The ischiopubic ramus is the inferior portion of the pelvic ring where the inferior pubic ramus merges with the ischial ramus to form the floor and medial boundary of the obturator foramen. It provides attachment for the gracilis, adductor longus and brevis, obturator externus, and the muscles of the perineum. Stress fractures of the ischiopubic ramus occur in distance runners and military recruits from repetitive loading.
Ischiopubic ramus stress fractures produce groin and medial thigh pain in runners and military recruits that is reproduced by single-leg stance and may be missed on plain radiographs but identified on MRI or bone scan. The ischiopubic ramus junction (synchondrosis) in children between ages 4 and 12 has an irregular, widened appearance that is a normal variant (Van Neck disease) sometimes confused with osteomyelitis or tumour on radiograph.
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