• S Decker, C Krettek, and T Stübig.
• Klinik für Unfallchirurgie, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Deutschland. Decker.Sebastian@mh-hannover.de.
• Unfallchirurg. 2020 Oct 1; 123 (10): 774-782.

BackgroundSacral fractures can be of traumatic origin and can also occur as insufficiency fractures. While the therapeutic target of mechanically stable insufficiency fractures is mainly pain relief, mechanically unstable insufficiency fractures and traumatic sacral fractures following high-energy trauma require biomechanical stabilization. Various surgical strategies are available for this, whereby minimally invasive techniques are now preferred whenever possible.ObjectiveThis article presents the clinical challenges and options for minimally invasive treatment of sacral fractures.Material And MethodsSelected important study data are discussed and our own treatment approach is presented.ResultsThe most important minimally invasive techniques for operative treatment of sacral fractures are presented: sacroiliac screw osteosynthesis, lumbopelvic stabilization and sacroplasty. The selection of the surgical technique should be made on an individual basis. While sacroiliac screw osteosynthesis is the international gold standard, diverse authors have also published minimally invasive techniques for lumbopelvic stabilization. The latter enables a higher mechanical stability. In contrast, sacroplasty should only be used as an alternative treatment in insufficiency fractures. Comparative studies of the described techniques are still missing.ConclusionAll surgical options have their indications. Nevertheless, the biomechanical stability which can be achieved differs widely. Therefore, an exact analysis should be carried out of what is necessary with respect to reduction and retention and what should be achieved when treating sacral fractures.

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