The Anatomy of the Pubis

A Large Bone Supporting the Hip and Lower Extremities

In This Article

The pubic bone is located in front of the pelvic girdle. In the rear, the ilium and ischium form the bowl shape of the pelvic girdle. The two halves of the pubic bone are joined in the middle by an area of cartilage called the pubic symphysis. The larger bones in the rear of the pelvic girdle are taller. These bones are located almost directly above the hip bone and are often visible in women and individuals with little body fat. The pubic bone is not visible outside of the body and joins the front-facing half of the pelvic girdle.

Anatomy

The pubis is located at the front of the body, just below the abdomen. This area provides structure and protection to the urogenital organs in both sexes, including the bladder, uterus, ovaries, prostate, and testes.

The largest portion of the pubis is called the pubic body, which is located at the highest point of the pubis. The rear portion of the pubis is joined to the ilium, one of the bones in the rear of the pelvic girdle. The ischiopubic ramus is the area where the ischium and the pubis join. This rear portion is also where the pubic tubercle is located, which is a small bump where muscles and ligaments attach to.

The area of the pubis where the pubic bone meets with the ilium is an angle called the superior pubic ramus. Between the superior pubic ramus and the upper area of the pubis is the pectineal line, which is another area where muscles and ligaments insert for stabilization. Just opposite the superior pubic ramus is the inferior pubic ramus which points downward on the lateral body of the pubis.

The pubic bone then arches downward and turns to cartilage in the middle. This arched area of bone is called the pubic arch which also joins with the pubic symphysis where the two ends of the pubic bone meet.

Anatomical Variations

One of the most significant anatomical variations of the pubic bone is the difference in pelvic measurements. This means the distance between the pubic symphysis and the insertion point of the hip may vary, as may the angles of the pubic arch, the length of the pubic symphysis, and the radius of the indent where the hip inserts. Pubic bone variations relative to the ability to bear children are also present. 

The female pelvis may be classified as gynecoid, indicating a highly accommodating pelvis for the purpose of childbirth, or anthropoid, indicating a somewhat suitable structure for childbirth.

Other pelvis types more commonly found in men are android and platypelloid, which have angles which are not biologically intended to allow for childbirth. A woman who has a pelvis categorized as platypelloid or anthropoid will typically not undergo traditional vaginal childbirth and often requires alternative methods of delivering a child (such as a cesarian section).

Function

The main function of the pubis is to protect the intestines, bladder, and internal sex organs. The pubis also joins the bones of the hip and provides support close to the body, while allowing for movement farther down the leg.

The pubis joins the rear bones of the pelvic girdle, holding them in place and allowing for a circular structure to join the upper half of the body with the lower half of the body.

The pubic bone also has several skeletal landmarks which allow for insertion of muscles, cartilage, ligaments, and tendons. Each of these structures allow for sound formation of joints, bones, and bodily structures.

The pubic bone has a minor motor function, as its primary role is to stabilize the pelvic girdle. The cartilaginous pubic symphysis has slight motion in its loose joining of the two halves of the pubic bone. However, the main purpose of this cartilage is also for stabilization. The organs within the pelvic girdle all have intricate innervation, meaning several major nerves are running through the pelvic girdle and its structures.

Associated Conditions

As with any bone, the pubic bone can be fractured and must be immobilized to allow for proper and complete healing. This immobilization is often complemented by blood tests to ensure the absence of infection and radiographs to monitor the healing process.

The pubis can also be affected by an inflammatory condition called osteitis pubis, in which a person experiences what seems like abdominal pain or pain to the lower groin. If not properly treated, this condition can evolve into osteomyelitis of the pubic bone. Osteitis pubis is a condition which is often mistaken for simple abdominal pain, menstrual pain in women, or pulled muscles. It can occur during pregnancy. Receiving a proper diagnosis through ultrasound and a thorough examination is important to performing accurate treatment.

Osteomyelitis is a bone infection which is difficult to treat due to the likelihood and ease of the infection spreading to other bones through nearby tissues or the bloodstream. While osteomyelitis to this bone is somewhat rare, it is a condition which often results in additional medical complications.

Osteitis pubis and osteomyelitis are treated by strong antibiotics which are intended to kill the bacteria and rid the area of the infection. These conditions also often result in external skin and tissue wounds, which must be properly cleansed, dressed, and immobilized to allow for full and complete healing.

Rehabilitation

Rehabilitation for fractures of the pubic bone largely consists of immobilization to allow for healing of the bone. The pubic bone is difficult to immobilize apart from the rest of the body, meaning large-scale restrictions are required to avoid any movement which may impede the healing process. These restrictions often include bed rest for several weeks, while completing passive upper and lower extremity movement with the help of a therapist. Once a radiograph indicates healing is complete, an individual enters physical rehabilitation to strengthen muscles and prevent a recurrence of injury.

Rehabilitation for a pubis fracture is similar to the process followed after osteomyelitis or osteitis pubis. Disciplines including physical therapy and occupational therapy can address a variety of treatment areas to restore function. Focus is placed on regaining muscle strength which may have been lost as a result of immobilization and deconditioning. This is addressed through resistive exercise programs to the upper and lower extremities, simulated and assisted self-care completion, balance training, ambulation training, and other treatments specific to the individual’s needs.

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