A novel approach to Roy-Camille type 2 sacral fracture: Percutaneous lumbopelvic fixation following manual hyperextension-assisted closed reduction

Transverse sacral fractures with spinopelvic dissociation, commonly referred to as “suicidal jumper's fractures” -particularly Roy-Camille type 2 injuries- represent a rare and unstable injury pattern frequently associated with neurological deficits. Surgical management typically requires complex reduction maneuvers and rigid fixation to restore spinopelvic continuity and optimize functional outcomes. We report the case of an 18-year-old male who sustained a Roy-Camille type 2 sacral fracture following a high-energy motorcycle accident. Neurological examination revealed hypoesthesia in the S3–S5 dermatomes, absent bulbocavernosus reflex and loss of anal sphincter tone. Imaging demonstrated a transverse sacral fracture at the S2 level with posterior displacement of the cephalad segment. A novel closed reduction technique was performed prior to incision, involving simultaneous manual hyperextension at the lumbosacral junction and counter-traction through the extremities. This maneuver achieved satisfactory realignment without requiring joystick manipulation or external fixation. Percutaneous lumbopelvic fixation was subsequently applied using bilateral L5 pedicle and iliac screws. The patient experienced progressive neurological recovery without implant-related complications. This case illustrates that manual hyperextension-assisted closed reduction -when combined with percutaneous lumbopelvic fixation- may serve as a safe, reproducible, and resource-efficient strategy for Roy-Camille type 2 sacral fractures. This technique eliminates the need for external fixation or open reduction, and may be particularly beneficial in urgent trauma scenarios. Further clinical studies are warranted to validate its applicability across broader patient populations and fracture morphologies. • A rare Roy-Camille type 2 sacral fracture was treated using closed reduction. • Manual hyperextension and counter-traction provided satisfactory alignment. • Neurological deficits improved postoperatively without direct decompression. • Percutaneous bilateral L5–iliac fixation ensured stable fracture stabilization. • This technical note describes a novel minimally invasive reduction maneuver.