{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T09:53:43Z","timestamp":1767952423639,"version":"3.49.0"},"reference-count":40,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Powi\u015bla\u0144ski University","award":["02\/2025"],"award-info":[{"award-number":["02\/2025"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Fragility fractures of the pelvis (FFPs) are a significant concern in the elderly population, often leading to severe morbidity and mortality. This study aims to evaluate the diagnostic challenges, clinical outcomes, and mortality rates associated with FFPs in patients referred to multiple hospitals. Methods: A total of 99 patients with suspected pelvic fragility fractures were enrolled between January 2023 and June 2025. Initial diagnoses were made using plain X-rays, with computed tomography (CT) utilized to assess posterior ring fractures. Data on demographics, fracture types according to the Fragility Fracture of the Pelvis (FFP) Classification, hemoglobin levels, and mortality rates were collected and analyzed. Results: The findings revealed that while plain X-rays identified only anterior pelvic ring fractures, CT scans detected posterior ring fractures in 60.6% of cases. Patients with Nakatani II and III pelvic ramus fractures exhibited the most significant decreases in hemoglobin levels. The overall mortality rate was found to be 13.13%, with the highest rates observed in FFP I (13.5%) and FFP II (11.9%) groups. Conclusions: The findings of this study underscore the importance of CT imaging in the diagnosis of FFPs and highlight the need for close monitoring of hemoglobin levels in affected patients. This study also emphasizes the increased mortality risk associated with more complex fracture types. Future research should focus on evaluating functional independence and treatment outcomes to guide clinical decision-making in managing fragility fractures of the pelvis.<\/jats:p>","DOI":"10.3390\/jcm15020531","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:09:06Z","timestamp":1767946146000},"page":"531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of CT Imaging on the Diagnosis of Fragility Fractures of the Pelvis: An Observational Prospective Multicenter Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1979-849X","authenticated-orcid":false,"given":"Micha\u0142","family":"Ku\u0142akowski","sequence":"first","affiliation":[{"name":"Orthopedic and Trauma Department, Jan Biziel University Hospital nr 2, 85-168 Bydgoszcz, Poland"},{"name":"Faculty of Health Sciences, Powislanski University, 82-500 Kwidzyn, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1894-2835","authenticated-orcid":false,"given":"Karol","family":"Elster","sequence":"additional","affiliation":[{"name":"Orthopedic and Trauma Department, Jan Biziel University Hospital nr 2, 85-168 Bydgoszcz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-8520-6228","authenticated-orcid":false,"given":"Wojciech","family":"Iluk","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic and Trauma Surgery, Provincial Integrated Hospital, 82-300 Elbl\u0105g, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0207-7282","authenticated-orcid":false,"given":"Dawid","family":"Pacek","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology of the Musculoskeletal System, 109 Military Hospital, 71-422 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-3433-2981","authenticated-orcid":false,"given":"Tomasz","family":"Gieroba","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Regional Specialistic Hospital, 20-718 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5597-3633","authenticated-orcid":false,"given":"Micha\u0142","family":"Wojciechowski","sequence":"additional","affiliation":[{"name":"Orthopedic and Trauma Department, Jan Biziel University Hospital nr 2, 85-168 Bydgoszcz, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-9150-2097","authenticated-orcid":false,"given":"\u0141ukasz","family":"Pruffer","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics and Traumatology of the Musculoskeletal System, 109 Military Hospital, 71-422 Szczecin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-6681-3269","authenticated-orcid":false,"given":"Magdalena","family":"Krupka","sequence":"additional","affiliation":[{"name":"Department of Trauma and Orthopaedic Surgery, Regional Specialistic Hospital, 20-718 Lublin, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2754-1339","authenticated-orcid":false,"given":"Jaros\u0142aw","family":"Witkowski","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Traumatology and Hand Surgery, Faculty of Medicine, Wroclaw Medical University, 50-367 Wroclaw, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6894-5380","authenticated-orcid":false,"given":"Magdalena","family":"Grzonkowska","sequence":"additional","affiliation":[{"name":"Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5736-5348","authenticated-orcid":false,"given":"Mariusz","family":"Baumgart","sequence":"additional","affiliation":[{"name":"Department of Normal Anatomy, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University, 87-100 Toru\u0144, Poland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"144","DOI":"10.1055\/a-1023-4756","article-title":"Risks and Strategies to Avoid Approach-Related Complications During Operative Treatment of Pelvic Ring or Acetabular Fractures","volume":"159","author":"Kuper","year":"2021","journal-title":"Z. Orthop. Unfall"},{"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","first-page":"40","DOI":"10.1051\/sicotj\/2025035","article-title":"Osteoporotic vertebral fractures: An update","volume":"11","author":"Daskalakis","year":"2025","journal-title":"SICOT J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e36","DOI":"10.2106\/JBJS.15.00793","article-title":"Global Forum: Fractures in the Elderly","volume":"98","author":"McQueen","year":"2016","journal-title":"J. Bone Jt. Surg. Am."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"3205","DOI":"10.1210\/jc.2017-02656","article-title":"Persistence of Excess Mortality Following Individual Nonhip Fractures: A Relative Survival Analysis","volume":"103","author":"Tran","year":"2018","journal-title":"J. Clin. Endocrinol. Metab."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1007\/s11657-017-0318-3","article-title":"Vertebral fracture assessment in patients presenting with a non-hip non-vertebral fragility fracture: Experience of a UK Fracture Liaison Service","volume":"12","author":"Reniu","year":"2017","journal-title":"Arch. Osteoporos."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"709","DOI":"10.1530\/EOR-2024-0164","article-title":"One-year mortality rates of fragility fractures of the pelvis: A systematic review and meta-analysis","volume":"10","author":"Tran","year":"2025","journal-title":"EFORT Open Rev."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"466","DOI":"10.5114\/reum\/194107","article-title":"Osteoporosis in axial radiographic spondyloarthritis: Diagnostic limitations of bone mineral density and the need for comprehensive fracture risk assessment","volume":"62","author":"Zuchowski","year":"2024","journal-title":"Reumatologia"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Kulakowski, M., Elster, K., Janiak, M., Kulakowska, J., Zuchowski, P., Wojciechowski, R., Dura, M., Lech, M., Korolczuk, K., and Grzonkowska, M. (2024). CT-Based Evaluation of Volumetric Posterior Pelvic Bone Density with Implications for the Percutaneous Screw Fixation of the Sacroiliac Joint. J. Clin. Med., 13.","DOI":"10.3390\/jcm13206063"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Sassara, G.M., Smakaj, A., De Mauro, D., Righini, R., Arnone, A., Rovere, G., El Ezzo, O., Farsetti, P., Tarantino, U., and Liuzza, F. (2024). Evaluating Treatment Outcomes for Pelvic Insufficiency Fractures: A Systematic Review. J. Clin. Med., 13.","DOI":"10.3390\/jcm13113176"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1007\/s00068-021-01799-6","article-title":"Operative treatment of fragility fractures of the pelvis: A critical analysis of 140 patients","volume":"48","author":"Rommens","year":"2022","journal-title":"Eur. J. Trauma. Emerg. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"14201","DOI":"10.1038\/s41598-021-93559-0","article-title":"Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis","volume":"11","author":"Wagner","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"20436","DOI":"10.1038\/s41598-022-24525-7","article-title":"Safety and efficacy of two ilioiliac tension band plates osteosynthesis of fragility fractures of the pelvis","volume":"12","author":"Kulakowski","year":"2022","journal-title":"Sci. Rep."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"112618","DOI":"10.1016\/j.injury.2025.112618","article-title":"Mortality following fragility fractures of the pelvis: Systematic review and meta-analysis","volume":"56","author":"Yamamoto","year":"2025","journal-title":"Injury"},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Rommens, P.M., Hopf, J.C., Herteleer, M., Devlieger, B., Hofmann, A., and Wagner, D. (2020). Isolated Pubic Ramus Fractures Are Serious Adverse Events for Elderly Persons: An Observational Study on 138 Patients with Fragility Fractures of the Pelvis Type I (FFP Type I). J. Clin. Med., 9.","DOI":"10.3390\/jcm9082498"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1007\/s00068-022-01887-1","article-title":"Prospective assessment of key factors influencing treatment strategy and outcome of fragility fractures of the pelvis (FFP)","volume":"48","author":"Rommens","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","unstructured":"Kulakowski, M., Elster, K., Reichert, P., Krolikowska, A., Jerominko, J., Sleczka, P., Grzonkowska, M., Szpinda, M., and Baumgart, M. (2023). Anatomy of the sacroiliac joint with relation to the lumbosacral trunk: Is there sufficient space for a two-hole plate?. PLoS ONE, 18.","DOI":"10.1371\/journal.pone.0292620"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1549","DOI":"10.1007\/s00198-023-06812-9","article-title":"Imaging of pelvic ring fractures in older adults and its clinical implications-a systematic review","volume":"34","author":"Mennen","year":"2023","journal-title":"Osteoporos. Int."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Pedersen, V., Lampart, A., Bingisser, R., and Nickel, C.H. (2020). Accuracy of plain radiography in detecting fractures in older individuals after low-energy falls: Current evidence. Trauma Surg. Acute Care Open, 5.","DOI":"10.1136\/tsaco-2020-000560"},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Rommens, P.M., Wagner, D., and Hofmann, A. (2017). Fragility Fractures of the Pelvis. JBJS Rev., 5.","DOI":"10.2106\/JBJS.RVW.16.00057"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1097\/BOT.0b013e318162ab6e","article-title":"Superior pubic ramus fractures fixed with percutaneous screws: What predicts fixation failure?","volume":"22","author":"Starr","year":"2008","journal-title":"J. Orthop. Trauma"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1733","DOI":"10.1016\/j.injury.2013.06.023","article-title":"Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment","volume":"44","author":"Rommens","year":"2013","journal-title":"Injury"},{"key":"ref_23","first-page":"70","article-title":"Osteoporotic Pelvic Fractures","volume":"115","author":"Oberkircher","year":"2018","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/j.injury.2021.09.056","article-title":"What is the long-term clinical outcome after fragility fractures of the pelvis? A CT-based cross-sectional study","volume":"53","author":"Banierink","year":"2022","journal-title":"Injury"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"380","DOI":"10.7326\/0003-4819-152-6-201003160-00008","article-title":"Meta-analysis: Excess mortality after hip fracture among older women and men","volume":"152","author":"Haentjens","year":"2010","journal-title":"Ann. Intern. Med."},{"key":"ref_26","doi-asserted-by":"crossref","unstructured":"Sivapathasuntharam, D., Smith, G., Master, M.A., and Bates, P. (2022). Fragility fractures of the pelvis in the older population. Age Ageing, 51.","DOI":"10.1093\/ageing\/afac063"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Reito, A., Kuoppala, M., Pajulammi, H., Hokkinen, L., Kyrola, K., and Paloneva, J. (2019). 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. BMC Geriatr., 19.","DOI":"10.1186\/s12877-019-1320-y"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1813","DOI":"10.1007\/s00264-017-3567-2","article-title":"Implementation of a standardized protocol to manage elderly patients with low energy pelvic fractures: Can service improvement be expected?","volume":"41","author":"Kanakaris","year":"2017","journal-title":"Int. Orthop."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Putzeys, G., Dekeyser, T., Garre, P., Chesser, T., and Pottel, H. (2023). Posterior pelvic ring involvement detected with CT taken within a week of admission in acute fragility fractures of the pelvis (FFP) does not predict failure of conservative treatment: A retrospective cohort study. BMC Musculoskelet. Disord., 24.","DOI":"10.1186\/s12891-023-06439-1"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1007\/s10195-012-0182-2","article-title":"Combined pubic rami and sacral osteoporotic fractures: A prospective study","volume":"13","author":"Alnaib","year":"2012","journal-title":"J. Orthop. Traumatol."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"Gordon, A., Saracco, M., Giannoudis, P.V., and Kanakaris, N.K. (2025). Fragility Fractures of the Pelvis-Current Understanding and Open Questions. J. Clin. Med., 14.","DOI":"10.3390\/jcm14145122"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"2337","DOI":"10.1016\/j.ejrad.2011.07.012","article-title":"Comparison of diagnostic accuracy of Magnetic Resonance Imaging and Multidetector Computed Tomography in the detection of pelvic fractures","volume":"81","author":"Henes","year":"2012","journal-title":"Eur. J. Radiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1097\/TA.0b013e31822ad41f","article-title":"Hemorrhage after low-energy pelvic trauma","volume":"72","author":"Krappinger","year":"2012","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"30","DOI":"10.1016\/j.jamcollsurg.2006.03.017","article-title":"Auditing 655 fatalities with pelvic fractures by autopsy as a basis to evaluate trauma care","volume":"203","author":"Papadopoulos","year":"2006","journal-title":"J. Am. Coll. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Kolodziejczyk, H., Brzeszczynski, F., and Bonczak, O. (2025). Transfusion Risk Factors in Low-Energy Pelvic Fractures: A Retrospective Cohort Study. Geriatr. Orthop. Surg. Rehabil., 16.","DOI":"10.1177\/21514593251351557"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"1585","DOI":"10.1007\/s00068-024-02492-0","article-title":"Clinically relevant bleeding risk in low-energy fragility fractures of the pelvis in elderly patients","volume":"50","author":"Loggers","year":"2024","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"103786","DOI":"10.12998\/wjcc.v13.i21.103786","article-title":"Life-threatening vascular injury in an elderly patient with isolated pubic ramus fracture: A case report","volume":"13","author":"Sakellariou","year":"2025","journal-title":"World J. Clin. Cases"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1007\/s00402-009-0942-5","article-title":"Fractures of the pubic rami: A retrospective review of 534 cases","volume":"129","author":"Krappinger","year":"2009","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Banierink, H., Ten Duis, K., 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_40","doi-asserted-by":"crossref","first-page":"16124","DOI":"10.1038\/s41598-023-43249-w","article-title":"Conservative versus operative treatment of FFP II fractures in a geriatric cohort: A prospective randomized pilot trial","volume":"13","author":"Thiesen","year":"2023","journal-title":"Sci. Rep."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/531\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T08:22:27Z","timestamp":1767946947000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/2\/531"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1,9]]},"references-count":40,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2026,1]]}},"alternative-id":["jcm15020531"],"URL":"https:\/\/doi.org\/10.3390\/jcm15020531","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1,9]]}}}