Fractures of the pubic rami are nearly always associated with further pelvic ring injuries. The treatment of these fractures is guided by the displacement and other associated pelvic ring injuries.
In many cases, a strong periosteum, the inguinal ligament and the pectineal ligament will provide adequate stability and no additional treatment is required. With more complex, unstable pelvic ring injuries, ramus fractures may require fixation to restore stability and promote healing.
The decision for operative vs. nonoperative is best made by evaluating the entire pelvic ring and its stability instead of focusing only on the ramus fracture.
For more complex injuries, posterior reduction and fixation must precede fixation of the ramus fractures. In these cases, the anterior fixation supplements and stabilizes the posterior fixation.