Pubic rami fracture

[Giannig]

I am writing a progress note and have come up on the differential diagnoses for pubic rami fracture. This is what I have listed so far:
1. Fracture of head of femur.

Pertinent positives: Pt identifies some pain near trochanter area.

Pertinent negatives: Leg is not shortened or rotated.

2. Fracture of acetabulum.

Pertinent positives: Leg is rarely shortened or extremely rotated.

Pertinent negatives:

3. Fracture of iliac crest.

Pertinent positives: Leg is rarely shortened or extremely rotated

Pertinent negatives:

Would someone be so kind as to suggest some other ideas for pertinent positives and negatives?

Thanks in advance,
Gianni

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[Rendar5]

externally rotated, not extremely rotated.

not sure that there is such a thing as a differential for an identified fracture on x-ray...you kind of already have the diagnosis. unless you're asking for something else.

 

[SpecterGT260]

externally rotated, not extremely rotated.

not sure that there is such a thing as a differential for an identified fracture on x-ray...you kind of already have the diagnosis. unless you're asking for something else.

I was a little confused about the question as well... Still, they make us give differentials for things where the concept of "differential" doesn't fit well.

OP, my approach would be to think about what other injuries may be present but not yet ruled out. The pelvis likes to break in 2 spots. Do we know that it isn't? It's also usually super traumatic which means neurovascular injury is likely. Toes reperfusing? motor/sensory function intact? How is the back? Pelvic fractures have been known to avulse transverse spinous processes.

You didn't really describe what you are trying to do.... is this a real patient and you have a set of physical findings? Or are you just given a diagnosis of rami fx and you need to come up with a list of cases which might present in a similar fashion?

 

[Giannig]

I was a little confused about the question as well... Still, they make us give differentials for things where the concept of "differential" doesn't fit well.

OP, my approach would be to think about what other injuries may be present but not yet ruled out. The pelvis likes to break in 2 spots. Do we know that it isn't? It's also usually super traumatic which means neurovascular injury is likely. Toes reperfusing? motor/sensory function intact? How is the back? Pelvic fractures have been known to avulse transverse spinous processes.

You didn't really describe what you are trying to do.... is this a real patient and you have a set of physical findings? Or are you just given a diagnosis of rami fx and you need to come up with a list of cases which might present in a similar fashion?

I am new to the forum and this was my first post. Looking at it now I see that it was confusing. I was given a diagnosis of superior and inferior pubic rami fracture and need to come up with 3 cases which might present in a similar way and why. I understand that there is no external rotation and no shortening of the extremity of the involved side. I have no idea what else presents like this. Would you be willing to give me suggestions or tell me where I might find this information?
Thanks in advance. If you have further questions, please let me know.

 

[Rendar5]

I am new to the forum and this was my first post. Looking at it now I see that it was confusing. I was given a diagnosis of superior and inferior pubic rami fracture and need to come up with 3 cases which might present in a similar way and why. I understand that there is no external rotation and no shortening of the extremity of the involved side. I have no idea what else presents like this. Would you be willing to give me suggestions or tell me where I might find this information?
Thanks in advance. If you have further questions, please let me know.

Well, unfortunately, you were given a dumb question with only silly answers available. to you. acetabular fx's are the only thing that do present similarly. you can write contusion if you want, but honestly you can tell the difference right away. maybe nondisplaced femur fracture too.

 

[SpecterGT260]

I am new to the forum and this was my first post. Looking at it now I see that it was confusing. I was given a diagnosis of superior and inferior pubic rami fracture and need to come up with 3 cases which might present in a similar way and why. I understand that there is no external rotation and no shortening of the extremity of the involved side. I have no idea what else presents like this. Would you be willing to give me suggestions or tell me where I might find this information?
Thanks in advance. If you have further questions, please let me know.

If I were given that assignment I would go to a site like diagnosaurus.com and start with either the fracture or the key symptom and then see what it spits out. but I agree with the above that the assignment is kinda silly. I know med schools want us to learn to build diagnoses and not just land on the "most likely" diagnosis based on whatever the boards-style presentation is, but still...

 

[colbgw02]

Can you clarify what you're looking for? Are you looking for a DDx of pubic rami fractures? Or are you looking for a DDx for the symptoms that would be seen with pubic rami fractures?

 

[Giannig]

Can you clarify what you're looking for? Are you looking for a DDx of pubic rami fractures? Or are you looking for a DDx for the symptoms that would be seen with pubic rami fractures?

I am looking for 3 DDx for the symptoms that would be seen with pubic rami fractures.

 

[colbgw02]

I am looking for 3 DDx for the symptoms that would be seen with pubic rami fractures.

Okay, so really it's anything that could cause groin or hip pain. Off the top of my head, in adults, and in no particular order:

Any hip arthritis, usually OA, to include septic arthritis
Acetabular labral tear
Femoral avascular necrosis
FAI
Piriformis syndrome
Femoral head or neck insufficiency fracture
Proximal femoral fracture - acute traumatic or pathologic
Iliopsoas or trochanteric bursitis
Iliopsoas or gluteal tendinopathy
Transient osteoporosis of the hip
Inguinal or femoral hernia
Varicocele
Any muscle strain

HTH.