Fracture of pubic rami during hip fracture fixation: a rare case of traction table-related injury

Abstract

We present a case of an elderly and comorbid patient who was scheduled to undergo a hip fracture fixation using an intramedullary nail. Unfortunately, this was delayed by 3 weeks as the patient was unfit to undergo this procedure. She was placed onto the traction table and intraoperatively sustained a superior and inferior pubic rami fracture while attempting reduction on the traction table. Closed-reduction techniques using traction tables and perineal posts are not without morbidity. Risk factors such as osteoporosis and delayed-fixation should be accounted for when managing this complex and often frail group of patients.

Keywords: geriatric medicine; orthopaedic and trauma surgery; orthopaedics; osteoporosis.

Figure 1

Preoperative X-ray of pelvis showing intrer-trochanteric neck of femur fracture.

Figure 2

Intraoperative imaging of right hip and hemi-pelvis (post-traction application) showing superior and inferior pubic rami fracture and intrer-trochanteric neck of femur fracture.

Figure 3

Postoperative CT scan demonstrating intact pelvic ring and stable pelvic weight-baring complex.

Figure 4

Postoperative imaging of right hip and pelvis showing neck of femur fracture fixed with IM(Intra-medullary) nail and superior and inferior pubic rami fracture.

Figure 5

Factors effecting bone strength.

Figure 6

Ideal position of perineal post and distribution of energy vectors through the pelvis and femur on application of traction (Created by author: Dr A. Gomindes 2021).