{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T15:43:49Z","timestamp":1783093429064,"version":"3.54.6"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2017,1]]},"abstract":"<jats:sec>\n            <jats:title>Objective:<\/jats:title>\n            <jats:p>We sought to determine the role of lumbopelvic fixation (LPF) in the treatment of zone II sacral fractures with varying levels of sacral comminution combined with anterior pelvic ring (PR) instability. We also sought to determine the proximal extent of LPF necessary for adequate stabilization and the role of LPF in complex sacral fractures when only 1 transiliac\u2013transsacral (TI\u2013TS) screw is feasible.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Materials and Methods:<\/jats:title>\n            <jats:p>Fifteen L4 to pelvis fresh-frozen cadaveric specimens were tested intact in flexion-extension (FE) and axial rotation (AR) in a bilateral stance gliding hip model. Two comminution severities were simulated through the sacral foramen using an oscillating saw, with either a single vertical fracture (small gap, 1 mm) or 2 vertical fractures 10 mm apart with the intermediary bone removed (large gap). We assessed sacral fracture zone (SZ), PR, and total lumbopelvic (TL) stability during FE and AR. The following variables were tested: (1) presence of transverse cross-connector, (2) presence of anterior plate, (3) extent of LPF (L4 vs. L5), (4) fracture gap size (small vs. large), (5) number of TI\u2013TS screws (1 vs. 2).<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results:<\/jats:title>\n            <jats:p>The transverse cross-connector and anterior plate significantly increased PR stability during AR (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.02 and <jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01, respectively). Increased sacral comminution significantly affected SZ stability during FE (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.01). Two versus 1 TI\u2013TS screw in a large-gap model significantly affected TL stability (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.04) and trended toward increased SZ stabilization during FE (<jats:italic toggle=\"yes\">P<\/jats:italic> = 0.08). Addition of LPF (L4 and L5) significantly improved SZ and TL stability during AR and FE (<jats:italic toggle=\"yes\">P<\/jats:italic> &lt; 0.05). LPF in combination with TI\u2013TS screws resulted in the least amount of motion across all 3 zones (SZ, PR, and TL) compared with all other constructs in both small-gap and large-gap models.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions:<\/jats:title>\n            <jats:p>The role of LPF in the treatment of complex sacral fractures is supported, especially in the setting of sacral comminution. LPF with proximal fixation at L4 in a hybrid approach might be needed in highly comminuted cases and when only 1 TI\u2013TS screw is feasible to obtain maximum biomechanical support across the fracture zone.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/bot.0000000000000703","type":"journal-article","created":{"date-parts":[[2016,12,20]],"date-time":"2016-12-20T19:48:27Z","timestamp":1482263307000},"page":"37-46","source":"Crossref","is-referenced-by-count":33,"title":["Does Lumbopelvic Fixation Add Stability? A Cadaveric Biomechanical Analysis of an Unstable Pelvic Fracture Model"],"prefix":"10.1097","volume":"31","author":[{"given":"Ehsan","family":"Jazini","sequence":"first","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Noelle","family":"Klocke","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc, Audubon, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Tannous","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Herman S.","family":"Johal","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Hao","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc, Audubon, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kanaan","family":"Salloum","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc, Audubon, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Gelb","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jason W.","family":"Nascone","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Belin","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C. Max","family":"Hoshino","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mir","family":"Hussain","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc, Audubon, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert V.","family":"O'Toole","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, MD; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brandon","family":"Bucklen","sequence":"additional","affiliation":[{"name":"Globus Medical, Inc, Audubon, PA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven C.","family":"Ludwig","sequence":"additional","affiliation":[{"name":"R Adams Cowley Shock Trauma Center, 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