It’s not just a pelvic fracture – why we need to transform pelvic fragility fracture care!

Introduction: Pelvic fractures are a common fragility fracture but often under recognised. There is a wide range of incidence 6.9-78.6/100,000/year being reported in the UK. The objective of this study was to measure incidence of pelvic fracture and re-fracture rate for the population of Gwent (592,000).

Methods: A retrospective service evaluation of all fragility fracture patients seen by Aneurin Bevan Fracture Liaison Service (AB-FLS) between January 2022 and December 2025 was completed. Pelvic fracture cases were extracted from the FLS-DB for analysis. Data were analysed to describe patient demographics, incidence of pelvic fractures and 12 months risk of further fractures.

Results: A total of 9,320 patients with fragility fractures were identified over a four-year period, of whom 6.2% (n = 579) had sustained a pelvic fracture. In 2022, only 56 were identified, but enhanced collaboration with radiology teams and systematic screening of radiology reports, led to improved case identification, increasing to 97 cases in 2023, 217 cases in 2024, and 212 cases in 2025.

Based on the Gwent population of approximately 592,000, the annual incidence of pelvic fractures over the four-year period was 24.4 per 100,000 population. However, improved fragility fracture case ascertainment, meant that annual incidence in the most recent two years (2024–2025) was 36.2 per 100,000 population.

Analysis was completed for 370 pelvic fractures admitted from 2022 to 2024. Mean age was 83.7±8.4 (55.6-101.8) years and 78.9% were females. 62.2% were admitted to hospital. More than half (204; 55.1%) had sustained at least one previous fragility fracture.

Bone treatment was commenced for 226 (61%), while specialist assessment deemed 85 (22.9%) inappropriate for bone treatment and 45 patients (12.2%) declined treatment.

In spite of this, follow-up to date identified that 310 (83.7%) have not had a further fracture after the index fracture, but 60 (16.2%) had re-fractured. Within 12-months 36 (9.7%) had a re-fracture of hip, wrist, spine, humerus or pelvis, and 10 (2.7%) of these were at the hip.

Conclusion: Over 60% of patients with pelvic fractures required inpatient care, and 10% sustained another fracture within 12 months. These findings highlight the need for enhanced multidisciplinary collaboration between Radiology, Rheumatology, Orthogeriatricians, and Fracture Liaison Services to ensure prompt fracture identification, timely orthogeriatric review, initiation of inpatient bone treatment, and close coordination with FLS.