Sacral fractures are often underdiagnosed, but are frequent in the setting of pelvic ring injuries. They are mostly caused by high velocity injuries or they can be pathological in aetiology. We sought to assess the clinical outcomes of the surgically treated unstable sacral fractures, with or without neurological deficits. unstable sacral fractures were included in the study. Single centre, prospectively collected data, retrospective review of patients who sustained vertically unstable fractures of the sacrum who underwent surgical fixation. out of a total of 432 patients with pelvis and acetabulum injuries. fifty six patients met the inclusion criteria. 18 patients had sustained zone one injuries. 14 patients had zone 2 injuries and 10 patients had zone 3 injurie. Operative fixation was performed percutaneously using cannulated screws in 18 patients.. Open fixation of the sacrum using the anterior approach in 6 patients. Posterior approach was indicates in all 10 of the zone 3 injuries of the sacrum. While in 4 patients, combined approaches were used. 3 patients had decompression and spinopelvic fixation. Neurological deficits were present in 16% of the patients. 2 patients presented with neurgenic bladder. Of the 4 patients who had neurological fall out, 3 resolved with posterior decompression and posterior fixation. All 4 neurological deficits were due to taction or compression of the nerve roots. No hardware failures or non unions observed. The rate of neurological deficit was related more to the degree of pelvic ring instability than to a particular fracture pattern. Low rates of complications and successful surgical treatment of sacral fractures is achiavable. Timeous accurate diagnosis mandatory

Background. The suicidal jumper's fracture of the pelvis is a special form of sacrum fractures associated with high energy trauma. The typical H-type fracture pattern runs transforaminal on both sides with a connecting transverse component between S1 and S3. Due to the high-grade instability operative treatment is imperative. Aim of this study was to compare iliosacral double screwing (2×7,3mm canulated screw with 16mm thread) with spinopelvic internal fixation. Methods. Both methods were tested on 6 synthetic and 6 anatomical pelvises. After osteotomy and alternating osteosynthesis stability was tested with a universal testing machine (Zwick) in a simulated two-leg stand. Data were generated by a 3-dimensional computer-assisted ultrasoundsystem (Zebris©) (3 translational datasets x,y,z and 3 ankles). Testing was performed after preload of 50N and two setting cycles of 100N followed by a full load cycle of 150N. ASCII-data were then transferred to SPSS for statistical analysis. Results. Both experimental series showed similar results. There was a tendancy of less displacement when iliosacral screwing was performed. However, no statistical significance could be observed between both techniques. Discussion. Although the spinopelvic internal fixation is a more rigid system, the double screwing may compensate this as it interacts in the center of the fracture. We therefore think that iliosacral double screwing is an appropriate technique for stabilisation of this special fracture type. The possibility of percutaneous osteosynthesis and of its performance in a supine position, this procedure provides essential advantages for the operative treatment of polytraumatized patients