Transsacral Bar Fixation for Osteoporotic H-Type Sacral Fractures: A Viable Alternative to Spinopelvic Fixation

Background: H-type sacral fragility fractures are commonly deemed biomechanically unstable and often treated with spinopelvic fixation (SPF). However, elderly osteoporotic patients may benefit from less invasive approaches. Methods: A retrospective cohort of 51 elderly patients with CT-confirmed H-type sacral fractures underwent navigated transsacral bar (TSB) fixation. Radiographic stability and clinical outcomes were evaluated at 3 months. Results: No revision surgeries or implant failures were observed. Most patients regained mobility at discharge. TSB alone provided adequate stabilization, challenging the necessity of routine SPF in this demographic. Conclusion: Navigated TSB fixation offers a stable, less invasive alternative to SPF for selected osteoporotic sacral fractures