{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,17]],"date-time":"2026-09-17T23:28:31Z","timestamp":1789687711329,"version":"4.0.1"},"reference-count":127,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T00:00:00Z","timestamp":1752796800000},"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>Fragility fractures of the pelvis (FFPs) are common in elderly patients, particularly those with osteoporosis. FFPs can be associated with high mortality, morbidity, and functional decline. Known risk factors include being over 80 years old and delays in surgical intervention when this is required. While the role of surgery in FFPs remains less defined than in proximal femoral fractures in the elderly, studies indicate that surgical fixation offers improved survival and functional outcomes. Similarly, the choice of fixation method, whether posterior or anterior, and their combinations, vary between clinicians. It depends on the fracture type and patient-specific factors, such as bone quality and comorbidities, as well as the surgeon\u2019s experience and the availability of resources. Additionally, orthobiologic adjuncts such as cement augmentation and sacroplasty can enhance the stability of an osteoporotic fracture during surgical intervention. Furthermore, medical treatments for osteoporosis, especially the use of teriparatide, have demonstrated beneficial effects in reducing fractures and promoting healing of the FFPs. Return to pre-injury activities is often limited, with independence rates remaining low at mid-term follow-up. Factors that influence clinical outcomes include fracture type, with Type III and IV fractures generally leading to poorer outcomes, and patient age, functional reserve, and comorbidities. The present tutorial aims to summarise the relevant evidence on all aspects of FFPs, inform an updated management strategy, and provide a template of the reconstruction ladder referring to the most available surgical techniques and treatment methods. Further research, based on large-scale studies, is needed to address the open questions described in this manuscript and refine surgical techniques, as well as determine optimal treatment pathways for this vulnerable patient population.<\/jats:p>","DOI":"10.3390\/jcm14145122","type":"journal-article","created":{"date-parts":[[2025,7,18]],"date-time":"2025-07-18T13:33:27Z","timestamp":1752845607000},"page":"5122","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":8,"title":["Fragility Fractures of the Pelvis\u2014Current Understanding and Open Questions"],"prefix":"10.3390","volume":"14","author":[{"given":"Amber","family":"Gordon","sequence":"first","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospitals, Leeds LS1 3EX, UK"},{"name":"Academic Department of Trauma and Orthopaedics, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Department of Orthopaedic Surgery, University of Arizona, Tucson, AZ 85721, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2190-9574","authenticated-orcid":false,"given":"Michela","family":"Saracco","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospitals, Leeds LS1 3EX, UK"},{"name":"Academic Department of Trauma and Orthopaedics, University of Leeds, Leeds LS2 9JT, UK"},{"name":"Department of Public Health, Division of Orthopedic Surgery, University of Naples Federico II, 80138 Naples, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5205-7696","authenticated-orcid":false,"given":"Peter V.","family":"Giannoudis","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospitals, Leeds LS1 3EX, UK"},{"name":"Academic Department of Trauma and Orthopaedics, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1695-1519","authenticated-orcid":false,"given":"Nikolaos K.","family":"Kanakaris","sequence":"additional","affiliation":[{"name":"Leeds Major Trauma Centre, Leeds Teaching Hospitals, Leeds LS1 3EX, UK"},{"name":"Academic Department of Trauma and Orthopaedics, University of Leeds, Leeds LS2 9JT, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,18]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1670","DOI":"10.1016\/j.injury.2023.04.006","article-title":"Severe trauma with associated pelvic fractures: The impact of regional trauma networks on clinical outcome","volume":"54","author":"Kanakaris","year":"2023","journal-title":"Injury"},{"key":"ref_2","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":"Kuper","year":"2019","journal-title":"EFORT Open Rev."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Moldovan, F., and Moldovan, L. 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