Percutaneous fixation of posterior pelvic ring lesions in the elderly: current evidence and recent advances

Introduction Percutaneous fixation techniques are increasingly used in the management of posterior pelvic ring lesions in the elderly. As the incidence of fragility fractures continues to rise, a growing number of implants and surgical techniques have been developed to address the specific challenges of this vulnerable population. The goal of this scoping review is to address the following questions: 1) What are the latest advances in percutaneous fixation of posterior pelvic ring fractures? 2) What are the clinical results and current level of evidence supporting these techniques? Methods A systematic search using the keywords “((Percutaneous) OR (Minimal* invasive) OR (Transsacral) OR (Innovative implant)) AND ((Pelvic fragility fracture) OR (Sacral fracture))” was performed in PubMed and Cochrane Library using PRISMA-ScR guidelines. Studies published from the 11 th of August 2020 up to the 11 th of August 2025 were included and assessed independently by two reviewers. Results A total of 334 studies were found, of which 107 were included in this review following the screening process. Of these, 22 studies pursued a biomechanical approach. Various new implants (e.g. ISG-Rod System, SI-Plate, TriFix, SACRONAIL®) and technologies (e.g. 3D computer-assisted navigation/O-arm/Robot) are described in the recent literature. Using navigation significantly reduces the rate of screw malposition. Additional cement augmentation can reduce the length of a patient’s stay in hospital. (Bilateral) transsacral fixation reduces the risk of fracture progression. Novel implants, such as curved implants and photodynamic nails, offer promising alternatives for patients with dysmorphic sacra. Conclusion Iliosacral screw fixation is considered the gold standard for the percutaneous stabilization of the posterior pelvic ring. However, given the vast range of new implants and technologies available, decisions should always be made on a case-by-case basis. High-quality evidence studies comparing new implants with conventional SI screws are desirable.