Sacral fractures have historically been an overlooked entity due to their heterogeneous nature. Furthermore they are complex in nature and pose diagnostic challenges and technical difficulties for treatment. They can be differentiated into traumatic (70%) and atraumatic (approx. 30%) etiology. Since the world’s older population continues to grow at an unprecedented rate, in nearby future the ratio will change in favor of atraumatic fractures (e.g. sacral insufficiency fractures). The traumatic sacral fracture is the result of a severe high-energy trauma and typically part of a pelvic ring injury. Such high forces lead to damage and disruption of the soft tissue surrounding the pelvis. In contrast the atraumatic fracture occurs in the form of an osteoporotic or insufficiency fracture without a history of trauma. Therefore multiple injuries are rare in these patients. These characteristics make it necessary to differentiate in planning the operative care. Numerous classification systems and the lack of valid therapeutic algorithm lead to a case by case decisions in treatment, depending on the local organizational structures (orthopedics, neurosurgeons or/and trauma surgeons).
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