Background Early CT of acute fragility fractures of the pelvis (FFP) in the elderly allows evaluation of the posterior pelvic structures. This improves classification of these injuries, compared to plain radiographs but the contribution of this knowledge to clinical decision making remains unclear. Objectives Does early CT influences treatment and can it predict outcome and treatment failure? Methods A retrospective cohort study of 320 patients aged over 65 years diagnosed with an acute

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... y fracture of the pelvis, at the emergency department of a single, level-one trauma centre. Data were retrieved from the German DGU Pelvic Injury Registry between 2009 and 2016. Fractures were classified according to the Tile classification. Statistical analysis compared the subgroups including radiograph only (X-RAY), CT with isolated pubic rami fracture (CTia) and CT with combined posterior pelvic fracture (CTcp). Results There were 285 female (89%) and 35 male (11%) subjects with a mean age of 83 years (range 65–102). 279 patients (87%) were living at home. 157 patients (49%) of the cohort had a CT scan showing 32 type A (20%); 114 type B (73%) and 11 type C (7%) fractures. 77% of patients living at home returned home and 17% moved to a nursing home, after discharge from the hospital. Mortality rate during hospitalisation was 5.0% and 14% at one-year post-trauma. Secondary fracture displacement occurred in 30%. Primary surgery was performed in two cases (1%); secondary surgery in 6 cases (2%). There was no significant association between subgroup (X-RAY, CTia, CTcp) and change in residential status (p = 0.98), complications during hospitalisation (p = 0.62) and mortality rate during admission (p = 0.94) and at 1 year (p = 0.89). A significant increased median length of stay was observed comparing subgroups CTcp (22 days) with subgroups CTia (15.5 days) and X-RAY (17 days) only. Secondary displacement was significantly higher in subgroup CTcp (p = 0.0403) but secondary displacement had no impact on complications nor mortality rate. Conclusions Our data suggest that early CT in patients with acute fragility fracture of the pelvis, in order to detect posterior lesions, does not add clinical useful information to guide treatment or affect outcome.