Pelvic fragility fractures, such as pubic ramus fractures, are a common and painful condition in the elderly population. Despite this, there are few regional anaesthesia options available to effectively relieve pain in these fracture types and avoid potential side effects from opioid administration. This case report describes an elderly patient with a superior ramus fracture, who received effective pain relief with motor sparing, using a standard-volume point-of-care ultrasound-guided pericapsular nerve group (PENG) block performed in the emergency department. The standard-volume PENG block performed by an emergency clinician appears to be a safe, effective and feasible regional anaesthesia technique for superior pubic ramus fracture, with the additional benefit of motor sparing that may potentially facilitate earlier mobilisation and discharge.

UNASSIGNED: Aneurysmal bone cysts (ABC) are expansile, lytic, and benign but locally aggressive lesions. Pelvic ABCs are rare and sometimes difficult to manage surgically.
UNASSIGNED: A 17-year-old female presented with progressive pain and swelling in the right inguinal region. Pelvis radiograph showed a lytic expansile lesion of the superior pubic ramus. A multiloculated cystic lesion was evident on magnetic resonance imaging, and postoperative histopathological evaluation confirmed the diagnosis of ABC. The patient was treated successfully with an intralesional curettage and bone grafting. The postoperative course was uncomplicated with complete healing and no recurrence after 14 months of follow-up.
UNASSIGNED: ABC of the pubic ramus is a rare entity. Complete intralesional curettage and bone ‎grafting ‎is an effective treatment for pubic ABC. An individualized management approach ‎considering ‎the surgical team expertise, tumor size, and proximity to neighboring structures ‎is recommended.‎.

Stress fractures refer to overuse injuries of bone resulting from repetitive mechanical stress. Stress fractures of the hip and pelvic region, while relatively uncommon, have become increasingly recognized in certain populations, particularly long-distance runners and military recruits. The diagnosis of such injuries can be challenging, often hampered by a nonspecific physical examination and limited sensitivity of plain radiography. Early recognition is important to direct appropriate management, lessen time lost from sport, and avoid potential complications. The present article reviews the epidemiology, diagnosis, and management of bone stress injuries of the hip and pelvis, specifically the sacrum, pubic ramus, and femoral neck.

UNASSIGNED: Osteochondromas are the most common benign bone tumors (accounting for 20-50% of all benign bone tumors). They are developmental malformations rather than true neoplasms and are thought to originate within the periosteum. They usually affect bones that develop by enchondral ossification and rarely originate from bones that develop by intramembranous ossification such as the scapula, pubic rami, clavicle, and ribs.
UNASSIGNED: We present a case of a 24-year-old male, who came with a swelling in the right side inguinal region for 2 years which was diagnosed to be osteochondroma by trocar biopsy. The site and presentation are rare. The patient had no visceral or vascular involvement though the lesion was very near many vital structures on superior pubic ramus.
UNASSIGNED: Osteochondroma arising from the pelvis is an unusual presentation which should be kept in mind as a differential diagnosis when evaluating mass in pelvis.

BACKGROUND: In the vast majority of patients with pelvic ring lesions, there is a combination of fractures of the posterior and anterior pelvic ring. Anterior fractures are painful and contribute to loss of stability of the pelvic ring. For these reasons, stabilization of pubic rami fractures is recommended together with posterior pelvic ring fixation. Retrograde transpubic screw osteosynthesis enjoys increasing acceptance due to its minimal invasive technique and adequate stability.
METHODS: We retrospectively reviewed the results of 158 retrograde transpubic screw osteosyntheses in 128 patients with pelvic ring lesions including a pubic ramus fracture. Sixty-three patients suffered a high-energy injury, 65 a fragility fracture of the pelvis.
RESULTS: One hundred and forty-six screws (92.4%) were inserted through a percutaneous procedure. There were no vascular, neurological or urological complications. Fifty-nine screws (39%) yielded an excellent reduction with less than one cortical width of displacement. Slight secondary displacement was seen in 33 of these fractures (55.9%). Early surgical complications were seen in 16 screws (10.1%): suboptimal pathway in 10, local hematoma in 4 and local infection in 3. Early revision surgery was done in 7 screws (4.4%). Median follow-up was 27.6 weeks, 83 screws (52.5%) had a follow-up of more than 6 months. During follow-up, 7.6% of screws loosened. Operative revision was performed in 13%. 75 fractures (90.3%) with a follow-up of ≥ 6 months showed radiographic evidence of healing. There was no difference in the healing rate of high-energy and fragility fractures. Nonunion rate was not dependent on the quality of primary reduction, secondary displacement, or screw loosening. Infection (p 0.001) and surgery ≥ 6 months after trauma (p 0.02) more often led to nonunion.
CONCLUSIONS: Retrograde transpubic screw osteosynthesis is a reliable method for splinting pubic rami fractures in high and low energy pelvic trauma. Although a slight secondary fracture displacement is seen in most cases, it does not affect fracture healing. Retrograde transpubic screw is a adequate minimal-invasive osteosynthesis to stabilize the anterior pelvic ring, especially in fragility fracture of the pelvis. Delayed operation (> 6 months) and infection show higher rate of nonunion.

BACKGROUND: Osteochondroma are benign neoplasms which arise from small cartilage nodules within the periosteum. They can be either pedunculated or sessile and are more common in the extremities. They rarely develop in bones like scapula, feet, hands and pelvis. Management of the lesion is by en-bloc excision.
METHODS: We present a case of 18 year female, who came with a swelling in right groin since 2 years which was diagnosed to be osteochondroma on x-ray and magnetic resonance imaging. Excision biopsy was done as the patient wanted it to be removed for cosmetic purpose and confirmed it to be non-malignant osteochondroma. There has been no recurrence even after 1 year of follow up.
CONCLUSIONS: Thus osteochondroma of the pelvis should be kept in mind as a differential diagnosis when evaluating mass in pelvis. Also these have to be removed when they pose cosmetic problems.

BACKGROUND: Aneurysmal bone cyst is an expansile, lytic, multiloculated, fluid filled cavities which usually occurs in the metaphysis of the long bones. ABC of the pubic ramus is a rare entity..
METHODS: We present a case of a 21 year old male who presented with a swelling of the right inguinal region which was gradually progressive. Radiologically, there was a lytic expansile lesion of the superior pubic ramus. A contrast computed tomography revealed multiloculated cystic cavities and histopathology confirmed the diagnosis of ABC. Surgical excision of the complete tumor by anterior approach was done. Till date (2 years since surgery) patient has no recurrence.
CONCLUSIONS: ABC of pubic ramus is a rare entity and other differentials should always be kept in mind with confirmation of diagnosis by histopathology. Treatment with surgical curettage and bone grafting the defect is curative in selective cases but in this case due to size and location excision is the choice of treatment.

Meningiomas are well-recognized neoplasms of the central nervous system. Primary extracranial meningiomas (ECMs) are extremely rare and arise in various anatomic sites. We present a 56-year-old female with 13-year history of primary grade I meningothelial meningioma of right pubic symphysis, orthotopic heart transplant, and right total hip arthroplasty, who presented with progressive right hip pain for 3 weeks. Primary intracranial, intraspinal and other tumors were excluded. Imaging revealed a destructive lytic lesion at right superior and inferior pubic rami and body, associated with extensive bone destruction and soft tissue mass. Touch imprint (TI) cytology of computed tomography (CT)-guided core biopsy from the right pubic ramus (PRA) lesion showed a spindle cell neoplasm, with classical syncytial, lobular, and whorling cellular arrangement, composed of spindle, oval or round nuclei with occasional pseudoinclusions, consistent with known history of osseous meningioma. Tumor was further characterized by histopathology as grade 1 meningioma with meningothelial features. To our knowledge, primary osseous ECM arising specifically at the PRA has not been reported previously. ECM at this site may pose a diagnostic challenge for cytologists as its features may resemble other more commonly observed lesions. Accurate diagnosis requires awareness of occurrence of ECM at PRA and recognition of its characteristic cytomorphology. TI cytological features of our case are presented and previously described cytology of ECMs and diagnostic pitfalls are reviewed. Diagn. Cytopathol. 2016;44:618-622. © 2016 Wiley Periodicals, Inc.