• Ilona Schubert, Andreas Höch, Olaf Pöppelmeier, Christoph Josten, and Peter C Strohm.
• Klinik für Orthopädie und Unfallchirurgie, Klinikum am Bruderwald, Sozialstiftung Bamberg, Buger Straße 80, 96049, Bamberg, Deutschland. ilona@schubert-home.com.
• Unfallchirurg. 2020 Nov 1; 123 (11): 896-903.

BackgroundSacral U‑shaped fractures are rare but severe injuries. Due to the resulting spinopelvic dissociation they are highly unstable. Reduction and stabilization are usually required and decompression may be necessary due to frequent concomitant neurological injuries. In the literature there is no consensus with respect to the selection of the surgical approach.Case PresentationsAfter a road traffic accident an 18-year-old woman suffered a U-fracture of the sacrum type II according to Roy-Camille and was treated with bilateral double sacroiliac screw osteosynthesis and sacral laminectomy. A 76-year-old man with a U‑fracture type I according to Roy-Camille after falling down the stairs was treated by lumbopelvic fixation. A 24-year-old man with U‑fracture type II according to Roy Camille after a road accident was treated with triangular vertebropelvic stabilization and sacral laminectomy. For all patients the outcome was good.ConclusionSurgical treatment is necessary, with minimally invasive techniques offering advantages over open surgery. A distinction must be made between lumbopelvic fixation and posterior pelvic ring fixation. Multiple aspects must be taken into consideration of the indications when selecting the surgical technique.

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