{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T12:04:37Z","timestamp":1789646677793,"version":"4.0.0"},"reference-count":34,"publisher":"BMJ","issue":"9","license":[{"start":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T00:00:00Z","timestamp":1789603200000},"content-version":"unspecified","delay-in-days":16,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001702","name":"AO Foundation","doi-asserted-by":"publisher","award":["NA"],"award-info":[{"award-number":["NA"]}],"id":[{"id":"10.13039\/501100001702","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2026,7,16]]},"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Fragility fractures of the pelvis (FFPs) are low-energy osteoporotic fractures that primarily affect elderly patients. They are associated with substantial morbidity, mortality and healthcare burden, and their incidence continues to rise as the global population ages. Despite the availability of dedicated classification systems and advances in surgical techniques, high-quality evidence to guide optimal management remains limited, and treatment algorithms are not standardised. To address these gaps, we established an international, observational cohort study designed to collect comprehensive data on patients with FFP and varying degrees of pelvic instability. The study aims to evaluate outcomes of non-operative and operative management and to identify predictors of favourable outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and analysis<\/jats:title>\n                    <jats:p>This international, prospective, multicentre, observational cohort study will enrol approximately 420 patients aged \u226565 years with FFP (types II\u2013IV) over a 4-year period at 10 large AO Trauma centres in the USA, Canada, Japan, Hong Kong, France, Switzerland, the Netherlands and Germany. Patients will be followed for up to 12 months. Data collected will include fracture characteristics, treatment details, radiological and functional outcomes, patient-reported outcomes, mortality and procedure-related adverse events. All treatments will adhere to the standard of care at each participating centre.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Ethics and dissemination<\/jats:title>\n                    <jats:p>Ethics approval was obtained from the responsible ethics committee at each participating site before recruitment. All patients will be enrolled following an informed consent process approved by the relevant ethics committee. Study results will be disseminated through peer-reviewed publications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"clintrialgov\" specific-use=\"clinicaltrial pre-results\" xlink:href=\"NCT04182776\">NCT04182776<\/jats:ext-link>\n                      .\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2026-120446","type":"journal-article","created":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T11:45:18Z","timestamp":1789645518000},"page":"e120446","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Fragility fractures of the pelvis in the elderly: protocol for an international prospective multicentre observational cohort study"],"prefix":"10.1136","volume":"16","clinical-trial-number":[{"clinical-trial-number":"nct04182776","registry":"10.18810\/clinical-trials-gov","type":"preResults"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5175-3876","authenticated-orcid":false,"given":"Pol Maria","family":"Rommens","sequence":"first","affiliation":[{"name":"Department of Orthopaedics and Traumatology, University Medical Center of the Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7748-7115","authenticated-orcid":false,"given":"Alexander","family":"Joeris","sequence":"additional","affiliation":[{"name":"AO Innovation Translation Center, Medical Scientific Affairs, AO Foundation, Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mehdi","family":"Boudissa","sequence":"additional","affiliation":[{"name":"Chirurgien des H\u00f4pitaux Traumatologie des membres et du squelette axial, TIMC-IMAG, La Tronche, Auvergne-Rh\u00f4ne-Alpes, France"},{"name":"H\u00f4pital Nord, Universit\u00e9 Grenoble Alpes, Saint-Martin-d\u2019Heres, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory J","family":"Della Rocca","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Missouri, Columbia, Missouri, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Fang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology, Queen Mary Hospital, Hong Kong, China"},{"name":"The University of Hong Kong, Hong Kong, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4978-2878","authenticated-orcid":false,"given":"Maximilian J","family":"Hartel","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank FA","family":"Ijpma","sequence":"additional","affiliation":[{"name":"Department of Trauma Surgery, University Medical Centre Groningen, Groningen, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f6rn Christian","family":"Link","sequence":"additional","affiliation":[{"name":"Cantonal Hospital Lucerne Department of Orthopedics and Traumatology, Lucerne, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anser","family":"Nasir","sequence":"additional","affiliation":[{"name":"Center for Orthopedic and Trauma Surgery, Johannes Gutenberg University Mainz, Mainz, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Pieroh","sequence":"additional","affiliation":[{"name":"Department for Orthopedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, 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