The pubis forms the anterior pelvis, comprising the pubic body (medial — articulates at the symphysis), the superior pubic ramus (connects to the ilium at the iliopubic eminence), and the inferior pubic ramus (connecting to the ischium). The pectineal line of the superior ramus is the attachment for Cooper's ligament and the pectineus muscle. Pubic stress fractures in runners and pubic rami fractures in osteoporotic falls are the most common pubic injuries.
Pubic stress fractures present as groin pain in runners with tenderness on direct pubic ramus palpation. MRI shows bone marrow oedema at the cortical fracture site. Female military recruits are particularly susceptible from calcium-deficient high-mileage training. Management is reduction in loading and nutritional optimisation. Pubic rami fractures in falls (classic osteoporotic injury) are managed with mobilisation and fall prevention strategies.
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