{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T18:07:33Z","timestamp":1791223653539,"version":"4.1.0"},"reference-count":33,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T00:00:00Z","timestamp":1696291200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Purpose: Pelvic fractures in older adults are a major public health problem and socioeconomic burden. The standard of care has changed over the past years, and there is limited consensus on which patients benefit from surgical fixation. There is currently no nationwide treatment protocol to guide the decision-making process. Therefore, the aim of this survey was to provide more insight into if, when, and why patients with a fragility fracture of the pelvis (FFPs) would be considered for additional imaging and surgical fixation by treating physicians. Methods: An online clinical vignette-based survey of hypothetical scenarios was sent out to all orthopedic and trauma surgeons in the Netherlands. The questionnaire comprised multiple-choice questions and radiographic images. Differences between subgroups were calculated using the X2 test or the Fisher exact test. Results: 169 surgeons responded to the survey, with varying levels of experience and working in different types of hospitals. In a patient with a simple pubic ramus fracture and ASA 2 or ASA 4, 32% and 18% of the respondents would always advise a CT scan for further analysis. In the same patients, 11% and 31% of the respondents would not advise a CT scan, respectively. When presented with three cases of increasing severity of co-morbidity (ASA) and\/or increasing age and\/or different clinical presentation of an FFP type 3c on a CT scan, an increasing number of respondents would not consider surgical fixation. There was significant variation in practice patterns between the respondents who do not work in a hospital performing pelvic and acetabular (P&amp;A) fracture surgery and those who do work in a P&amp;A referral hospital. Most respondents (77%) refer patients 1\u20135 times a year to an expert center for surgical fixation. Conclusion: There is currently a wide variety of clinical practices regarding the imaging and management of FFPs, which seems to be influenced by the type of hospital the patients are presented to. A regional or national evidence-based treatment protocol should be implemented to ensure a more uniform approach.<\/jats:p>","DOI":"10.3390\/jcm12196344","type":"journal-article","created":{"date-parts":[[2023,10,3]],"date-time":"2023-10-03T07:28:29Z","timestamp":1696318109000},"page":"6344","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Pelvic Ring Fractures in Older Adult Patients\u2014Assessing Physician Practice Variation among (Orthopedic) Trauma Surgeons"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0436-6133","authenticated-orcid":false,"given":"Anna H. M.","family":"Mennen","sequence":"first","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sharon","family":"Oud","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jens A.","family":"Halm","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf W.","family":"Peters","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hanna C.","family":"Willems","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine and Geriatrics, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daphne","family":"Van Embden","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,10,3]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1097\/TA.0000000000000656","article-title":"Injury in the aged: Geriatric trauma care at the crossroads","volume":"78","author":"Kozar","year":"2015","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"905","DOI":"10.1001\/archinternmed.2010.106","article-title":"Trends in Fall-Related Hospital Admissions in Older Persons in the Netherlands","volume":"170","author":"Hartholt","year":"2010","journal-title":"Arch. Intern. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1007\/s00590-017-2044-3","article-title":"Pelvic fractures in the Netherlands: Epidemiology, characteristics and risk factors for in-hospital mortality in the older and younger population","volume":"28","author":"Verbeek","year":"2018","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1007\/s001980070112","article-title":"Epidemiology of Osteoporotic Pelvic Fractures in Elderly People in Finland: Sharp Increase in 1970\u20131997 and Alarming Projections for the New Millennium","volume":"11","author":"Kannus","year":"2000","journal-title":"Osteoporos. Int."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2834","DOI":"10.3390\/jcm11102834","article-title":"Pelvic Fractures-An Underestimated Problem? Incidence and Mortality Risk after Pelvic Fracture in Austria, 2010\u20132018","volume":"11","author":"Behanova","year":"2022","journal-title":"J. Clin. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"258","DOI":"10.1093\/ageing\/afu123","article-title":"Admission for osteoporotic pelvic fractures and predictors of length of hospital stay, mortality and loss of independence","volume":"44","author":"Marrinan","year":"2015","journal-title":"Age Ageing"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1186\/s12877-019-1320-y","article-title":"Mortality and comorbidity after non-operatively managed, low-energy pelvic fracture in patients over age 70: A comparison with an age-matched femoral neck fracture cohort and general population","volume":"19","author":"Reito","year":"2019","journal-title":"BMC Geriatr."},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Banierink, H., Duis, K.T., de Vries, R., Wendt, K., Heineman, E., Reininga, I., and Ijpma, F. (2019). Pelvic ring injury in the elderly: Fragile patients with substantial mortality rates and long-term physical impairment. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0216809"},{"key":"ref_9","first-page":"w13859","article-title":"Pubic rami fractures in the elderly\u2014A neglected injury?","volume":"143","author":"Studer","year":"2013","journal-title":"Swiss Med. Wkly."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1016\/j.injury.2009.12.014","article-title":"Ten-year mortality among hospitalised patients with fractures of the pubic rami","volume":"41","author":"Poeze","year":"2010","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1431","DOI":"10.1007\/s00590-014-1439-7","article-title":"Elderly pelvic fractures: The incidence is increasing and patient demographics can be used to predict the outcome","volume":"24","author":"Clement","year":"2014","journal-title":"Eur. J. Orthop. Surg. Traumatol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"707","DOI":"10.1016\/j.injury.2016.01.027","article-title":"Pelvic X-ray misses out on detecting sacral fractures in the elderly\u2014Importance of CT imaging in blunt pelvic trauma","volume":"47","author":"Schicho","year":"2016","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1326","DOI":"10.1016\/j.injury.2012.05.016","article-title":"Detection of posterior pelvic injuries in fractures of the pubic rami","volume":"43","author":"Scheyerer","year":"2012","journal-title":"Injury"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"101","DOI":"10.55095\/achot2015\/015","article-title":"Fragility fractures of the pelvis: Should they be fixed?","volume":"82","author":"Rommens","year":"2015","journal-title":"Acta Chir. Orthop. Traumatol. Cech."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1007\/s12178-012-9128-9","article-title":"Fragility fractures of the pelvis","volume":"5","author":"Soles","year":"2012","journal-title":"Curr. Rev. Musculoskelet. Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"234","DOI":"10.1097\/01.brs.0000194788.45002.1b","article-title":"An Evaluation of Image-Guided Technologies in the Placement of Percutaneous Iliosacral Screws","volume":"31","author":"Smith","year":"2006","journal-title":"Spine"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1631","DOI":"10.1016\/j.injury.2015.04.036","article-title":"Percutaneous iliosacral screw fixation after osteoporotic posterior ring fractures of the pelvis reduces pain significantly in elderly patients","volume":"46","author":"Hopf","year":"2015","journal-title":"Injury"},{"key":"ref_18","doi-asserted-by":"crossref","unstructured":"Wilson, D.G.G., Kelly, J., and Rickman, M. (2021). Operative management of fragility fractures of the pelvis\u2014A systematic review. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04579-w"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2049","DOI":"10.1007\/s00198-021-05900-y","article-title":"The clinician\u2019s guide to prevention and treatment of osteoporosis","volume":"33","author":"LeBoff","year":"2022","journal-title":"Osteoporos. Int."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1016\/j.injury.2014.10.050","article-title":"Significance of clinical examination, CT and MRI scan in the diagnosis of posterior pelvic ring fractures","volume":"46","author":"Hartel","year":"2015","journal-title":"Injury"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"349","DOI":"10.1007\/s00068-015-0530-z","article-title":"Fragility fractures of the sacrum: How to identify and when to treat surgically?","volume":"41","author":"Wagner","year":"2015","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"100735","DOI":"10.1016\/j.tcr.2022.100735","article-title":"Spinal anesthesia in the percutaneous fixation of fragility fractures of the pelvis","volume":"42","author":"Mennen","year":"2022","journal-title":"Trauma Case Rep."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2717","DOI":"10.1016\/j.injury.2017.11.002","article-title":"Good functional outcome in patients suffering fragility fractures of the pelvis treated with percutaneous screw stabilisation: Assessment of complications and factors influencing failure","volume":"48","author":"Eckardt","year":"2017","journal-title":"Injury"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"S61","DOI":"10.1007\/s40520-015-0430-4","article-title":"Fragility fractures of the pelvis: Treatment and preliminary results","volume":"27","author":"Arduini","year":"2015","journal-title":"Aging Clin. Exp. Res."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.injury.2021.09.044","article-title":"Midterm follow-up of elderly patients with fragility fractures of the pelvis: A prospective cohort-study comparing operative and non-operative treatment according to a therapeutic algorithm","volume":"53","author":"Nuber","year":"2022","journal-title":"Injury"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1097\/BOT.0000000000001308","article-title":"Surgical Fixation of Geriatric Sacral U-Type Insufficiency Fractures: A Retrospective Analysis","volume":"32","author":"Pulley","year":"2018","journal-title":"J. Orthop. Trauma"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"534","DOI":"10.1097\/BRS.0000000000002899","article-title":"Additional Sacroplasty Does Not Improve Clinical Outcome in Minimally Invasive Navigation-Assisted Screw Fixation Procedures for Nondisplaced Insufficiency Fractures of the Sacrum","volume":"44","author":"Balling","year":"2019","journal-title":"Spine"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"245","DOI":"10.4103\/0019-5413.53454","article-title":"Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum","volume":"43","author":"Vanderschot","year":"2009","journal-title":"Indian J. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"313","DOI":"10.1302\/2058-5241.4.180062","article-title":"Pelvic ring fractures in the elderly","volume":"4","author":"Trulson","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Oberkircher, L., Lenz, J., B\u00fccking, B., Eschbach, D., Aigner, R., Bliemel, C., Schoeneberg, C., Ruchholtz, S., and Hack, J. (2021). Which factors influence treatment decision in fragility fractures of the pelvis?\u2014Results of a prospective study. BMC Musculoskelet. Disord., 22.","DOI":"10.1186\/s12891-021-04573-2"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2417","DOI":"10.1007\/s00402-022-04438-w","article-title":"Indications for surgical fixation of low-energy pelvic ring fractures in elderly: A systematic review","volume":"143","author":"Timmer","year":"2022","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.exger.2014.01.012","article-title":"Aging impairs the recovery in mechanical muscle function following 4days of disuse","volume":"52","author":"Hvid","year":"2014","journal-title":"Exp. Gerontol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"e75","DOI":"10.1097\/SLA.0000000000004078","article-title":"Global Overview of Response Rates in Patient and Health Care Professional Surveys in Surgery: A Systematic Review","volume":"275","author":"Meyer","year":"2022","journal-title":"Ann. Surg."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/19\/6344\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T21:04:30Z","timestamp":1760130270000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/19\/6344"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,3]]},"references-count":33,"journal-issue":{"issue":"19","published-online":{"date-parts":[[2023,10]]}},"alternative-id":["jcm12196344"],"URL":"https:\/\/doi.org\/10.3390\/jcm12196344","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,10,3]]}}}