European Journal of Trauma and Emergency Surgery · Feb 16, 2026

Operative versus non-operative treatment of fragility fractures of the pelvis: retrospective evaluation of one-year mortality and in-hospital complications

By Herteleer M, De Wever L, Janssens S et al.

This study assessed the impact of surgical intervention versus non-operative management in older adults with fragility fractures of the pelvis. Among 128 patients, no significant difference in one-year mortality was found, surgical patients had similar discharge institutionalization rates. Surgery was deemed safe for immobile patients. PURPOSE: Fragility fractures of the pelvis are increasing and are associated with high morbidity and mortality. The goal of this study was to assess whether surgical intervention in older adults experiencing severe pain during mobilization is associated with a lower incidence of complications compared to non-operative management for fragility fractures of the pelvis (FFP). METHODS: This retrospective single-center cohort study included 128 FFP patients between January 2021 and June 2023. Inclusion criteria were age ≥ 60 and isolated FFP. Data were collected from electronic medical records; one-year mortality data were verified through national registries. The primary outcome was one-year mortality; secondary outcomes included in-hospital complications, length of stay (LOS), discharge destination, and institutionalization. Statistical analyses included logistic regression and non-parametric tests. RESULTS: The median age was 85 years (IQR = 12), and 82.8% were female. There was no significant difference in one-year mortality between surgical and conservative groups (16.7% vs. 24.4%, p = 0.319). However, surgical patients had longer LOS (21 vs. 12 days, p = 0.002) with a median delay of surgery by 8 days (IQR 6) and more cardiovascular complications such as hypertension (16.7% vs. 3.5%, p = 0.009). Post-discharge institutionalization occurred in 22.6% of the total cohort. CONCLUSION: Surgery in patients who cannot mobilize with an FFP is safe. Patients with displaced FFP’s (type 3 and 4) more often failed non-operative treatment and required surgery. Further studies should focus on identifying factors of non-operative treatment failure and should prioritize functional outcomes and quality of life.

doi.org/10.1007/s00068-026-03111-w PubMed 41697363 Interventions