Age and “general health”—beside fracture classification—affect the therapeutic decision for geriatric pelvic ring fractures: a German pelvic injury register study

  • Andreas HöchEmail author
  • Philipp Pieroh
  • Florian Gras
  • Tim Hohmann
  • Sven Märdian
  • Francis Holmenschlager
  • Holger Keil
  • Hans-Georg Palm
  • Steven C. Herath
  • Christoph Josten
  • Hagen Schmal
  • Fabian M. Stuby
  • Pelvic Injury Register of the German Trauma Society
Original Paper



Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment decision in relation to fracture classification, age, and the resulting treatment are still rare.


Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury pattern, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classification were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups.


A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evaluation. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS > 16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classification increased the probability for an operative treatment (generalized odds ratio [OR] 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture pattern decreased this probability (OR 0.47 [0.41–0.53]). With increasing fracture instability, general health conditions were up to 50% of the reasons for conservative treatment.


The results of the present study underline the importance of the factors age and general health besides fracture classification for therapeutic decision-making in the treatment of pelvic ring fractures in the elderly.


Pelvic fracture Fragility fracture Pelvis Treatment Epidemiology 


Authors’ contributions

Conceived and designed the study: AH, PP, CJ, and FMS

Data acquisition: AH, FG, SM, FH, HK, HGP, SCH, HS, and FMS

Analyzed the data: AH, PP, TH, CJ, and FMS

Wrote and draft the paper: AH, PP, FG, HS, and FMS

Approved the final version of the manuscript: AH, PP, FG, TH, SM, FH, HK, HGP, SCH, HS, CJ, and FMS

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Supplementary material

264_2019_4326_MOESM1_ESM.docx (16 kb)
Supplementary Table 1 (DOCX 16 kb)


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Copyright information

© SICOT aisbl 2019

Authors and Affiliations

  • Andreas Höch
    • 1
    Email author
  • Philipp Pieroh
    • 1
    • 2
  • Florian Gras
    • 3
  • Tim Hohmann
    • 2
  • Sven Märdian
    • 4
  • Francis Holmenschlager
    • 5
  • Holger Keil
    • 6
    • 7
  • Hans-Georg Palm
    • 8
  • Steven C. Herath
    • 9
  • Christoph Josten
    • 1
  • Hagen Schmal
    • 10
  • Fabian M. Stuby
    • 11
  • Pelvic Injury Register of the German Trauma Society
  1. 1.Department of Orthopedics, Trauma and Plastic SurgeryUniversity of LeipzigLeipzigGermany
  2. 2.Department of Anatomy and Cell BiologyMartin Luther University Halle-WittenbergHalle (Saale)Germany
  3. 3.Department of Trauma-, Hand- and Reconstructive SurgeryUniversity Hospital JenaJenaGermany
  4. 4.Centre for Musculoskeletal SurgeryCharité - University Medicine BerlinBerlinGermany
  5. 5.Department of Trauma SurgeryOtto-von-Guericke-UniversityMagdeburgGermany
  6. 6.Department for Trauma, Hand Surgery and OrthopedicsHospital of KarlsruheKarlsruheGermany
  7. 7.Clinic for Trauma and Orthopaedic Surgery, BG Trauma Center Ludwigshafen at the University of HeidelbergMINTOS - Medical Imaging and Navigation in Trauma and Orthopaedic SurgeryLudwigshafenGermany
  8. 8.Trauma Research Group, Department of Orthopedics and Trauma Surgery, Reconstructive and Septic Surgery, and Sports TraumatologyGerman Armed Forces Hospital UlmUlmGermany
  9. 9.Department of Trauma, Hand and Reconstructive SurgerySaarland University HospitalHomburgGermany
  10. 10.Department of Orthopaedics and Traumatology, Odense University Hospital and Department of Clinical ResearchUniversity of Southern DenmarkOdenseDenmark
  11. 11.Department of Trauma SurgeryBG Trauma Centre MurnauMurnauGermany

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