S1-pedicle-based triangle fixation for U-type sacral fracture: a technical note

U-type sacral fractures, accounting for 2%-5% of sacral fractures, typically result from falls. In this single-case technical note, a U-type sacral fracture from a motor vehicle crash treated with a novel fixation technique avoiding lumbosacral extension is reported. A 59-year old female with a Roy-Camille type-2 U-type sacral fracture and multiple long-bone injuries, without neurological deficit, was transferred to the university-affiliated center. Despite a severe sacral fracture, she exhibited no neurological deficits. Surgery began supine to address a distal femur fracture; then the patient was repositioned prone for sacral fixation under general anesthesia. A midline incision between S1 and S3 revealed the posterior elements. Under fluoroscopy, bilateral S1 pedicle screws were placed, followed by S3-iliac screws. Bilateral titanium rods were applied, and distraction reduced the sacral fracture. S2-iliac screws were added, functioning as iliosacral stabilization. A pre-contoured rod connected the bilateral S2 screws, and tightening achieved definitive fixation. Sagittal alignment of the sacrum was improved by nearly 10Åã, from 130Åã preoperative to 140Åã postoperative. The patient mobilized by sitting on the first postoperative day without loss of reduction. This method, suitable for U-type sacral fractures, avoids lumbopelvic fixation and fusion, but further studies are warranted. The technique described may provide an alternative to traditional lumbopelvic constructs.   Cite this article as: Günerbüyük C, Baş A, Akgül T, Gedik CC. S1-pedicle-based triangle fixation for U-type sacral fracture: a technical note. Acta Orthop Traumatol Turc. 2026; 60(4), 0369, doi: 10.5152/j.aott.2026.25369.