Complications in Fragility Fractures of the Pelvis: A multicenter study based on the OF-Pelvis Classification and Score

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Kohler, Philipp Schenk, Pamela Schanderl, Volker Zimmermann, and 13 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7802586/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 6 You are reading this latest preprint version Abstract Osteoporotic pelvic ring fractures (OPRFs) are common in ageing populations and challenging due to multimorbidity and immobility-related complications. The OF-Pelvis classification and score support therapeutic decision-making, yet their relationship with in-hospital complications remains unclear. We conducted a prospective multicentre study of 390 patients treated at 14 German centres. Fractures were classified using the OF-Pelvis system; treatment recommendations were derived from the OF-Pelvis Score and compared with the therapy performed. Complications during hospitalisation were recorded, and predictors were assessed by logistic regression. Functional outcomes between treatment decision and discharge were analysed with repeated-measures general linear models. Overall, 258 patients (66%) underwent surgery and 132 (34%) received conservative care. Complications occurred in 26%, most commonly urinary tract infections and wound-related events. The OF-Pelvis Score showed high concordance with real-world treatment decisions, while age was the only independent predictor of complications; neither treatment modality nor the score independently predicted adverse events. Functional outcomes improved significantly across groups despite complications when managed within structured multidisciplinary care. These findings support the score’s utility for decision-making but indicate that complication risk is driven primarily by patient-related factors, emphasising the need for targeted geriatric co-management and prevention strategies. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Osteoporotic pelvic fractures pelvic ring fractures OF-Pelvis Score complications geriatric trauma frailty Figures Figure 1 Introduction Osteoporotic pelvic ring fractures (OPRF) represent a growing clinical challenge in geriatric trauma care [ 1 – 3 ]. Unlike high-energy trauma, these fractures typically occur after low-energy mechanisms in frail, elderly patients [ 4 ] with compromised bone quality and comorbidities [ 5 , 6 ]. They are associated with prolonged immobilization, high in-hospital complication rates, and significant functional decline [ 6 ]. In recent years, the development of the OF-Pelvis classification and its accompanying score [ 5 , 7 ] has provided clinicians with a structured framework to guide treatment decisions. Developed by the Working Group for Osteoporotic Fractures of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) the system incorporates both fracture morphology and patient-specific clinical parameters, including pain, mobility, neurological status, and comorbidity scores [ 5 , 7 ]. Although the OF-Pelvis Score correlates well with real-world treatment decisions and provides a functional basis for classifying fragility fractures [ 7 ], the correlation between this score and the incidence of complications during the hospital stay has not been thoroughly investigated. However, complications such as urinary tract infections, impaired wound healing, and prolonged immobility are common in this patient population and can significantly impact outcomes, especially for those who undergo surgery [ 6 , 8 , 9 ]. Despite these risks, it remains unclear to what extent fracture morphology, patient characteristics, or therapy modality independently impact adverse events. Several studies suggest that age and frailty, rather than the treatment itself, are stronger determinants of postoperative complications [ 8 , 10 , 11 ]. The ability to identify high-risk patients early is critical, not only for tailoring treatment but also for optimizing resource allocation and rehabilitation planning. This multicenter prospective study aims to contribute to closing this knowledge gap by evaluating the frequency, nature, and predictors of complications in patients with OPRF. Using the OF-Pelvis Score as a clinical stratification tool, we investigate whether treatment decisions were consistent with the score’s recommendation and how these relate to complication rates and functional recovery, thereby assessing its usefulness as both a therapeutic and prognostic tool. Materials and Methods Between 2021 and 2023, patients with pelvic fractures were enrolled, treated, and analyzed as part of this prospective multicenter study. Data were collected from 14 participating centers and consolidated at the lead coordinating center. Ethical approval was granted by the respective institutional review boards at each participating site. Data were collected at the time of hospital admission, on the day of treatment decision, and at discharge. The day treatment decision (TD) was defined as the day on which the therapeutic strategy for managing the pelvic fracture was determined. In addition to demographic data and bone quality (Hounsfield Units, DEXA T-score, and quantitative CT), fracture morphology was classified according to the OF-Pelvis classification (OFP classification). Additionally, the OF-Pelvis Score were calculated. The OF-Pelvis Score is a composite score that includes fracture morphology, patient mobility, pain, and neurological deficits attributable to the fracture. Patient health status is also incorporated, including ASA classification, the modified Frailty Index (mFI), and anticoagulant use. Additional modifiers such as fractures of the L5 transverse processes, fracture displacement, and bone marrow edema are also considered. A total OF-Pelvis Score of less than 8 suggests conservative treatment. A score greater than 8 indicates a recommendation for surgical treatment. A score of exactly 8 is considered a relative indication for surgery. The OF-Pelvis Score serves as a clinical decision support tool. The final treatment decision was made by the attending physician in accordance with best clinical practice. In each case, the treatment method, surgical or conservative, was recorded. Functional outcomes were assessed based on patient mobility, the Oswestry Disability Index (ODI), Barthel Index, EQ5D-5L Index Score and EQ5D Visual Analogue Scale (EQ5D-VAS), Timed Up and Go (TuG) test, and the patient’s self-reported walking distance before treatment and at discharge. Mobility was documented as a binary variable, categorizing patients as either independently mobile or non-mobile. Non-mobile patients included those who were bedridden or wheelchair-bound. The following complications during hospitalization were recorded: urinary tract infection, pneumonia, pressure ulcers, pulmonary embolism, surgical site complications, wound healing disorders, bleeding, implant malposition, and need for revision surgery. Statistics Differences in age, bone quality, and length of hospital stay were assessed using a univariate general linear model (GLM). Treatment type and occurrence of complications were entered as fixed factors (binary variables). Differences in the distribution of binary variables (e.g., sex, mobility, presence of osteoporosis, neurological deficits) and categorical variables (e.g., ASA classification, OF-Pelvis classification) between treatment groups and in relation to complications were analyzed using Chi-square or Fisher’s exact tests. If the test shows significance the contingence coefficient will be given. Logistic regression was used to evaluate the influence of age, ASA classification, pain, mobility, and treatment approach on the risk of complications. To assess the impact of complications and differences in treatment modality on functional outcomes over time, a repeated-measures general linear model (GLMrm) was used. The functional outcome at treatment decision and discharge was used as within-factor (repeated measure). This analysis was performed separately for each functional outcome variable (walking distance, ODI, Barthel Index, TuG, EQ5D index value, and EQ5D-VAS). To account multiple comparisons, post hoc pairwise tests were Bonferroni corrected. Mean and standard deviations were calculated for continuous variables, while frequencies and percentages were used for categorial variables. Results of the functional outcome analyses are presented graphically as means and corresponding 95% confidence intervals. All statistical analyses were performed using SPSS version 29 (IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp). A p-value of < 0.05 was considered statistically significant. Ethics approval and consent to participate The study was approved by the institutional review boards of all participating centers. All procedures were performed in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants or their legal representatives prior to inclusion. Ethical approval: The study was approved by the local institutional ethics committees of all participating centers: - University Hospital Leipzig: Ethikkommission der Medizinischen Fakultät: 522/20-ek - Klinikum Traunstein: Bayerische Landesärztekammer: 2017-136 - BG Klinikum Bergmannstrost Halle: Ärztekammer Sachsen-Anhalt: 88/21 - Universitätsklinikum Jena: Ethikkommission: 5507-0418- Universitätsklinikum Schleswig-Holstein, Kiel: Medizinische Fakultät der CAU zu Kiel: AZ B213/21 - Sana Klinikum Borna: Sächsische Landesärztekammer: EK-BR-30/22-1 - Klinikum Nürnberg: Ethik-Kommission FAU Erlangen-Nürnberg: 309_17 Bc (For other centers, local IRB approvals were also obtained; reference numbers available on request.) Consent to publish The manuscript does not include any individual person’s data in any form (images, videos, or identifiable information). Results Data from a total of 390 patients (57 men, 333 women) with a mean age of 80±8 years (range: 54–99 years) were analyzed. The most frequently observed fracture types were OFP3 (n=173, 44%) followed by OFP4 (n=164, 42%). OFP2 and OFP5 fractures were identified in 29 (7%) and 21 (5%) patients, respectively. OFP1 fractures were diagnosed in 3 patients (1%). Patients were admitted to the hospital on average 12±24 days (range: 0–210 days). A total of 132 patients (34%) were treated conservatively, while 258 patients (66%) underwent surgical treatment. The average length of hospital stay was significantly longer in patients with complications (16±10 days) compared to those without complications (11±6 days, p<0.001). Table 1 presents the patients characteristics stratified by treatment group and occurrence of complication. Table 1: Baseline characteristics of patients with osteoporotic pelvic ring fractures, stratified by treatment type (surgical, conservative) and complication status Patient Characteristics Total (N=390) Surgery (N=258) p Conservative (N=132) p Complication No Complication Complication No Complication Women/Men 333/57 59/10 157/28 1.000 29/4 84/15 0.781 Age (years) 80±8 82±7 79±8 0.008 83±9 81±9 0.161 Hospitalization [d] 13±8 18±10 13±6 <0.001 13±9 9±5 0.002 Bone Quality HU 29±45 28±45 34±50 0.347 14±26 26±37 0.114 DEXA -0,24±0,93 -0.33±1.09 -0.15±0.70 0.138 -0.22±0.86 -0.37±1.18 0.517 QCT -0,2±0,8 -0.2±0.9 -0.2±0.9 0.972 0±0 -0.1±0.6 0.424 ASA classification 0.469 0.197 I 6 (2%) 0 (0%) 3 (2%) 0 (0%) 3 (3%) II 145 (37%) 22 (32%) 72 (40%) 9 (29%) 41 (43%) III 216 (55%) 44 (64%) 101 (56%) 19 (61%) 49 (51%) IV 14 (4%) 3 (4%) 5 (3%) 3 (10%) 3 (3%) Unknown 9 (2%) Osteoporosis 1.000 1.000 Yes 377 (97%) 66 (96%) 176 (95%) 33 (100%) 98 (99%) None 13 (3%) 3 (4%) 9 (5%) 0 (0%) 1 (1%) Neurological Deficit 0.733 0.573 Yes 13 (3%) 2 (3%) 8 (4%) 0 (0%) 3 (3%) None 377 (97%) 67 (97%) 177 (96%) 33 (100%) 96 (97%) OF-Pelvis classification 0.002 0.970 OFP1 3 (1%) 1 (1%) 0 (0%) 0 (0%) 2 (2%) OFP2 29 (7%) 0 (0%) 3 (2%) 6 (18%) 20 (20%) OFP3 173 (44%) 24 (35%) 67 (36%) 20 (61%) 60 (61%) OFP4 164 (42%) 33 (48%) 109 (59%) 6 (18%) 14 (14%) OFP5 21 (5%) 11 (16%) 6 (3%) 1 (3%) 3 (3%) OF-Pelvis Score 9±2 10±2 10±2 0.142 7±2 7±2 0.559 Mobile 0.777 0.054 Yes 218 (56%) 28 (41%) 79 (43%) 24 (73%) 87 (88%) No 172 (44%) 41 (59%) 106 (57%) 9 (27%) 12 (12%) Complications occurred in 102 patients (26%), with no significant association with sex (14 men [25%], 88 women [27%], p=0.871) or OFP classification (p=0.086). Most patients (n=349, 90%) were treated in accordance with the recommendation of the OF-Pelvis Score. Compliance of the OF-Pelvis Score recommendation showed no significant association on complication rates (p=0.139). ASA classification among patients ranged from ASA I (n=6) to ASA IV (n=14). Most patients were classified as ASA III (n=213, 55%), followed by ASA II (n=144, 37%). No significant association between ASA classification and occurrence of complications could be demonstrated (p=0.074). Fracture morphology according to the OFP classification showed a significant association with the occurrence of complications (contingency coefficient=0.168, p=0.029). This association was not significant in conservatively treated patients (p=0.970), but it was significant in surgically treated patients (contingency coefficient=0.251, p=0.002). An overview of the complications identified in patients with pelvic fractures is provided in Table 2. Table 2: Identified complications for the complete group of patients with pelvic fractures and for the surgically and conservatively treated patients. Total Surgery Conservative P Urinary tract infection 34 20 14 0.449 Pneumonia 5 2 3 0.343 Pressure ulcer 4 3 1 1.000 Pulmonary embolism 1 - 1 0.342 Surgical site complication Wound healing disorder 2 2 - Bleeding 4 4 - Implant malposition 3 3 - Revision surgery 8 8 - Other complications 39 28 11 0.479 Logistic regression was performed using data from 377 patients to predict complications, 13 patients were excluded due to missing information in at least one of the predictor variables. The model achieved a prediction accuracy of 74.5%, with a Nagelkerke R² of 0.06, indicating poor to moderate explanatory power. Of 100 patients who experienced complications, the model correctly predicted complications in only 4 cases (4%). In 96 patients, complications occurred but were not predicted by the model. All patients without complications were correctly classified as such. In total, the model predicted no complications for 373 patients, of whom 277 (74.3%) were correctly classified (Table 3). Within the logistic regression model, only age was identified as a significant predictor of complication occurrence, with a regression coefficient of 4% (p=0.017). Accordingly, each additional year of age, the likelihood of developing a complication increased by 4%. No significant associations were found for the other variables: ASA classification (p>0.397; ASA I as reference), pain (p=0.952), mobility (p=0.504), or treatment type (p=0.616). The repeated-measures general linear model (GLM) demonstrated statistically significant improvements in all functional outcome measures (walking distance, ODI, Barthel Index, TuG) during the inpatient period (all p<0.001). No significant main effects of complications or treatment type were observed for these outcomes, except for the TuG, where an interaction effect between complication status and treatment type was detected (p=0.049). Post hoc pairwise comparisons revealed that, at the time of treatment decision (TD), surgically treated patients who later developed complications required on average 20 seconds longer to complete the TuG compared to conservatively treated patients (p=0.038). Among patients without complications, no significant difference in TuG times at TD was observed between treatment groups. The TuG test was completed by 148 patients at TD and by 292 patients at the time of discharge (p<0.001). The results of these functional outcome variables over time are illustrated in Figure 1. Discussion This prospective multicenter study documented 102 in-hospital complications (26%) in patients with osteoporotic pelvic ring fractures (OPRFs), most commonly urinary tract infections, wound-related problems, hemorrhage, and revision surgeries. Complications were more frequent in surgically treated patients (34%) than in those treated conservatively (14%), which aligns with previous data from Rommens et al. (27.5% vs. 19.8%) [6]. However, logistic regression showed that treatment modality was not an independent predictor of complications. The only significant predictor was patient age (p = 0.017), with each additional year increasing complication risk by 4%. This likely reflects the accumulation of comorbidities with age, which were not fully captured in our dataset but may have contributed to vulnerability. This finding aligns with previous research that also identified advanced age as a major contributing factor to negative outcomes in patients with fragility fractures [10-15]. Neither the OF-Pelvis Score, ASA classification, baseline pain, nor initial mobility were independently associated with complication risk. The OF-Pelvis fracture classification showed a significant association with complications in surgically treated patients. This underlines the importance of not only the treatment decision itself, but also the underlying injury pattern and its interaction with patient-related risk factors. While our study focused on the OF system, prior research using the Fragility Fracture of the Pelvis (FFP) classification has demonstrated that more unstable morphologies (FFP III and IV) are linked to increased complications [6]. Combining morphological and systemic risk assessments may thus provide a more complete prognostic framework. In contrast, ASA classification, baseline pain levels, initial mobility, and the OF-Pelvis Score were not independently associated with in-hospital complications. These findings challenge the assumption that surgical treatment or fracture severity alone increase risk and instead highlight patient-related factors such as frailty and age as primary determinants [10-12,16,17]. Supporting this view, Keppler et al. showed that orthogeriatric co-management in pelvic and acetabular fractures reduces complications such as urinary tract infections and revision surgeries and enables earlier mobilization, highlighting the value of standardized interdisciplinary protocols addressing frailty and comorbidity more effectively than surgical decision-making alone [15]. Consistently, Forssten et al. identified frailty, measured via the Orthopedic Frailty Score, as a key independent predictor of mortality and complications in over 66,000 geriatric pelvic fracture patients [10]. Rege et al. extended this evidence to younger trauma patients, demonstrating that frailty, measured by a modified frailty index (mFI), was a stronger predictor of mortality and severe complications than age or ASA classification, underlining the need to assess frailty across all age groups [18]. These findings support our observation that patient-related vulnerability, rather than fracture morphology or treatment modality, primarily determines complication risk and highlight the importance of integrating frailty assessment into the management of osteoporotic pelvic ring fractures. A detailed analysis of complications revealed that the majority were non-life-threatening but clinically significant events. Urinary tract infections (34 cases) and wound-related issues, including hematoma and material malposition were among the most impactful. Although rare, more serious events like pulmonary embolism and pneumonia were also observed. These rates are within the range reported in similar large-scale cohort studies [6,12,19,20] and confirm the need for meticulous perioperative monitoring, especially in surgically treated elderly patients [6,9,12,21]. Functional outcomes improved significantly across all measures, regardless of treatment group or complication status, supporting the value of structured multidisciplinary care. This aligns with prior research showing that rehabilitation protocols, not treatment type alone, drive recovery [17,22-24]. Nevertheless, a closer look reveals that the TuG performance was significantly delayed in patients who developed complications and underwent surgical treatment. This interaction effect suggests that while complications may not dictate outcomes, they can hinder short-term functional recovery. These results are consistent with others indicating that, while postoperative complications hinder recovery of mobility, they do not prevent long-term functional outcomes. Conversely, patients treated for OPRFs had lower mortality rates in the long-term follow-up [12,23]. However, a limitation is that patients who were not mobile or unable to perform the TuG were excluded from analysis, which may have introduced selection bias. The EQ5D index value and EQ5D-VAS measures showed subjective health improvements across all patient subgroups. Pain scores declined most notably in the surgical group, which aligns with previous data showing that mechanical stabilization reduces nociceptive stimuli in unstable pelvic injuries [25]. These pain reductions also likely facilitated faster participation in rehabilitation activities and thus other outcome measures. Despite the higher complication rates among surgically treated patients, this group demonstrated the greatest pain reduction and fastest subjective recovery. This emphasizes that, while relevant, complications must be considered in the context of therapeutic benefit. Not all complications carry the same clinical significance, and their occurrence does not negate the benefits of surgical stabilization when indicated. Comparative studies repeatedly point to variability in the treatment of fragility fractures across institutions [2]. This supports the idea of introducing standardized instruments, such as the OF-Pelvis Score, to improve the quality of care and reporting of outcomes. The results of this study therefore reflect the reality of healthcare provision in the German-speaking region. Building on prior work the study confirms the clinical concordance of the OF-Pelvis Score with actual treatment decisions (90% conformity) and highlights its dynamic application for guiding individualized therapy. Among the 390 patients evaluated, a majority had OFP3 and OFP4 fractures, reflecting the distribution commonly reported in similar cohorts [19]. Surgical treatment was more common among patients with OFP4 and OFP5 fractures, which supports the view that unstable morphologies require operative stabilization [26]. Limitations of the current study include the heterogeneous implementation across 14 participating centers and thus potential variations in surgical technique, and incomplete datasets for some variables, limiting the power of regression models. Despite these, the study provides a robust real-world snapshot of current practices in the treatment of osteoporotic pelvic fractures in Germany. The functional outcome measures are standard in the evaluation of these patients, but sometimes more may lead to selection bias, like the TuG test or needed to be age adjusted. In this large prospective multicenter study, in-hospital complications occurred in one out of four patients with osteoporotic pelvic ring fractures, most frequently in surgically treated and older individuals. However, surgical treatment itself was not an independent predictor of complications. Instead, age emerged as the sole significant risk factor. The OF-Pelvis Score demonstrated high agreement with real-world treatment decisions but did not predict complication risk. Despite the frequency of complications, functional outcomes improved across all subgroups, highlighting the resilience of structured multidisciplinary care. These findings underscore the need to shift focus from treatment modality to patient-related factors in managing complication risk. Declarations Data availability The datasets generated and analysed during the current study are available from the corresponding author on reasonable request . De-identified data, the statistical analysis plan and codebook will be provided upon request. Competing interests The authors declare no competing interests. Funding This research received no external funding. Author contributions F.C.K. and P.S. contributed equally. All authors contributed to the study conception and design. Data collection and analysis were performed collaboratively by the authors from the Working Group (Osteoporotic Fractures, Spine Section of the German Society for Orthopaedics and Trauma, DGOU) . The first draft of the manuscript was written by F.C.K. and P.S. and all authors commented on previous versions. All co-authors interpreted data and critically revised the manuscript. All authors approved the final version and agree to be accountable for all aspects of the work. Acknowledgements We thank the participating centres of the Working Group (Osteoporotic Fractures, Spine Section of the German Society for Orthopaedics and Trauma, DGOU) for patient recruitment and data collection Additional information Correspondence and requests for materials should be addressed to: PD Dr. med. habil. Felix C. Kohler Klinik für Unfall-, Hand- und Wiederherstellungschirurgie und Orthopädie Am Klinikum 1 07747 Jena [email protected] Use of large language models During manuscript preparation, large language models (e.g., ChatGPT) were used only to assist with language editing. The authors reviewed and edited the content as needed and take full responsibility for the manuscript’s content. References Rupp, M. et al. The incidence of fractures among the adult population of Germany: An analysis from 2009 through 2019. Deutsches Ärzteblatt Int. 118 , 665 (2021). Osche, D. B. et al. Fragility Fractures of the Pelvic Ring: Analysis of Epidemiology, Treatment Concepts, and Surgical Strategies from the Registry of the German Pelvic Multicenter Study Group. J. Clin. Med. 14 , 2935. https://doi.org:10.3390/jcm14092935 (2025). Hu, S., Guo, J., Zhu, B., Dong, Y. & Li, F. Epidemiology and burden of pelvic fractures: Results from the Global Burden of Disease Study 2019. 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Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 17 Feb, 2026 Reviewers invited by journal 17 Feb, 2026 Editor invited by journal 10 Oct, 2025 Editor assigned by journal 09 Oct, 2025 Submission checks completed at journal 09 Oct, 2025 First submitted to journal 07 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. 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Kohler","email":"data:image/png;base64,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","orcid":"","institution":"Jena University Hospital","correspondingAuthor":true,"prefix":"","firstName":"Felix","middleName":"C.","lastName":"Kohler","suffix":""},{"id":592641457,"identity":"bdc35f1c-77b1-4ffc-a216-f316ba74f55e","order_by":1,"name":"Philipp Schenk","email":"","orcid":"","institution":"BG Klinikum Bergmannstrost Halle","correspondingAuthor":false,"prefix":"","firstName":"Philipp","middleName":"","lastName":"Schenk","suffix":""},{"id":592641458,"identity":"a1f7fe9a-d007-4d7f-a813-8c78fcaf8f0b","order_by":2,"name":"Pamela Schanderl","email":"","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Pamela","middleName":"","lastName":"Schanderl","suffix":""},{"id":592641459,"identity":"1891a917-7fbd-47b5-89f1-74a9b308f258","order_by":3,"name":"Volker Zimmermann","email":"","orcid":"","institution":"Klinikum Traunstein","correspondingAuthor":false,"prefix":"","firstName":"Volker","middleName":"","lastName":"Zimmermann","suffix":""},{"id":592641460,"identity":"709370c9-af65-41aa-ac43-a18e051e2d76","order_by":4,"name":"Bernhard Ullrich","email":"","orcid":"","institution":"BG Klinikum Bergmannstrost Halle","correspondingAuthor":false,"prefix":"","firstName":"Bernhard","middleName":"","lastName":"Ullrich","suffix":""},{"id":592641461,"identity":"1b9d52ac-d78c-430f-9501-90c55850e59a","order_by":5,"name":"Martin Naisan","email":"","orcid":"","institution":"St. Josefs Hospital","correspondingAuthor":false,"prefix":"","firstName":"Martin","middleName":"","lastName":"Naisan","suffix":""},{"id":592641462,"identity":"ef65ddb1-9df2-4a55-b7a0-40297a5ac6be","order_by":6,"name":"Erik Wegner","email":"","orcid":"","institution":"University Medical Center of the Johannes Gutenberg University Mainz","correspondingAuthor":false,"prefix":"","firstName":"Erik","middleName":"","lastName":"Wegner","suffix":""},{"id":592641463,"identity":"c66e5617-454e-4ef2-939d-d5388a06cc3e","order_by":7,"name":"Michael Müller","email":"","orcid":"","institution":"University Hospital Schleswig-Holstein","correspondingAuthor":false,"prefix":"","firstName":"Michael","middleName":"","lastName":"Müller","suffix":""},{"id":592641464,"identity":"6e93503d-5af3-46c1-b6b4-b4d3622d52d3","order_by":8,"name":"Frank Hartmann","email":"","orcid":"","institution":"Diakonie Krankenhaus","correspondingAuthor":false,"prefix":"","firstName":"Frank","middleName":"","lastName":"Hartmann","suffix":""},{"id":592641465,"identity":"24ed8f58-65e1-4a42-8966-4fa58dd88ba8","order_by":9,"name":"Klaus J. Schnake","email":"","orcid":"","institution":"Malteser Waldkrankenhaus Erlangen","correspondingAuthor":false,"prefix":"","firstName":"Klaus","middleName":"J.","lastName":"Schnake","suffix":""},{"id":592641467,"identity":"c943f99f-be5b-4186-9ff3-c1d50082fff5","order_by":10,"name":"Imke Schmerwitz","email":"","orcid":"","institution":"Städtisches Klinkum Wolfenbüttel","correspondingAuthor":false,"prefix":"","firstName":"Imke","middleName":"","lastName":"Schmerwitz","suffix":""},{"id":592641468,"identity":"2d22b4dd-b556-4e40-91f3-aa49371cc5f8","order_by":11,"name":"Lars Behr","email":"","orcid":"","institution":"Sana Klinikum Borna","correspondingAuthor":false,"prefix":"","firstName":"Lars","middleName":"","lastName":"Behr","suffix":""},{"id":592641469,"identity":"044711d5-28d6-499a-be86-a88e699c3282","order_by":12,"name":"Max J. Scheyerer","email":"","orcid":"","institution":"Düsseldorf University Hospital","correspondingAuthor":false,"prefix":"","firstName":"Max","middleName":"J.","lastName":"Scheyerer","suffix":""},{"id":592641470,"identity":"9a8af1d0-153a-4f52-b600-2379d1a18b88","order_by":13,"name":"Robert Pätzold","email":"","orcid":"","institution":"Berufsgenossenschaftliche Unfallklinik Murnau","correspondingAuthor":false,"prefix":"","firstName":"Robert","middleName":"","lastName":"Pätzold","suffix":""},{"id":592641471,"identity":"c18d3fdd-f5eb-4795-9287-e5c93a2782eb","order_by":14,"name":"Sebastian Grüninger","email":"","orcid":"","institution":"Nuremberg Hospital","correspondingAuthor":false,"prefix":"","firstName":"Sebastian","middleName":"","lastName":"Grüninger","suffix":""},{"id":592641472,"identity":"f563b4df-8abb-49b5-a1f1-2153ab232372","order_by":15,"name":"Georg Osterhoff","email":"","orcid":"","institution":"University Hospital Leipzig","correspondingAuthor":false,"prefix":"","firstName":"Georg","middleName":"","lastName":"Osterhoff","suffix":""},{"id":592641473,"identity":"1d207728-4916-45df-b80e-163ccc2535a8","order_by":16,"name":"Ulrich J. A. Spiegl","email":"","orcid":"","institution":"München Klinik Harlaching","correspondingAuthor":false,"prefix":"","firstName":"Ulrich","middleName":"J. A.","lastName":"Spiegl","suffix":""}],"badges":[],"createdAt":"2025-10-07 21:08:12","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7802586/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7802586/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":103167173,"identity":"389c4cee-835b-4249-9fa0-df5b09e83fd5","added_by":"auto","created_at":"2026-02-22 12:44:22","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":76863,"visible":true,"origin":"","legend":"\u003cp\u003eFunctional outcome of patients with osteoporotic pelvic fractures at the day of treatment decision (TD) and at discharge. Results are presented separately for surgically and conservatively treated patients and further differentiated by the occurrence of complications. Values are shown as means with 95% confidence intervals.\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-7802586/v1/9337069e2b7d94a707a7b220.png"},{"id":103505136,"identity":"7b8db80f-b687-4102-8e84-2c3f84a215b8","added_by":"auto","created_at":"2026-02-26 13:24:57","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":914356,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7802586/v1/de4b3ec0-6ac9-4867-8044-cecf23d5ce28.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"\u003cp\u003eComplications in Fragility Fractures of the Pelvis: A multicenter study based on the OF-Pelvis Classification and Score\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOsteoporotic pelvic ring fractures (OPRF) represent a growing clinical challenge in geriatric trauma care [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Unlike high-energy trauma, these fractures typically occur after low-energy mechanisms in frail, elderly patients [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] with compromised bone quality and comorbidities [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. They are associated with prolonged immobilization, high in-hospital complication rates, and significant functional decline [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eIn recent years, the development of the OF-Pelvis classification and its accompanying score [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] has provided clinicians with a structured framework to guide treatment decisions. Developed by the Working Group for Osteoporotic Fractures of the Spine Section of the German Society for Orthopaedics and Trauma (DGOU) the system incorporates both fracture morphology and patient-specific clinical parameters, including pain, mobility, neurological status, and comorbidity scores [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAlthough the OF-Pelvis Score correlates well with real-world treatment decisions and provides a functional basis for classifying fragility fractures [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], the correlation between this score and the incidence of complications during the hospital stay has not been thoroughly investigated. However, complications such as urinary tract infections, impaired wound healing, and prolonged immobility are common in this patient population and can significantly impact outcomes, especially for those who undergo surgery [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite these risks, it remains unclear to what extent fracture morphology, patient characteristics, or therapy modality independently impact adverse events. Several studies suggest that age and frailty, rather than the treatment itself, are stronger determinants of postoperative complications [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. The ability to identify high-risk patients early is critical, not only for tailoring treatment but also for optimizing resource allocation and rehabilitation planning.\u003c/p\u003e \u003cp\u003eThis multicenter prospective study aims to contribute to closing this knowledge gap by evaluating the frequency, nature, and predictors of complications in patients with OPRF. Using the OF-Pelvis Score as a clinical stratification tool, we investigate whether treatment decisions were consistent with the score\u0026rsquo;s recommendation and how these relate to complication rates and functional recovery, thereby assessing its usefulness as both a therapeutic and prognostic tool.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003eBetween 2021 and 2023, patients with pelvic fractures were enrolled, treated, and analyzed as part of this prospective multicenter study. Data were collected from 14 participating centers and consolidated at the lead coordinating center. Ethical approval was granted by the respective institutional review boards at each participating site. Data were collected at the time of hospital admission, on the day of treatment decision, and at discharge. The day treatment decision (TD) was defined as the day on which the therapeutic strategy for managing the pelvic fracture was determined. In addition to demographic data and bone quality (Hounsfield Units, DEXA T-score, and quantitative CT), fracture morphology was classified according to the OF-Pelvis classification (OFP classification). Additionally, the OF-Pelvis Score were calculated. The OF-Pelvis Score is a composite score that includes fracture morphology, patient mobility, pain, and neurological deficits attributable to the fracture. Patient health status is also incorporated, including ASA classification, the modified Frailty Index (mFI), and anticoagulant use. Additional modifiers such as fractures of the L5 transverse processes, fracture displacement, and bone marrow edema are also considered. A total OF-Pelvis Score of less than 8 suggests conservative treatment. A score greater than 8 indicates a recommendation for surgical treatment. A score of exactly 8 is considered a relative indication for surgery. The OF-Pelvis Score serves as a clinical decision support tool. The final treatment decision was made by the attending physician in accordance with best clinical practice.\u003c/p\u003e \u003cp\u003eIn each case, the treatment method, surgical or conservative, was recorded. Functional outcomes were assessed based on patient mobility, the Oswestry Disability Index (ODI), Barthel Index, EQ5D-5L Index Score and EQ5D Visual Analogue Scale (EQ5D-VAS), Timed Up and Go (TuG) test, and the patient\u0026rsquo;s self-reported walking distance before treatment and at discharge. Mobility was documented as a binary variable, categorizing patients as either independently mobile or non-mobile. Non-mobile patients included those who were bedridden or wheelchair-bound.\u003c/p\u003e \u003cp\u003eThe following complications during hospitalization were recorded: urinary tract infection, pneumonia, pressure ulcers, pulmonary embolism, surgical site complications, wound healing disorders, bleeding, implant malposition, and need for revision surgery.\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStatistics\u003c/h2\u003e \u003cp\u003eDifferences in age, bone quality, and length of hospital stay were assessed using a univariate general linear model (GLM). Treatment type and occurrence of complications were entered as fixed factors (binary variables). Differences in the distribution of binary variables (e.g., sex, mobility, presence of osteoporosis, neurological deficits) and categorical variables (e.g., ASA classification, OF-Pelvis classification) between treatment groups and in relation to complications were analyzed using Chi-square or Fisher\u0026rsquo;s exact tests. If the test shows significance the contingence coefficient will be given. Logistic regression was used to evaluate the influence of age, ASA classification, pain, mobility, and treatment approach on the risk of complications. To assess the impact of complications and differences in treatment modality on functional outcomes over time, a repeated-measures general linear model (GLMrm) was used. The functional outcome at treatment decision and discharge was used as within-factor (repeated measure). This analysis was performed separately for each functional outcome variable (walking distance, ODI, Barthel Index, TuG, EQ5D index value, and EQ5D-VAS). To account multiple comparisons, post hoc pairwise tests were Bonferroni corrected. Mean and standard deviations were calculated for continuous variables, while frequencies and percentages were used for categorial variables. Results of the functional outcome analyses are presented graphically as means and corresponding 95% confidence intervals. All statistical analyses were performed using SPSS version 29 (IBM Corp. Released 2022. IBM SPSS Statistics for Windows, Version 29.0. Armonk, NY: IBM Corp). A p-value of \u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e \u003c/div\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study was approved by the institutional review boards of all participating centers. All procedures were performed in accordance with relevant guidelines and regulations (Declaration of Helsinki). Written informed consent was obtained from all participants or their legal representatives prior to inclusion.\u003c/p\u003e\n\u003cp\u003eEthical approval: The study was approved by the local institutional ethics committees of all participating centers:\u003c/p\u003e\n\u003cp\u003e- University Hospital Leipzig: Ethikkommission der Medizinischen Fakult\u0026auml;t: 522/20-ek\u003c/p\u003e\n\u003cp\u003e- Klinikum Traunstein: Bayerische Landes\u0026auml;rztekammer: 2017-136\u003c/p\u003e\n\u003cp\u003e- BG Klinikum Bergmannstrost Halle: \u0026Auml;rztekammer Sachsen-Anhalt: 88/21\u003c/p\u003e\n\u003cp\u003e- Universit\u0026auml;tsklinikum Jena: Ethikkommission: 5507-0418- Universit\u0026auml;tsklinikum Schleswig-Holstein, Kiel: Medizinische Fakult\u0026auml;t der CAU zu Kiel: AZ B213/21\u003c/p\u003e\n\u003cp\u003e- Sana Klinikum Borna: S\u0026auml;chsische Landes\u0026auml;rztekammer: EK-BR-30/22-1\u003c/p\u003e\n\u003cp\u003e- Klinikum N\u0026uuml;rnberg: Ethik-Kommission FAU Erlangen-N\u0026uuml;rnberg: 309_17 Bc (For other centers, local IRB approvals were also obtained; reference numbers available on request.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to publish\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe manuscript does not include any individual person\u0026rsquo;s data in any form (images, videos, or identifiable information).\u0026nbsp;\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003eData from a total of 390 patients (57 men, 333 women) with a mean age of 80\u0026plusmn;8 years (range: 54\u0026ndash;99 years) were analyzed. The most frequently observed fracture types were OFP3 (n=173, 44%) followed by OFP4 (n=164, 42%). OFP2 and OFP5 fractures were identified in 29 (7%) and 21 (5%) patients, respectively. OFP1 fractures were diagnosed in 3 patients (1%).\u003c/p\u003e\n\u003cp\u003ePatients were admitted to the hospital on average 12\u0026plusmn;24 days (range: 0\u0026ndash;210 days). A total of 132 patients (34%) were treated conservatively, while 258 patients (66%) underwent surgical treatment. The average length of hospital stay was significantly longer in patients with complications (16\u0026plusmn;10 days) compared to those without complications (11\u0026plusmn;6 days, p\u0026lt;0.001). Table 1 presents the patients characteristics stratified by treatment group and occurrence of complication.\u003c/p\u003e\n\u003cp\u003eTable 1: Baseline characteristics of patients with osteoporotic pelvic ring fractures, stratified by treatment type (surgical, conservative) and complication status\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"939\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003ePatient Characteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003eTotal (N=390)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 237px;\"\u003e\n \u003cp\u003eSurgery (N=258)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" style=\"width: 237px;\"\u003e\n \u003cp\u003eConservative (N=132)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eNo Complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003eComplication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003eNo Complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eWomen/Men\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e333/57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e59/10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e157/28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e29/4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e84/15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.781\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e80\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e82\u0026plusmn;7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e79\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e83\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e81\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.161\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHospitalization [d]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e13\u0026plusmn;8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e18\u0026plusmn;10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e13\u0026plusmn;6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e13\u0026plusmn;9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e9\u0026plusmn;5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eBone Quality\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eHU\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e29\u0026plusmn;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e28\u0026plusmn;45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e34\u0026plusmn;50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.347\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e14\u0026plusmn;26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e26\u0026plusmn;37\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.114\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eDEXA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-0,24\u0026plusmn;0,93\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.33\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e-0.15\u0026plusmn;0.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.138\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.22\u0026plusmn;0.86\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e-0.37\u0026plusmn;1.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eQCT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e-0,2\u0026plusmn;0,8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e-0.2\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e-0.2\u0026plusmn;0.9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.972\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0\u0026plusmn;0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e-0.1\u0026plusmn;0.6\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.424\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eASA classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.469\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.197\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e6 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e145 (37%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e22 (32%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e72 (40%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (29%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e41 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eIII\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e216 (55%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e44 (64%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e101 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e19 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e49 (51%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eIV\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e14 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e5 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (10%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eUnknown\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e9 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOsteoporosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e377 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e66 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e176 (95%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e98 (99%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e13 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e3 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e9 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNeurological Deficit\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.573\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e13 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e2 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e8 (4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNone\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e377 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e67 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e177 (96%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (100%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e96 (97%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOF-Pelvis classification\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.970\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOFP1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e3 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1 (1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e2 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOFP2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e29 (7%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e0 (0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e20 (20%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOFP3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e173 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (35%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e67 (36%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e20 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e60 (61%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOFP4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e164 (42%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e33 (48%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e109 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e6 (18%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e14 (14%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOFP5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e21 (5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e11 (16%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e6 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e1 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e3 (3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eOF-Pelvis Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e9\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e10\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e10\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.142\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e7\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e7\u0026plusmn;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.559\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eMobile\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e0.777\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e0.054\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e218 (56%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e28 (41%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e79 (43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e24 (73%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e87 (88%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 189px;\"\u003e\n \u003cp\u003eNo\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 115px;\"\u003e\n \u003cp\u003e172 (44%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e41 (59%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e106 (57%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 66px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 104px;\"\u003e\n \u003cp\u003e9 (27%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 133px;\"\u003e\n \u003cp\u003e12 (12%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 95px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eComplications occurred in 102 patients (26%), with no significant association with sex (14 men [25%], 88 women [27%], p=0.871) or OFP classification (p=0.086). Most patients (n=349, 90%) were treated in accordance with the recommendation of the OF-Pelvis Score. Compliance of the OF-Pelvis Score recommendation showed no significant association on complication rates (p=0.139). ASA classification among patients ranged from ASA I (n=6) to ASA IV (n=14). Most patients were classified as ASA III (n=213, 55%), followed by ASA II (n=144, 37%). No significant association between ASA classification and occurrence of complications could be demonstrated (p=0.074). Fracture morphology according to the OFP classification showed a significant association with the occurrence of complications (contingency coefficient=0.168, p=0.029). This association was not significant in conservatively treated patients (p=0.970), but it was significant in surgically treated patients (contingency coefficient=0.251, p=0.002). An overview of the complications identified in patients with pelvic fractures is provided in Table 2.\u003c/p\u003e\n\u003cp\u003eTable 2: Identified complications for the complete group of patients with pelvic fractures and for the surgically and conservatively treated patients.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"559\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eSurgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003eConservative\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eUrinary tract infection\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e34\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.449\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePneumonia\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.343\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePressure ulcer\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003ePulmonary embolism\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.342\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eSurgical site complication\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eWound healing disorder\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eBleeding\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eImplant malposition\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eRevision surgery\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e-\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 208px;\"\u003e\n \u003cp\u003eOther complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 53px;\"\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e28\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 107px;\"\u003e\n \u003cp\u003e11\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 50px;\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cbr\u003e\u003c/p\u003e\n\u003cp\u003eLogistic regression was performed using data from 377 patients to predict complications, 13 patients were excluded due to missing information in at least one of the predictor variables. The model achieved a prediction accuracy of 74.5%, with a Nagelkerke R\u0026sup2; of 0.06, indicating poor to moderate explanatory power. Of 100 patients who experienced complications, the model correctly predicted complications in only 4 cases (4%). In 96 patients, complications occurred but were not predicted by the model. All patients without complications were correctly classified as such. In total, the model predicted no complications for 373 patients, of whom 277 (74.3%) were correctly classified (Table 3).\u003c/p\u003e\n\u003cp\u003eWithin the logistic regression model, only age was identified as a significant predictor of complication occurrence, with a regression coefficient of 4% (p=0.017). Accordingly, each additional year of age, the likelihood of developing a complication increased by 4%. No significant associations were found for the other variables: ASA classification (p\u0026gt;0.397; ASA I as reference), pain (p=0.952), mobility (p=0.504), or treatment type (p=0.616).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe repeated-measures general linear model (GLM) demonstrated statistically significant improvements in all functional outcome measures (walking distance, ODI, Barthel Index, TuG) during the inpatient period (all p\u0026lt;0.001). No significant main effects of complications or treatment type were observed for these outcomes, except for the TuG, where an interaction effect between complication status and treatment type was detected (p=0.049).\u003c/p\u003e\n\u003cp\u003ePost hoc pairwise comparisons revealed that, at the time of treatment decision (TD), surgically treated patients who later developed complications required on average 20 seconds longer to complete the TuG compared to conservatively treated patients (p=0.038). Among patients without complications, no significant difference in TuG times at TD was observed between treatment groups. The TuG test was completed by 148 patients at TD and by 292 patients at the time of discharge (p\u0026lt;0.001). The results of these functional outcome variables over time are illustrated in Figure 1.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis prospective multicenter study documented 102 in-hospital complications (26%) in patients with osteoporotic pelvic ring fractures (OPRFs), most commonly urinary tract infections, wound-related problems, hemorrhage, and revision surgeries. Complications were more frequent in surgically treated patients (34%) than in those treated conservatively (14%), which aligns with previous data from Rommens et al. (27.5% vs. 19.8%)\u0026nbsp;[6].\u0026nbsp;However, logistic regression showed that treatment modality was not an independent predictor of complications. The only significant predictor was patient age (p = 0.017), with each additional year increasing complication risk by 4%. This likely reflects the accumulation of comorbidities with age, which were not fully captured in our dataset but may have contributed to vulnerability.\u0026nbsp;This finding aligns with previous research that also identified advanced age as a major contributing factor to negative outcomes in patients with fragility fractures\u0026nbsp;[10-15].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNeither the OF-Pelvis Score, ASA classification, baseline pain, nor initial mobility were independently associated with complication risk. The OF-Pelvis fracture classification showed a significant association with complications in surgically treated patients. This underlines the importance of not only the treatment decision itself, but also the underlying injury pattern and its interaction with patient-related risk factors. While our study focused on the OF system, prior research using the Fragility Fracture of the Pelvis (FFP) classification has demonstrated that more unstable morphologies (FFP III and IV) are linked to increased complications [6]. Combining morphological and systemic risk assessments may thus provide a more complete prognostic framework.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn contrast, ASA classification, baseline pain levels, initial mobility, and the OF-Pelvis Score were not independently associated with in-hospital complications. These findings challenge the assumption that surgical treatment or fracture severity alone increase risk and instead highlight patient-related factors such as frailty and age as primary determinants [10-12,16,17].\u0026nbsp;Supporting this view, Keppler et al. showed that orthogeriatric co-management in pelvic and acetabular fractures reduces complications such as urinary tract infections and revision surgeries and enables earlier mobilization, highlighting the value of standardized interdisciplinary protocols addressing frailty and comorbidity more effectively than surgical decision-making alone\u0026nbsp;[15]. Consistently, Forssten et al. identified frailty, measured via the Orthopedic Frailty Score, as a key independent predictor of mortality and complications in over 66,000 geriatric pelvic fracture patients\u0026nbsp;[10]. Rege et al. extended this evidence to younger trauma patients, demonstrating that frailty, measured by a modified frailty index (mFI), was a stronger predictor of mortality and severe complications than age or ASA classification, underlining the need to assess frailty across all age groups\u0026nbsp;[18]. These findings support our observation that patient-related vulnerability, rather than fracture morphology or treatment modality, primarily determines complication risk and highlight the importance of integrating frailty assessment into the management of osteoporotic pelvic ring fractures.\u003c/p\u003e\n\u003cp\u003eA detailed analysis of complications revealed that the majority were non-life-threatening but clinically significant events. Urinary tract infections (34 cases) and wound-related issues, including hematoma and material malposition were among the most impactful. Although rare, more serious events like pulmonary embolism and pneumonia were also observed. These rates are within the range reported in similar large-scale cohort studies [6,12,19,20] and confirm the need for meticulous perioperative monitoring, especially in surgically treated elderly patients [6,9,12,21].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eFunctional outcomes improved significantly across all measures, regardless of treatment group or complication status, supporting the value of structured multidisciplinary care. This aligns with prior research showing that rehabilitation protocols, not treatment type alone, drive recovery\u0026nbsp;[17,22-24]. Nevertheless, a closer look reveals that the TuG performance was significantly delayed in patients who developed complications and underwent surgical treatment. This interaction effect suggests that while complications may not dictate outcomes, they can hinder short-term functional recovery. These results are consistent with others indicating that, while postoperative complications hinder recovery of mobility, they do not prevent long-term functional outcomes. Conversely, patients treated for OPRFs had lower mortality rates in the long-term follow-up [12,23]. However, a limitation is that patients who were not mobile or unable to perform the TuG were excluded from analysis, which may have introduced selection bias.\u003c/p\u003e\n\u003cp\u003eThe EQ5D index value and EQ5D-VAS measures showed subjective health improvements across all patient subgroups. Pain scores declined most notably in the surgical group, which aligns with previous data showing that mechanical stabilization reduces nociceptive stimuli in unstable pelvic injuries [25]. These pain reductions also likely facilitated faster participation in rehabilitation activities and thus other outcome measures.\u003c/p\u003e\n\u003cp\u003eDespite the higher complication rates among surgically treated patients, this group demonstrated the greatest pain reduction and fastest subjective recovery. This emphasizes that, while relevant, complications must be considered in the context of therapeutic benefit. Not all complications carry the same clinical significance, and their occurrence does not negate the benefits of surgical stabilization when indicated.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eComparative studies repeatedly point to variability in the treatment of fragility fractures across institutions [2]. This supports the idea of introducing standardized instruments, such as the OF-Pelvis Score, to improve the quality of care and reporting of outcomes.\u003c/p\u003e\n\u003cp\u003eThe results of this study therefore reflect the reality of healthcare provision in the German-speaking region. Building on prior work the study confirms the clinical concordance of the OF-Pelvis Score with actual treatment decisions (90% conformity) and highlights its dynamic application for guiding individualized therapy. Among the 390 patients evaluated, a majority had OFP3 and OFP4 fractures, reflecting the distribution commonly reported in similar cohorts [19]. Surgical treatment was more common among patients with OFP4 and OFP5 fractures, which supports the view that unstable morphologies require operative stabilization [26].\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eLimitations of the current study include the heterogeneous implementation across 14 participating centers and thus potential variations in surgical technique, and incomplete datasets for some variables, limiting the power of regression models. Despite these, the study provides a robust real-world snapshot of current practices in the treatment of osteoporotic pelvic fractures in Germany. The functional outcome measures are standard in the evaluation of these patients, but sometimes more may lead to selection bias, like the TuG test or needed to be age adjusted.\u003c/p\u003e\n\u003cp\u003eIn this large prospective multicenter study, in-hospital complications occurred in one out of four patients with osteoporotic pelvic ring fractures, most frequently in surgically treated and older individuals. However, surgical treatment itself was not an independent predictor of complications. Instead, age emerged as the sole significant risk factor. The OF-Pelvis Score demonstrated high agreement with real-world treatment decisions but did not predict complication risk. Despite the frequency of complications, functional outcomes improved across all subgroups, highlighting the resilience of structured multidisciplinary care. These findings underscore the need to shift focus from treatment modality to patient-related factors in managing complication risk.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analysed during the current study are \u003cstrong\u003eavailable from the corresponding author on reasonable request\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e De-identified data, the statistical analysis plan and codebook will be provided upon request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eF.C.K. and P.S. contributed equally.\u003c/p\u003e\n\u003cp\u003eAll authors contributed to the study conception and design. Data collection and analysis were performed collaboratively by the authors from the\u0026nbsp;\u003cstrong\u003eWorking Group (Osteoporotic Fractures, Spine Section of the German Society for Orthopaedics and Trauma, DGOU)\u003c/strong\u003e. The first draft of the manuscript was written by F.C.K. and P.S. and all authors commented on previous versions.\u003cbr\u003e\u0026nbsp;All co-authors interpreted data and critically revised the manuscript. All authors approved the final version and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe thank the participating centres of the \u003cstrong\u003eWorking Group (Osteoporotic Fractures, Spine Section of the German Society for Orthopaedics and Trauma, DGOU)\u003c/strong\u003e for patient recruitment and data collection\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdditional information\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence and requests for materials should be addressed to:\u003c/p\u003e\n\u003cp\u003ePD Dr. med. habil. Felix C. Kohler\u003c/p\u003e\n\u003cp\u003eKlinik f\u0026uuml;r Unfall-, Hand- und Wiederherstellungschirurgie und Orthop\u0026auml;die\u003c/p\u003e\n\u003cp\u003eAm Klinikum 1\u003c/p\u003e\n\u003cp\u003e07747 Jena\u003c/p\u003e\n\u003cp\[email protected]\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eUse of large language models\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDuring manuscript preparation, large language models (e.g., ChatGPT) were used \u003cstrong\u003eonly\u003c/strong\u003e to assist with language editing. The authors reviewed and edited the content as needed and take full responsibility for the manuscript\u0026rsquo;s content.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eRupp, M. et al. The incidence of fractures among the adult population of Germany: An analysis from 2009 through 2019. \u003cem\u003eDeutsches \u0026Auml;rzteblatt Int.\u003c/em\u003e \u003cb\u003e118\u003c/b\u003e, 665 (2021).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsche, D. B. et al. Fragility Fractures of the Pelvic Ring: Analysis of Epidemiology, Treatment Concepts, and Surgical Strategies from the Registry of the German Pelvic Multicenter Study Group. \u003cem\u003eJ. Clin. Med.\u003c/em\u003e \u003cb\u003e14\u003c/b\u003e, 2935. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.3390/jcm14092935\u003c/span\u003e\u003cspan address=\"https://doi.org:10.3390/jcm14092935\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2025).\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu, S., Guo, J., Zhu, B., Dong, Y. \u0026amp; Li, F. 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Comprehensive classification of fragility fractures of the pelvic ring: Recommendations for surgical treatment. \u003cem\u003eInjury\u003c/em\u003e \u003cb\u003e44\u003c/b\u003e, 1733\u0026ndash;1744. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org:10.1016/j.injury.2013.06.023\u003c/span\u003e\u003cspan address=\"https://doi.org:10.1016/j.injury.2013.06.023\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2013).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Osteoporotic pelvic fractures, pelvic ring fractures, OF-Pelvis Score, complications, geriatric trauma, frailty","lastPublishedDoi":"10.21203/rs.3.rs-7802586/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7802586/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eOsteoporotic pelvic ring fractures (OPRFs) are common in ageing populations and challenging due to multimorbidity and immobility-related complications. The OF-Pelvis classification and score support therapeutic decision-making, yet their relationship with in-hospital complications remains unclear. We conducted a prospective multicentre study of 390 patients treated at 14 German centres. Fractures were classified using the OF-Pelvis system; treatment recommendations were derived from the OF-Pelvis Score and compared with the therapy performed. Complications during hospitalisation were recorded, and predictors were assessed by logistic regression. Functional outcomes between treatment decision and discharge were analysed with repeated-measures general linear models. Overall, 258 patients (66%) underwent surgery and 132 (34%) received conservative care. Complications occurred in 26%, most commonly urinary tract infections and wound-related events. The OF-Pelvis Score showed high concordance with real-world treatment decisions, while age was the only independent predictor of complications; neither treatment modality nor the score independently predicted adverse events. Functional outcomes improved significantly across groups despite complications when managed within structured multidisciplinary care. These findings support the score\u0026rsquo;s utility for decision-making but indicate that complication risk is driven primarily by patient-related factors, emphasising the need for targeted geriatric co-management and prevention strategies.\u003c/p\u003e","manuscriptTitle":"Complications in Fragility Fractures of the Pelvis: A multicenter study based on the OF-Pelvis Classification and Score","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-22 12:44:17","doi":"10.21203/rs.3.rs-7802586/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"253600646678342930288024868161637893690","date":"2026-02-17T09:43:16+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-17T09:03:22+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-10T10:46:36+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-09T08:39:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-09T08:38:35+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-07T20:56:00+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"342622ab-a93c-4d10-a386-edc81fc88e42","owner":[],"postedDate":"February 22nd, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[{"id":63211262,"name":"Health sciences/Diseases"},{"id":63211263,"name":"Health sciences/Health care"},{"id":63211264,"name":"Health sciences/Medical research"},{"id":63211265,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-02-22T12:44:17+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-22 12:44:17","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7802586","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7802586","identity":"rs-7802586","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}