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Pelvis/Hip Case 9 Diagnosis

Pubic ramus fractures can be diagnosed on AP pelvis x-ray. If the fracture is near the acetabulum, additional (Judet) views help to determine whether the acetabulum is involved.  Judet views are images obtained by log rolling the patient 45° to each side.  If the acetabulum is involved, then this should be managed as an acetabulum fracture and not a simple pubic ramus fracture.

If there is no fracture on x rays but clinical suspicion is still high, CT or MRI would make the diagnosis.  Of note, 2-9% of hip fractures are occult (the X-rays are negative). The role of CT and MRI is mainly to make sure a fracture of the acetabulum or femoral neck is not missed, since these are often managed operatively.