{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T10:00:23Z","timestamp":1790589623572,"version":"4.1.0"},"reference-count":23,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T00:00:00Z","timestamp":1769990400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Global Spine Journal"],"published-print":{"date-parts":[[2026,9]]},"abstract":"<jats:sec>\n                    <jats:title>Study Design<\/jats:title>\n                    <jats:p>Retrospective Cohort Study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To evaluate clinical and patient reported outcomes between operative and non-operative management strategies for sacral U-type fractures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      This retrospective review included patients with sacral U-type fractures from a 12-year period at a Level 1 trauma center. Demographic, Modified 5-Item Frailty Index (mFI-5), complications, outcomes, and Patient-Reported Outcomes Measurement Information System (PROMIS) data were collected. Fractures were classified by the AO Spine Sacral Injury Classification System (AOSSIC) and analyzed by subtype and treatment modality (trans-sacral screw fixation (TSF) or lumbopelvic fixation (LPF) vs non-operative). Statistical significance was\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .05.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixty-five patients met inclusion criteria (mean age 59.7 \u00b1 21.3 years, 49% male). Forty-seven (72%) were treated operatively (10 LPF, 37 TSF) and 18 non-operatively. Among C0 fractures, PROMIS Pain Interference (PI) and Physical Function (PF) scores were similar between operative and non-operative groups (62.96 vs 66.08,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .48; 30.01 vs 32.40,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .62). Similar findings were observed for C3 fractures (PI 62.62 vs 64.23,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .58; PF 30.29 vs 29.3,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = .78). mFI-5 frailty scores were higher among non-operative C3 fracture patients compared to operative cases (2.25 vs 0.90,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; .001). Complication rates were low and comparable between groups. Symptomatic screw removal occurred in 8% of TSF cases.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Operative and non-operative management of AOSSIC Type C sacral fractures yield comparable PROMIS outcomes and complication rates when frailty scores are considered. TSF was associated with higher rates of symptomatic screw removal. Further investigation is needed to determine the optimal treatment and impact of frailty metrics for these injuries.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21925682261422685","type":"journal-article","created":{"date-parts":[[2026,2,2]],"date-time":"2026-02-02T15:41:08Z","timestamp":1770046868000},"page":"3100-3107","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Sacral U-Type Fractures: A Comparative Study of Treatment Approaches"],"prefix":"10.1177","volume":"16","author":[{"given":"Arnaldo","family":"Martinez Rivera","sequence":"first","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Garrison P.","family":"Bentz","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dillon H.","family":"Stone","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel E.","family":"Pereira","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6973-078X","authenticated-orcid":false,"given":"Jeffrey T.","family":"Galla","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5903-7989","authenticated-orcid":false,"given":"Jonathan A.","family":"Ledesma","sequence":"additional","affiliation":[{"name":"University of Illinois Chicago"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7452-2712","authenticated-orcid":false,"given":"Jonathan","family":"Dalton","sequence":"additional","affiliation":[{"name":"Rothman Orthopaedic Institute at Jefferson"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Blake K.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"suffix":"Jr.","given":"John C.","family":"Clohisy","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jenna-Leigh","family":"Wilson","sequence":"additional","affiliation":[{"name":"Washington University in St. Louis"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian J.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Washington University in St. 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