{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T06:16:22Z","timestamp":1783664182408,"version":"3.55.0"},"reference-count":35,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T00:00:00Z","timestamp":1783641600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Bioeng. Biotechnol."],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Sacroiliac joint screw (SIJS) fixation is widely regarded as the gold standard for treating unstable posterior pelvic ring injuries. However, the technique presents notable challenges, including a high risk of neurovascular injury and a steep learning curve. This study aimed to introduce a novel Posterior Internal Fixation (P-INFIX) system and evaluate its biomechanical performance in the treatment of Denis zone I sacral fractures using finite element analysis.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A three-dimensional pelvic model\u2014cortical bone, cancellous bone, and cartilage\u2014was reconstructed from computed tomography data of a healthy volunteer. A Denis zone I sacral fracture was simulated and stabilized using either the P-INFIX system (bilateral pedicle screws connected by a transverse Kirschner wire) or the standard SIJS. Finite element analysis was conducted under simulated sitting, supine, and lateral decubitus conditions to assess fracture fragment displacement and implant stress distribution.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The P-INFIX system provided fracture stability comparable to SIJS under most testing conditions. Although SIJS demonstrated a slight statistical advantage in limiting lateral fragment displacement (For example, Z2 in the sitting position: 0.13\u00a0mm vs. 0.18\u00a0mm,\n                      <jats:italic>P<\/jats:italic>\n                      = 0.001), all measured displacements were far below the clinically significant threshold (&amp;lt;1.3\u00a0mm). In terms of implant performance, the peak stress in P-INFIX (sitting: 141\u00a0MPa; supine: 320\u00a0MPa) was higher than that in SIJS; however, it remained well within the safe range below the yield strength of titanium alloy (1,050\u00a0MPa).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The novel P-INFIX system demonstrated biomechanical stability comparable to the gold standard SIJS in managing Denis zone I sacral fractures. Given its potential to reduce surgical risks and simplify the procedure through a \u201csafe channel\u201d lateral to the posterior superior iliac spine, P-INFIX represents a promising and more accessible alternative fixation technique.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fbioe.2026.1871603","type":"journal-article","created":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:37:43Z","timestamp":1783661863000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["A novel internal fixation system for sacral fractures: a finite element biomechanical study"],"prefix":"10.3389","volume":"14","author":[{"given":"Bin","family":"Chen","sequence":"first","affiliation":[{"name":"Second Clinical Medical College, Shanxi Medical University","place":["Taiyuan, China"]},{"name":"Department of Orthopaedics, Second Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xinbo","family":"Gu","sequence":"additional","affiliation":[{"name":"Second Clinical Medical College, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Beiyang","family":"Wang","sequence":"additional","affiliation":[{"name":"Third Hospital of Shanxi Medical University, Shanxi Bethune Hospital, Shanxi Academy of Medical Sciences, Tongji Shanxi Hospital","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ningning","family":"Shen","sequence":"additional","affiliation":[{"name":"Second Clinical Medical College, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mingming","family":"Kang","sequence":"additional","affiliation":[{"name":"Second Clinical Medical College, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"Second Clinical Medical College, Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haiyu","family":"Sun","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Second Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Huan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Second Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yonghong","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Second Hospital of Shanxi Medical University","place":["Taiyuan, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,10]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"607","DOI":"10.1007\/s00264-011-1381-9","article-title":"Wide resection of sacral chordoma via a posterior approach","volume":"36","author":"Asavamongkolkul","year":"2012","journal-title":"Int. Orthop."},{"key":"B2","doi-asserted-by":"publisher","first-page":"3764","DOI":"10.12659\/MSM.900673","article-title":"Treatment of unstable posterior pelvic ring fracture with pedicle screw-rod fixator Versus locking compression plate: a comparative study","volume":"22","author":"Bi","year":"2016","journal-title":"Med. Sci. Monit."},{"key":"B3","doi-asserted-by":"publisher","first-page":"336","DOI":"10.3390\/life16020336","article-title":"Biomechanical comparison of three fixation constructs for tile type C1.2 pelvic ring fractures: a finite element analysis","volume":"16","author":"Carp","year":"2026","journal-title":"Life (Basel)"},{"key":"B4","doi-asserted-by":"publisher","first-page":"967","DOI":"10.31616\/asj.2018.12.6.967","article-title":"Biomechanical study of posterior pelvic fixations in vertically unstable sacral fractures: an alternative to triangular osteosynthesis","volume":"12","author":"Chaiyamongkol","year":"2018","journal-title":"Asian Spine J."},{"key":"B5","doi-asserted-by":"publisher","first-page":"185","DOI":"10.31616\/asj.2021.0492","article-title":"An in vitro biomechanical analysis of contralateral sacroiliac joint motion following unilateral sacroiliac stabilization with and without lumbosacral fixation","volume":"17","author":"Cho","year":"2023","journal-title":"Asian Spine J."},{"key":"B6","doi-asserted-by":"publisher","first-page":"1558","DOI":"10.1007\/s00586-014-3313-z","article-title":"Comparison of the risk of breakage of two kinds of sacroiliac screws in the treatment of bilateral sacral fractures","volume":"23","author":"Fu","year":"2014","journal-title":"Eur. Spine J."},{"key":"B7","doi-asserted-by":"publisher","first-page":"306","DOI":"10.1007\/s00402-025-05904-x","article-title":"The myth of 2.5 cm symphyseal diastasis","volume":"145","author":"G\u00e4nsslen","year":"2025","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"B8","doi-asserted-by":"publisher","first-page":"669321","DOI":"10.3389\/fbioe.2021.669321","article-title":"Biomechanical effects of a cross connector in sacral fractures \u2013 a finite element analysis","volume":"9","author":"Gierig","year":"2021","journal-title":"Front. Bioeng. Biotechnol."},{"key":"B9","doi-asserted-by":"publisher","first-page":"522","DOI":"10.1055\/a-1190-5987","article-title":"The S2-Alar-Iliac screw for pelvic trauma","volume":"159","author":"Hartensuer","year":"2021","journal-title":"Z. Orthop. Unfallchirurgie"},{"key":"B10","doi-asserted-by":"publisher","first-page":"135","DOI":"10.1097\/00003086-200202000-00014","article-title":"Fluoroscopy-based multiplanar image guidance for insertion of sacroiliac screws","volume":"395","author":"Hinsche","year":"2002","journal-title":"Clin. Orthop."},{"key":"B11","doi-asserted-by":"publisher","first-page":"875","DOI":"10.1016\/j.spinee.2017.02.001","article-title":"Analysis of the s2 alar-iliac screw as compared with the traditional iliac screw: does it increase stability with sacroiliac fixation of the spine?","volume":"17","author":"Hoernschemeyer","year":"2017","journal-title":"Spine J."},{"key":"B12","doi-asserted-by":"publisher","first-page":"195","DOI":"10.1111\/os.12431","article-title":"Biomechanical comparison of three internal fixation techniques for stabilizing posterior pelvic ring disruption: a 3D finite element analysis","volume":"11","author":"Hu","year":"2019","journal-title":"Orthop. Surg."},{"key":"B13","doi-asserted-by":"publisher","first-page":"364","DOI":"10.1186\/s12893-024-02654-2","article-title":"Modified screw-rod fixation for management of posterior pelvic ring fractures: a retrospective study","volume":"24","author":"Huang","year":"2024","journal-title":"BMC Surg."},{"key":"B14","doi-asserted-by":"publisher","first-page":"921","DOI":"10.1007\/s00402-016-2471-3","article-title":"The incidence of and factors affecting iliosacral screw loosening in pelvic ring injury","volume":"136","author":"Kim","year":"2016","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"B15","doi-asserted-by":"publisher","first-page":"E355","DOI":"10.1097\/BRS.0000000000004791","article-title":"Effect of lumbar fusion and pelvic fixation rigidity on hip joint stress: a finite element analysis","volume":"48","author":"Kozaki","year":"2023","journal-title":"Spine"},{"key":"B16","doi-asserted-by":"publisher","first-page":"680","DOI":"10.1111\/ans.16694","article-title":"Optimal pin position in supraacetabular external fixation","volume":"91","author":"Krassnig","year":"2021","journal-title":"ANZ J. Surg."},{"key":"B17","doi-asserted-by":"publisher","first-page":"298","DOI":"10.20408\/jti.2023.0002","article-title":"Percutaneous screw fixation and external stabilization as definitive surgical intervention for a pelvic ring injury combined with an acetabular fracture in the acute phase of polytrauma in Korea: a case report","volume":"36","author":"Lee","year":"2023","journal-title":"J. Trauma Inj."},{"key":"B18","doi-asserted-by":"publisher","first-page":"506","DOI":"10.3390\/jpm13030506","article-title":"Finite element analysis of channel screw and conventional plate technique in tile B2 pelvic fracture","volume":"13","author":"Li","year":"2023","journal-title":"J. Pers. Med."},{"key":"B19","doi-asserted-by":"publisher","first-page":"351","DOI":"10.1007\/s00264-022-05655-z","article-title":"The efficacy of \u201cTiRobot\u201dorthopaedic robot-assisted VS conventional fluoroscopic percutaneous screw fixation of the sacroiliac joint","volume":"47","author":"Li","year":"2023","journal-title":"Int. Orthop."},{"key":"B20","doi-asserted-by":"publisher","first-page":"8","DOI":"10.1186\/s13018-022-03489-4","article-title":"Robotic guidance for percutaneous placement of triangular osteosynthesis in vertically unstable sacrum fractures: a single-center retrospective study","volume":"18","author":"Liu","year":"2023","journal-title":"J. Orthop. Surg. Res."},{"key":"B21","doi-asserted-by":"publisher","first-page":"210","DOI":"10.1186\/s13018-024-04672-5","article-title":"Biomimetic design and clinical application of Ti-6Al-4V lattice hemipelvis prosthesis for pelvic reconstruction","volume":"19","author":"Li","year":"2024","journal-title":"J. Orthop. Surg. Res."},{"key":"B22","doi-asserted-by":"publisher","first-page":"4424","DOI":"10.1038\/s41598-023-31418-w","article-title":"Biomechanical comparison of four triangular osteosynthesis fixations for unilateral vertical sacral fractures","volume":"13","author":"Ma","year":"2023","journal-title":"Sci. Rep."},{"key":"B23","doi-asserted-by":"publisher","first-page":"1873","DOI":"10.1007\/s00068-023-02259-z","article-title":"Minimally invasive bilateral fixed angle locking fixation of the dorsal pelvic ring: clinical proof of concept and preliminary treatment results","volume":"49","author":"Marintschev","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"B24","doi-asserted-by":"publisher","first-page":"2001","DOI":"10.1177\/21925682211069095","article-title":"Improved outcomes with concurrent instrumentation and fusion of the sacroiliac joint in patients with long lumbosacral constructs","volume":"13","author":"Noureldine","year":"2023","journal-title":"Glob. Spine J."},{"key":"B25","doi-asserted-by":"publisher","first-page":"745","DOI":"10.1016\/j.medengphy.2014.01.002","article-title":"3-D finite element analysis of the influence of synovial condition in sacroiliac joint on the load transmission in human pelvic system","volume":"36","author":"Shi","year":"2014","journal-title":"Med. Eng. Phys."},{"key":"B26","doi-asserted-by":"publisher","first-page":"725","DOI":"10.1097\/BRS.0b013e3181d39091","article-title":"Understanding bony safety zones in the posterior iliac crest: an anatomic study from the hamann-todd collection","volume":"35","author":"Smucker","year":"2010","journal-title":"Spine"},{"key":"B27","doi-asserted-by":"publisher","first-page":"e0273351","DOI":"10.1371\/journal.pone.0273351","article-title":"Biomechanical study of anterior and posterior pelvic rings using pedicle screw fixation for tile C1 pelvic fractures: finite element analysis","volume":"17","author":"Song","year":"2022","journal-title":"PLOS One"},{"key":"B28","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1186\/1749-799X-7-31","article-title":"Biomechanical stability of a supra-acetabular pedicle screw internal fixation device (INFIX) vs external fixation and plates for vertically unstable pelvic fractures","volume":"7","author":"Vigdorchik","year":"2012","journal-title":"J. Orthop. Surg. Res."},{"key":"B29","doi-asserted-by":"publisher","first-page":"14201","DOI":"10.1038\/s41598-021-93559-0","article-title":"Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis","volume":"11","author":"Wagner","year":"2021","journal-title":"Sci. Rep."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2253","DOI":"10.1007\/s00264-015-2891-7","article-title":"A novel combined hemipelvic endoprosthesis for peri-acetabular tumours involving sacroiliac joint: a finite element study","volume":"39","author":"Wang","year":"2015","journal-title":"Int. Orthop."},{"key":"B31","doi-asserted-by":"publisher","first-page":"1524991","DOI":"10.3389\/fonc.2024.1524991","article-title":"Different surgical methods of hysterectomy for the management of endometrial cancer: a systematic review and network meta-analysis","volume":"14","author":"Yuan","year":"2025","journal-title":"Front. Oncol."},{"key":"B32","doi-asserted-by":"publisher","first-page":"887123","DOI":"10.3389\/fpubh.2022.887123","article-title":"Application of smart healthcare in comparative analysis of effect of early external fixator and plate internal fixation treatment on postoperative complications and lower limb function recovery of patients with unstable pelvic fracture","volume":"10","author":"Zhang","year":"2022","journal-title":"Front. Public Health"},{"key":"B33","doi-asserted-by":"publisher","first-page":"9544","DOI":"10.1038\/s41598-024-60341-x","article-title":"Biomechanical comparative study on external fixators of new configurations in the treatment of tile C pelvic injury","volume":"14","author":"Zhao","year":"2024","journal-title":"Sci. Rep."},{"key":"B34","doi-asserted-by":"publisher","first-page":"e20139","DOI":"10.7717\/peerj.20139","article-title":"Biomechanical analysis of iliosacral and transiliac\u2013transsacral screw combinations for fixation of undisplaced denis II vertical shear fractures in dysmorphic sacrum","volume":"13","author":"Zhao","year":"2025","journal-title":"PeerJ"},{"key":"B35","doi-asserted-by":"publisher","first-page":"1653169","DOI":"10.3389\/fsurg.2025.1653169","article-title":"Posterior pelvic ring fixation: evolution of surgical approaches and evidence-based outcomes for unstable fractures","volume":"12","author":"Zhou","year":"2025","journal-title":"Front. Surg."}],"container-title":["Frontiers in Bioengineering and Biotechnology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1871603\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,10]],"date-time":"2026-07-10T05:37:44Z","timestamp":1783661864000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fbioe.2026.1871603\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,10]]},"references-count":35,"alternative-id":["10.3389\/fbioe.2026.1871603"],"URL":"https:\/\/doi.org\/10.3389\/fbioe.2026.1871603","relation":{},"ISSN":["2296-4185"],"issn-type":[{"value":"2296-4185","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,10]]},"article-number":"1871603"}}