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Background <p>Transverse sacral fractures with spinopelvic dissociation are highly unstable and can cause severe&#xa0;neurological compromise. In cases combining an H-shaped sacral fracture, a floating Roy-Camille type 3 component,&#xa0;and a free canal fragment, posterior plating, standard spinopelvic fixation, or transiliac-transsacral screw fixation&#xa0;may be unsafe, particularly after decompression, due to a dorsal cortical defect.</p> Method <p>A 49-year-old woman sustained polytrauma after a fall from the fifth floor, including an AO/OTA 61-C3.2&#xa0;unstable pelvic ring injury. Computed tomography (CT) demonstrated an H-shaped sacral fracture with an S1–2&#xa0;transverse Roy-Camille type 3 component and a large canal fragment with bilateral fractures and a floating distal&#xa0;sacral fragment. After angioembolization for active pelvic hemorrhage and damage control orthopedics, definitive&#xa0;posterior surgery was performed on post-injury day 5. Decompression was achieved via laminectomy (L5–S2) and&#xa0;removal of the canal fragment. The floating sacral fragment was reduced using a Kapandji-like maneuver with&#xa0;bilateral neurodissectors. Minimally invasive crab-shaped spinopelvic fixation was performed using bilateral iliac&#xa0;screws and percutaneous L5 pedicle screws connected using transverse rods and longitudinal offset connectors.&#xa0;Offset connectors were positioned along the dorsal sacral cortex as buttresses to prevent redisplacement of the&#xa0;distal fragment and secured around the S2 spinous process.</p> Results <p>The operative time was 270 min, with 100 mL of blood loss. Postoperative imaging confirmed a satisfactory&#xa0;reduction. Mild anterior shortening occurred within three months without progression, union at six months, or&#xa0;complete union without implant failure at 1 year. The patient regained independent ambulation with mild residual&#xa0;sensory disturbances and urinary dysfunction.</p> Conclusion <p>Modified crab-shaped fixation using offset connectors as dorsal buttresses can provide stable reduction and&#xa0;maintain alignment until union in complex spinopelvic dissociation patterns where standard constructs or transiliac&#xa0;transsacral screw (TITSS) are not feasible.</p>

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Modified spinopelvic crab-shaped fixation using offset connectors for a H-shaped sacral fracture with a floating Roy-Camille type 3 transverse component: a case report

  • 期刊论文

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  • 发表日期：

    2026年3月27日

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  • Akinori Okuda,
  • Keisuke Masuda,
  • Hironobu Konishi,
  • Masaki Ikejiri,
  • Kenichi Nakano,
  • Naoki Maegawa,
  • Hideki Shigematsu,
  • Hidetada Fukushima,
  • Kenji Kawamura

摘要

Background

Transverse sacral fractures with spinopelvic dissociation are highly unstable and can cause severe neurological compromise. In cases combining an H-shaped sacral fracture, a floating Roy-Camille type 3 component, and a free canal fragment, posterior plating, standard spinopelvic fixation, or transiliac-transsacral screw fixation may be unsafe, particularly after decompression, due to a dorsal cortical defect.

Method

A 49-year-old woman sustained polytrauma after a fall from the fifth floor, including an AO/OTA 61-C3.2 unstable pelvic ring injury. Computed tomography (CT) demonstrated an H-shaped sacral fracture with an S1–2 transverse Roy-Camille type 3 component and a large canal fragment with bilateral fractures and a floating distal sacral fragment. After angioembolization for active pelvic hemorrhage and damage control orthopedics, definitive posterior surgery was performed on post-injury day 5. Decompression was achieved via laminectomy (L5–S2) and removal of the canal fragment. The floating sacral fragment was reduced using a Kapandji-like maneuver with bilateral neurodissectors. Minimally invasive crab-shaped spinopelvic fixation was performed using bilateral iliac screws and percutaneous L5 pedicle screws connected using transverse rods and longitudinal offset connectors. Offset connectors were positioned along the dorsal sacral cortex as buttresses to prevent redisplacement of the distal fragment and secured around the S2 spinous process.

Results

The operative time was 270 min, with 100 mL of blood loss. Postoperative imaging confirmed a satisfactory reduction. Mild anterior shortening occurred within three months without progression, union at six months, or complete union without implant failure at 1 year. The patient regained independent ambulation with mild residual sensory disturbances and urinary dysfunction.

Conclusion

Modified crab-shaped fixation using offset connectors as dorsal buttresses can provide stable reduction and maintain alignment until union in complex spinopelvic dissociation patterns where standard constructs or transiliac transsacral screw (TITSS) are not feasible.