{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,31]],"date-time":"2026-08-31T21:09:34Z","timestamp":1788210574674,"version":"build-2803163510"},"reference-count":52,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T00:00:00Z","timestamp":1723507200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Silony Medical AG"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>(1) Background: Pelvic fractures, and particularly instabilities of the dorsal pelvic ring, are becoming increasingly prevalent, particularly in orthogeriatric patients. Spino-pelvic triangular osteosynthesis is an effective approach to achieve sufficient stabilization in vertically unstable fractures. This study compares two types of osteosynthesis: the conventional one and a novel instrumentation where the iliosacral screw is placed through a fenestrated iliac screw. (2) Methods: Sixteen artificial osteoporotic L5+pelvis models with an unstable sacral fracture have been instrumented with either an iliac screw connected with a rod to a L5 pedicle screw and an iliosacral screw (TF) or a fenestrated ilium screw connected with a rod to a L5 pedicle screw and an iliosacral screw passing through the fenestra of the iliac screw (TFS). Biomechanical testing was performed using cyclic loading until failure. (3) Results: Both configurations yielded comparable results with regard to initial stiffness, implant loosening, and cycles to failure. The TFS exhibited markedly higher values for cycles to failure and markedly lower values for loosening. However, due to the characteristics of the artificial bone model, these findings were not significant. (4) Conclusions: The novel triangular fixation systems demonstrated comparable results to the standard triangular osteosynthesis configuration.<\/jats:p>","DOI":"10.3390\/jcm13164744","type":"journal-article","created":{"date-parts":[[2024,8,13]],"date-time":"2024-08-13T06:02:37Z","timestamp":1723528957000},"page":"4744","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Lumbopelvic Stabilization with Two Methods of Triangular Osteosynthesis: A Biomechanical Study"],"prefix":"10.3390","volume":"13","author":[{"given":"Niklas","family":"Gr\u00fcneweller","sequence":"first","affiliation":[{"name":"Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julia","family":"Leunig","sequence":"additional","affiliation":[{"name":"Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany"},{"name":"AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0484-887X","authenticated-orcid":false,"given":"Ivan","family":"Zderic","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9795-115X","authenticated-orcid":false,"given":"Boyko","family":"Gueorguiev","sequence":"additional","affiliation":[{"name":"AO Research Institute Davos, Clavadelerstrasse 8, 7270 Davos, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Colcuc","sequence":"additional","affiliation":[{"name":"Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2352-7951","authenticated-orcid":false,"given":"Dirk","family":"W\u00e4hnert","sequence":"additional","affiliation":[{"name":"Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Vordemvenne","sequence":"additional","affiliation":[{"name":"Bielefeld University, Medical School and University Medical Center OWL, Protestant Hospital of the Bethel Foundation, Department of Trauma and Orthopedic Surgery, Burgsteig 13, 33617 Bielefeld, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,13]]},"reference":[{"key":"ref_1","first-page":"221","article-title":"Sex Differences in Pelvic Fractures-a Retrospective Analysis of 16 359 Cases from the German Trauma Registry","volume":"120","author":"Audretsch","year":"2023","journal-title":"Dtsch. Arztebl. Int."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1016\/j.archger.2017.03.007","article-title":"Pelvic ring fractures in the elderly now and then\u2014A pelvic registry study","volume":"71","author":"Rollmann","year":"2017","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"S10","DOI":"10.1016\/j.injury.2021.09.016","article-title":"The FFP-classification: From eminence to evidence","volume":"54","author":"Rommens","year":"2023","journal-title":"Injury"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"663","DOI":"10.1007\/s00113-011-2020-z","article-title":"Beckenringfrakturen im Alter","volume":"114","author":"Fuchs","year":"2011","journal-title":"Der Unfallchirurg"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"923","DOI":"10.1007\/s00113-020-00952-x","article-title":"[Triangular minimally invasive spinopelvic stabilization for type C pelvic fractures according to AO\/OTA and type IV according to FFP]","volume":"124","author":"Riesner","year":"2021","journal-title":"Der Unfallchirurg"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1007\/s11657-022-01191-w","article-title":"Fracture distribution in postmenopausal women: A FRISBEE sub-study","volume":"18","author":"Aude","year":"2022","journal-title":"Arch. Osteoporos."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"80","DOI":"10.1016\/j.archger.2016.06.020","article-title":"Risk factors for pelvic insufficiency fractures and outcome after conservative therapy","volume":"67","author":"Maier","year":"2016","journal-title":"Arch. Gerontol. Geriatr."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2881","DOI":"10.1007\/s00068-021-01799-6","article-title":"Operative treatment of fragility fractures of the pelvis: A critical analysis of 140 patients","volume":"48","author":"Rommens","year":"2022","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1177\/2151458510397504","article-title":"A guide to improving the care of patients with fragility fractures","volume":"2","author":"Bukata","year":"2011","journal-title":"Geriatr. Orthop. Surg. Rehabil."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"1040","DOI":"10.1016\/j.injury.2008.11.027","article-title":"U-shaped sacral fractures: Surgical treatment and quality of life","volume":"40","author":"Gribnau","year":"2009","journal-title":"Injury"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1016\/S0020-1383(00)00179-0","article-title":"Current management of U-shaped sacral fractures or spino-pelvic dissociation","volume":"33","author":"Hunt","year":"2002","journal-title":"Injury"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"402","DOI":"10.1016\/j.injury.2010.12.011","article-title":"Traumatic spinopelvic dissociation or U-shaped sacral fracture: A review of the literature","volume":"43","author":"Yi","year":"2012","journal-title":"Injury"},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"102993","DOI":"10.1016\/j.otsr.2021.102993","article-title":"Minimally invasive triangular lumboiliac and iliosacral fixation of posterior pelvic ring injuries with vertical instability: Technical note","volume":"107","author":"Prost","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1016\/j.otsr.2013.03.025","article-title":"Technique for reduction and percutaneous fixation of U- and H-shaped sacral fractures","volume":"99","author":"Ruatti","year":"2013","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_15","doi-asserted-by":"crossref","unstructured":"Kulakowski, M., Reichert, P., Elster, K., Sleczka, P., Oleksy, L., and Krolikowska, A. (2022). Safety and efficacy of two ilioiliac tension band plates osteosynthesis of fragility fractures of the pelvis. Sci. Rep., 12.","DOI":"10.1038\/s41598-022-24525-7"},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1007\/s00068-020-01498-8","article-title":"Minimally invasive posterior locked compression plate osteosynthesis shows excellent results in elderly patients with fragility fractures of the pelvis","volume":"47","author":"Schmerwitz","year":"2021","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.otsr.2019.06.014","article-title":"Posterior transiliac plating in vertically unstable sacral fracture","volume":"106","author":"Boudissa","year":"2020","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.injury.2011.08.005","article-title":"Stabilization of fatigue fractures of the dorsal pelvis with a trans-sacral bar. Operative technique and outcome","volume":"43","author":"Mehling","year":"2012","journal-title":"Injury"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"307","DOI":"10.1097\/00005131-199806000-00002","article-title":"Triangular osteosynthesis of vertically unstable sacrum fractures: A new concept allowing early weight-bearing","volume":"12","author":"Schildhauer","year":"1998","journal-title":"J. Orthop. Trauma"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"425","DOI":"10.22603\/ssrr.2020-0213","article-title":"Minimally Invasive \u201cCrab-Shaped Fixation\u201d for Treating Patients with Fragility Fractures of the Pelvis","volume":"5","author":"Yoshimura","year":"2021","journal-title":"Spine Surg. Relat. Res."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"2740","DOI":"10.1002\/jor.25634","article-title":"Cerclage augmentation of S1-S2 transsacral screw fixation in osteoporotic posterior pelvis ring injuries: A biomechanical feasibility study","volume":"41","author":"Berk","year":"2023","journal-title":"J. Orthop. Res."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1535","DOI":"10.1007\/s00068-022-02212-6","article-title":"Does minimally invasive percutaneous transilial internal fixator became an effective option for sacral fractures? A prospective study with novel implantation technique","volume":"49","author":"Kassem","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_23","first-page":"658","article-title":"Innovative Technique for Posterior Fixation of Vertically Unstable Pelvic Ring Fracture: A Case Report","volume":"11","author":"Bozorgmanesh","year":"2023","journal-title":"Arch. Bone Jt. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1186\/s10195-024-00776-0","article-title":"Effect of different lumbar-iliac fixation and sacral slope for Tile C1.3 pelvic fractures: A biomechanical study","volume":"25","author":"Fan","year":"2024","journal-title":"J. Orthop. Traumatol."},{"key":"ref_25","doi-asserted-by":"crossref","unstructured":"Rovere, G., De Mauro, D., Smakaj, A., Sassara, G., De Vitis, R., Farsetti, P., Camarda, L., Maccauro, G., and Liuzza, F. (2024). Triangular osteosynthesis and lumbopelvic fixation as a valid surgical treatment in posterior pelvic ring lesions: A systematic review. Front. Surg., 11.","DOI":"10.3389\/fsurg.2024.1266393"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e337","DOI":"10.1097\/BOT.0000000000002298","article-title":"Technical Note on Placement of Low-Profile Triangular Osteosynthesis for Unstable Posterior Pelvic Ring Injuries","volume":"36","author":"Steelman","year":"2022","journal-title":"J. Orthop. Trauma"},{"key":"ref_27","doi-asserted-by":"crossref","unstructured":"Gruneweller, N., Leunig, J., Zderic, I., Gueorguiev, B., Wahnert, D., and Vordemvenne, T. (2023). Stabilization of Traumatic Iliosacral Instability Using Innovative Implants: A Biomechanical Comparison. J. Clin. Med., 13.","DOI":"10.3390\/jcm13010194"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"761","DOI":"10.1002\/jor.24895","article-title":"Screw-in-screw fixation of fragility sacrum fractures provides high stability without loosening-biomechanical evaluation of a new concept","volume":"39","author":"Zderic","year":"2021","journal-title":"J. Orthop. Res."},{"key":"ref_29","first-page":"970","article-title":"[Therapy of unstable sacrum fractures in pelvic ring. Results of of osteosynthesis with early mobilization]","volume":"65","author":"Josten","year":"1994","journal-title":"Chirurg"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1097\/00005131-200301000-00004","article-title":"Triangular osteosynthesis and iliosacral screw fixation for unstable sacral fractures: A cadaveric and biomechanical evaluation under cyclic loads","volume":"17","author":"Schildhauer","year":"2003","journal-title":"J. Orthop. Trauma"},{"key":"ref_31","first-page":"E62","article-title":"Less invasive lumbopelvic stabilization of posterior pelvic ring instability: Technique and preliminary results","volume":"71","author":"Keel","year":"2011","journal-title":"J. Trauma"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"973","DOI":"10.1302\/0301-620X.100B7.BJJ-2017-1377.R1","article-title":"Evaluation of strategies for the treatment of type B and C pelvic fractures: Results from the German Pelvic Injury Register","volume":"100-B","author":"Schmal","year":"2018","journal-title":"Bone Joint J."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1016\/j.promfg.2020.03.070","article-title":"Torque Control during Bone Insertion of Cortical Screws","volume":"46","author":"Moldovan","year":"2020","journal-title":"Procedia Manuf."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1485","DOI":"10.1002\/jor.23401","article-title":"Biomechanical comparison of augmented versus non-augmented sacroiliac screws in a novel hemi-pelvis test model","volume":"35","author":"Gruneweller","year":"2017","journal-title":"J. Orthop. Res."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1016\/j.spinee.2015.08.016","article-title":"Primary stability of three different iliosacral screw fixation techniques in osteoporotic cadaver specimens-a biomechanical investigation","volume":"16","author":"Oberkircher","year":"2016","journal-title":"Spine J."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"102945","DOI":"10.1016\/j.otsr.2021.102945","article-title":"Pull-out strength evaluation of cement augmented iliac screws in osteoporotic spino-pelvic fixation","volume":"107","author":"Oberkircher","year":"2021","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"481","DOI":"10.1097\/00005131-200308000-00002","article-title":"Biomechanical comparison of posterior pelvic ring fixation","volume":"17","author":"Yinger","year":"2003","journal-title":"J. Orthop. Trauma"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"110783","DOI":"10.1016\/j.injury.2023.05.014","article-title":"Comparison of sacroiliac screw techniques for unstable sacroiliac joint disruptions: A finite element model analysis","volume":"54","author":"Goncalves","year":"2023","journal-title":"Injury"},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"1543","DOI":"10.1002\/jor.22667","article-title":"3D statistical modeling techniques to investigate the anatomy of the sacrum, its bone mass distribution, and the trans-sacral corridors","volume":"32","author":"Wagner","year":"2014","journal-title":"J. Orthop. Res."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1385","DOI":"10.1007\/s00402-019-03204-9","article-title":"Space available for trans-sacral implants to treat fractures of the pelvis assessed by virtual implant positioning","volume":"139","author":"Wagner","year":"2019","journal-title":"Arch. Orthop. Trauma Surg."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1354","DOI":"10.1007\/s43465-022-00656-x","article-title":"Different Lengths of Percutaneous Transverse Iliosacral Screw in Geometric Osseous Fixation Pathway: A Finite-Element Analysis","volume":"56","author":"Wu","year":"2022","journal-title":"Indian J. Orthop."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1016\/j.otsr.2013.03.023","article-title":"Mechanical comparison between lengthened and short sacroiliac screws in sacral fracture fixation: A finite element analysis","volume":"99","author":"Zhao","year":"2013","journal-title":"Orthop. Traumatol. Surg. Res."},{"key":"ref_43","doi-asserted-by":"crossref","unstructured":"Tripathi, S., Nishida, N., Soehnlen, S., Kelkar, A., Kumaran, Y., Seki, T., Sakai, T., and Goel, V.K. (2024). Pelvic Ring Fractures: A Biomechanical Comparison of Sacral and Lumbopelvic Fixation Techniques. Bioengineering, 11.","DOI":"10.20944\/preprints202402.0132.v1"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"2553","DOI":"10.1007\/s00068-023-02341-6","article-title":"Sacroiliac versus transiliac-transsacral screw osteosynthesis in osteoporotic pelvic fractures: A biomechanical comparison","volume":"49","author":"Cintean","year":"2023","journal-title":"Eur. J. Trauma Emerg. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"853","DOI":"10.1007\/s43390-020-00108-2","article-title":"Biomechanical comparison of sacral and transarticular sacroiliac screw fixation","volume":"8","author":"Fradet","year":"2020","journal-title":"Spine Deform."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"245","DOI":"10.4103\/0019-5413.53454","article-title":"Trans-iliac-sacral-iliac-bar procedure to treat insufficiency fractures of the sacrum","volume":"43","author":"Vanderschot","year":"2009","journal-title":"Indian J. Orthop."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Wagner, D., Kisilak, M., Porcheron, G., Kramer, S., Mehling, I., Hofmann, A., and Rommens, P.M. (2021). Trans-sacral bar osteosynthesis provides low mortality and high mobility in patients with fragility fractures of the pelvis. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-93559-0"},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Ma, Y., Zhao, Y., Hong, H., Huang, T., and Li, Y. (2023). Biomechanical comparison of four triangular osteosynthesis fixations for unilateral vertical sacral fractures. Sci. Rep., 13.","DOI":"10.1038\/s41598-023-31418-w"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1186\/s13018-021-02581-5","article-title":"Biomechanical study of transsacral-transiliac screw fixation versus lumbopelvic fixation and bilateral triangular fixation for \u201cH\u201d- and \u201cU\u201d-type sacrum fractures with traumatic spondylopelvic dissociation: A finite element analysis study","volume":"16","author":"Peng","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"421","DOI":"10.25259\/SNI_301_2022","article-title":"Novel within ring fixation using iliac screws and an iliosacral screw locking system technique for fragility fracture of the pelvis","volume":"13","author":"Sawada","year":"2022","journal-title":"Surg. Neurol. Int."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"625","DOI":"10.1186\/s13018-021-02770-2","article-title":"Instability of the posterior pelvic ring: Introduction of innovative implants","volume":"16","author":"Gruneweller","year":"2021","journal-title":"J. Orthop. Surg. Res."},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Lodde, M.F., Katthagen, J.C., Schopper, C.O., Zderic, I., Richards, G., Gueorguiev, B., Raschke, M.J., and Hartensuer, R. (2021). Biomechanical Comparison of Five Fixation Techniques for Unstable Fragility Fractures of the Pelvic Ring. J. Clin. Med., 10.","DOI":"10.3390\/jcm10112326"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4744\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:35:41Z","timestamp":1760110541000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/16\/4744"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,13]]},"references-count":52,"journal-issue":{"issue":"16","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["jcm13164744"],"URL":"https:\/\/doi.org\/10.3390\/jcm13164744","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,13]]}}}