However, due to new fractures on pubic ramus
, full weight bearing was delayed for approximately 6 months.
But the zone of highest von-Mises stress varied during gait from superior pubic ramus
for maximum load (Figure 3a) to central inferior ilium for minimum load (Figure 3b).
In this study, the case of a patient, who has been receiving bisphosphonate treatment for 10 years and developed multiple fractures (left femoral diaphysis, bilateral pubic ramus
and sacrum), was presented and the literature was reviewed.
There may be palpable tenderness over the pubic ramus
, but the most specific sign is tenderness over the medial inguinal floor, or Hesselbach's triangle.
A technetium bone scan was performed and demonstrated abnormal uptake about the right superior pubic ramus
and the left pubic rami.
The anteroposterior radiograph of the pelvis shows a lytic, expansile lesion of the right acetabulum that extends into the ilium and superior pubic ramus
with cortical breakthrough of the iliopubic line.