Physiotherapy: Pubic Rami Fracture

Pubic Rami Fracture

This Information booklet will help you understand your injury and provide advice on suitable exercises to aid your recovery.

The pubic rami are a group of bones that make up part of the pelvis. A pubic ramus fracture is a break in one of these bones.

These fractures do not need an operation and will heal with time, analgesia and therapy. They often take about 6-8 weeks to heal.

You can fully weight bear as pain allows and there are no limitations to range of movement only to avoid twisting on the leg.

Walking is the best treatment for these injuries and will help with your circulation and healing.

Pain relief medication

There are a lot of muscle attachments around the pelvis and this can make movement very painful. It is essential to keep on top of your pain relief, if you feel that your pain is not controlled please inform a member of staff in the hospital or your GP at home.

It is common that at rest you will feel no pain. Pain will generally increase on movement and weight bearing so please comply with the recommended pain relief prescribed.

Keeping on top of your pain relief will also aid you in participating with therapy. Movement and mobility is essential in helping this injury to heal.

Treatment and discharge planning

Your therapist will guide you on which exercises in this booklet are appropriate for you.

They will also assess your mobility and provide you with an appropriate mobility aid.

Depending on your ability post injury the health care professionals on the ward will discuss which discharge options would be suitable in order to facilitate your recovery.

Bed exercises

1. To assist good circulation  

• Move both ankles and toes up and down as much as possible.  Repeat x…………

2. Knee / Hip Flexion

• Lying on your back, bend and straighten your leg.  Repeat x……………     

3. Hip Abduction

• Lying on your back, bring your leg out to the side, then back to the middle. Repeat x……………

4. Bridging

• Lay on your back with your knees bent up.
• Lift your bottom off the bed and hold for 5s. Repeat x……………  

Chair exercises

• Heel and Toes Taps 
• Rise up onto your toes and then your heels.  Repeat x………….

2.  Knee Flexion

• Slide the affected leg forwards and back along the floor.  Repeat x …………… 

3.  Knee Extension

• Straighten your knee in front of you, so that your foot lifts off the floor. Hold for 5 seconds.  Repeat x………..

4.  Hip Flexion

• Lift one knee at a time towards your chest. Repeat x ……………

Standing exercises

Stand holding onto a support in front of you

1. Heel Raises

• Slowly raise your heels off the floor, and lower again. Repeat x……………    

2. Hip Flexion

Stand holding a support in front of you

• Lift your knee towards your chest then lower your foot to the ground.  Repeat x……………    

3. Hip Abduction

• Stand holding onto a support
• Lift your leg out to the side and return to the starting position
• Ensure you don’t lean sideways Repeat x……………   

4. Hip Extension

• Stand holding onto a chair.
• Keeping your body upright, move your leg back as far as possible with your knee straight. Return to the starting position.
• Ensure you don’t lean forwards.  Repeat x……….

5. Squat

• Holding onto a chair with your feet hip width apart, slowly bend your knees and stick your bottom out. 
• Go down as far as you feel comfortable then stand up tall.  Repeat x……….  

Everyday activities

Walking

Use the walking aid provided by the therapist.  Gradually increase how far you walk as able.

Stairs

If you need to, you will be taught how to do the stairs before you go home.

Going up: Unaffected leg goes up first, followed by the affected leg and finally the walking aid.

Going down:  The walking aid goes down first, followed by the affected leg and then the unaffected leg.

Getting in and out of bed

When getting into bed, try to shuffle your bottom back onto the bed as far as possible before lifting your legs up.  If you struggle to lift your affected leg the therapy team can teach you an easier technique.  You can sleep in which every position you find most comfortable but may prefer to place a pillow in between your knees when sleeping on your side.

Sitting

Avoid sitting on low chairs or for prolonged periods of time.  Use your hands on the arms of the chair to help gently lower yourself.    

Washing and dressing

Initially you may need to sit to wash and dress due to pain felt in standing.  Dress your affected leg first and undress it last. The Therapy team will provide equipment if required. 

Bathing/Showering

Bathing may be difficult initially as you have to bend a lot when getting in and out.  If you have a shower over the bath, you should take care when stepping into the bath.  If you feel you are unable to do this safely, you should continue to strip wash.  If you have a shower cubicle, you should step in with your unaffected leg first.  Wash your legs and feet with long-handled aids or assistance as required. 

When getting in a car:

• Have the seat pushed right back and reclined slightly.  Stand with your back to the seat and slowly lower yourself to the edge of the seat.
• Push yourself backwards towards the driver’s seat as far as you can go, then lift your legs in slowly

When getting out of the car:

• Try to step out onto the road rather than straight onto the pavement.

If you have any concerns or question regarding the information in this leaflet, please speak to your Physiotherapist.

Confidentiality

‘The Trust’s vision is to keep your information safe in our hands.’ We promise to use your information fairly and legally, and in-line with local and national policies. You have a right to understand how your information is used and you can request a copy of the information we hold about you at any time.

For further information on confidentiality contact the Information Governance Team:

Information.Governance@ncic.nhs.uk | 01228 603961

Feedback

We appreciate and encourage feedback, which helps us to improve our services. If you have any comments, compliments or concerns to make about your care, please contact the Patient, Advice & Liaison Service:

pals@ncic.nhs.uk | 01228 814008 or 01946 523818

If you would like to raise a complaint regarding your care, please contact the Complaints Department:

complaints@ncic.nhs.uk | 01228 936302