Age Matters: Elevated Mortality and Distinct Injury Patterns in Elderly (≥75 years) Patients with High-Energy Pelvic Ring Injuries

Background High-energy pelvic ring injuries (PRIs) are increasingly observed in the elderly, a population with unique physiological vulnerabilities. However, outcome data in patients aged ≥75 years remain scarce. Methods In this retrospective cohort study, 331 patients with high-energy PRIs over 11 years at a Level 1 trauma centre were analysed. Using 1:1 propensity score matching, outcomes in patients aged ≥75 years were compared with younger patients (<75), adjusting for injury severity and baseline characteristics. Results Twenty-eight patients aged ≥75 were matched to 28 younger counterparts. Mortality was significantly higher in the elderly group (32 % vs. 7 %, p = 0.006), despite comparable injury severity scores. Elderly patients were less likely to be admitted to the intensive care unit (ICU) (29 % vs. 64 %, p = 0.007), with shorter ICU stays, though total hospital length of stay did not differ. Fracture morphology and mechanisms of injury also varied by age, with older adults showing simpler patterns but higher mortality. Conclusion Elderly patients with high-energy PRIs exhibit distinct injury mechanisms and patterns, experience a five-fold higher mortality despite less frequent ICU admission and matched injury severity. These findings highlight the urgent need for age-adapted trauma protocols and proactive perioperative strategies in managing pelvic trauma in the elderly.