Purpose Pelvic ring fractures in the elderly gain increasing importance. Nonetheless, data on factors influencing treatment deci?sion in relation to fracture classification, age, and the resulting treatment are still rare. Methods Prospectively collected data of the German Pelvic Injury Registry from patients aged over 65 years with a pelvic ring fracture were evaluated retrospectively. Acetabular fractures, as well as type A1 and A3 fractures, were excluded. The variables age, injury patt, type of treatment, the reason for conservative treatment, and Orthopaedic Trauma Association (OTA)/Tile classi?fication were analyzed. Furthermore, the fracture distribution was examined after dividing patients into six age groups. Results A total of 1814 patients with a mean age of 80.7 ± 7.6 years, predominantly female (79.0%), were available for evalua?tion. The majority of patients suffered from isolated pelvic ring fractures (70.1%) and 8.2% were severely injured (ISS>16). The most common fracture types were type A2 (35.4%), type B2 (38.0%), and type C1 (7.3%). Especially pelvic ring fractures of type A2 (96.9%) and type B2 (83.0%) were treated conservatively (overall 76.9%). Fracture instability according to the OTA/Tile classi?fication increased the probability for an operative treatment (generalized odds ratio ( OR 6.90 [5.62; 8.52]). In contrary, increasing age independent of the fracture patt decreased this probability ( OR 0.47 [0.41?0.53]). With increasing fracture instability, gener?al health conditions were up to 50% of the reasons for conservative treatment. Conclusion The results of the present study underline the importance of the factors age and general health besides fracture clas?sification for therapeutic decision?making in the treatment of pelvic ring fractures in the elderly.