The sacrum is a crucial component of the biomechanics and plays a protective role for the nervous system around the spinal column and pelvis however, its fractures have not received as much attention as other pelvic injuries, which has resulted in poor care and potential neurological damage.
Sacral fractures are group of fractures occurring in young people following road accidents, falls from height or in old patients with osteoporosis after minor trauma.
Management of sacral fractures may be conservative treatment or open reduction internal fixation. Fixation of these fractures can be done by percutaneous ilio-sacral screw, ilio-iliac fixation or internal fixation by plates and screws.
There are many contraindications to open reduction internal fixation of sacral fractures such as in patients who are unstable and critically ill or have severe soft tissue injury as Morel-Lavalle lesion which represents a large area of hematoma and fat necrosis under degloved skin. This lesion may lead to wound infection and implant failure and must be treated before any operative intervention. Posterior ilioiliac fixation allows minimally invasive early definitive fixation of sacral fractures and posterior pelvic ring stabilization.