Fractured Ischium, Anterior View

Description

Centered in an anterior male pelvis, the os coxae are presented with the ilium superiorly, the pubis anteromedially at the pubic symphysis, and the ischium forming the inferoposterior portion of the pelvic ring. Along the inferior ramus of the ischium (ischiopubic ramus), a fracture line separates bone adjacent to the obturator foramen, just inferior to the superior pubic ramus and medial to the acetabulum. Superiorly, the lower lumbar vertebrae and intervertebral discs transition into the sacrum at the midline, while laterally the femoral heads and necks sit within the acetabula, oriented inferomedially toward the lesser trochanters. Fractures of the ischiopubic ramus are common in low-energy pubic rami injuries in older adults and can also occur as part of pelvic ring trauma in younger patients, where anterior ring disruption may accompany posterior sacral fractures that are easy to miss on initial assessment. Pain localizes to the groin or perineum and increases with weight bearing because the inferior pubic ramus and ischial ramus transmit forces between the acetabulum and pubic symphysis during stance. Proximity to the obturator canal makes this anatomy worth revisiting when correlating with obturator nerve irritation (medial thigh pain, weak adduction) and when planning anterior pelvic fixation where screws traverse the superior pubic ramus close to the obturator neurovascular bundle. A key landmark. Use this artwork for pelvic anatomy teaching in gross anatomy and radiographic anatomy courses, pairing it with AP pelvis radiographs and CT axial slices to explain the pelvic ring concept and typical pubic ramus fracture patterns. It also suits orthopaedic trauma, emergency medicine, and physiotherapy materials discussing gait-limiting pelvic fractures and rehabilitation expectations after stable anterior ring injuries. Anatomical accuracy verified by SciePro's Medical Advisory Board.