabulum: A Case Series and Surgical Technique.pubmed.ncbi.nlm.nih.gov
103. Beyond Strict Physics: Using Poiseuille's Law as a Practical Framework to Optimize and Personalize Cementoplasty.pubmed.ncbi.nlm.nih.gov
104. Articular impactions in acetabular fractures.pubmed.ncbi.nlm.nih.gov
105. Guidelines on the Use of Therapeutic Apheresis in Clinical Practice-Evidence-Based Approach From the Writing Committee of the American Society for Apheresis: The Tenth Special Issue.pubmed.ncbi.nlm.nih.gov
106. Automated multi-scale computational pathotyping (AMSCP) of inflamed synovial tissue.pubmed.ncbi.nlm.nih.gov
107. Clinical practice guidelines for the care of girls and women with Turner syndrome.pubmed.ncbi.nlm.nih.gov
108. Fatal Injuries Caused by Falling Trees: Correlation Between Postmortem Computed Tomography and Forensic Autopsy Findings in Eight Cases.pubmed.ncbi.nlm.nih.gov
109. How to minimize complications during and after periacetabular osteotomy : lessons learned from over 700 patients with and without concomitant hip arthroscopy.pubmed.ncbi.nlm.nih.gov
110. Preoperative Three-Dimensional Planning Using Computed Tomography Improves Screw Placement in Patients Undergoing Acetabular Revision Surgery.pubmed.ncbi.nlm.nih.gov
111. Hip adductor muscle abscess complicating a case of septic arthritis of the symphysis pubis: A case report.pubmed.ncbi.nlm.nih.gov

Eğitim amaçlıdır; hasta başında tanı ve tedavi kararının yerine geçmez, tıbbi tavsiye değildir. Metinler yapay zekâ desteğiyle yazıldı ve otomatik bir adımda kaynak alıntılarıyla karşılaştırıldı; bu bir tıbbi doğrulama değildir ve içerik uzman radyolog incelemesinden geçmedi. Klinik kararlarda güncel kılavuzları, kurum protokollerini ve radyoloji raporunu esas alın.