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Sacral U-Type Fractures: A Comparative Study of Treatment Approaches
Arnaldo Martinez Rivera1, Garrison P Bentz1, Dillon H Stone1
1Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, MO, USA.
Global Spine Journal
|February 2, 2026
Summary
Operative and non-operative treatments for sacral U-type fractures show similar patient-reported outcomes and complication rates. Trans-sacral screw fixation (TSF) had higher symptomatic screw removal rates, with frailty scores influencing management decisions.
Area of Science:
- Orthopedic Surgery
- Trauma Surgery
- Spinal Surgery
Background:
- Sacral U-type fractures are complex injuries requiring careful management.
- Evaluating outcomes of operative versus non-operative strategies is crucial for patient care.
Purpose of the Study:
- To compare clinical and patient-reported outcomes for operative and non-operative management of sacral U-type fractures.
- To analyze the impact of frailty on treatment outcomes in these patients.
Main Methods:
- Retrospective cohort study of patients with sacral U-type fractures over 12 years.
- Data collected included demographics, Modified 5-Item Frailty Index (mFI-5), complications, and PROMIS scores.
- Fractures classified by AO Spine Sacral Injury Classification System (AOSSIC), analyzed by subtype and treatment (trans-sacral screw fixation, lumbopelvic fixation, or non-operative).
Main Results:
- Sixty-five patients included; 72% treated operatively.
- Comparable PROMIS Pain Interference and Physical Function scores between operative and non-operative groups for C0 and C3 fractures.
- Higher mFI-5 frailty scores in non-operative C3 fracture patients (2.25 vs 0.90).
- Low and comparable complication rates; 8% symptomatic screw removal in TSF cases.
Conclusions:
- Operative and non-operative management of AOSSIC Type C sacral fractures yield similar PROMIS outcomes and complication rates, especially when considering frailty.
- Trans-sacral screw fixation (TSF) is associated with increased symptomatic screw removal.
- Further research is needed to optimize treatment strategies and understand the role of frailty in sacral fracture management.
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