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

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.