[Sacral fractures : Interface between spinal and pelvic ring injuries]

Sacral fractures represent an often overlooked interface between spinal and pelvic ring injuries. They typically occur in high-energy trauma or in older patients with osteoporosis.

Due to their complex anatomy and deep location, they are difficult to detect using conventional radiography; thus, computed tomography (CT) is considered the diagnostic gold standard and allows precise fracture analysis. Magnetic resonance imaging (MRI) is particularly valuable for insufficiency or stress-related fractures to detect early bone marrow edema. Biomechanically, the sacrum plays a central role in transmitting load from the trunk to the lower limbs and protects critical neurovascular structures. Fractures can lead to significant instability and neurological deficits, especially when the sacral foramina (Denis zone II) or the sacral canal (Denis zone III) are involved. The AO classification distinguishes between stable (type A), potentially unstable (type B), and spinopelvic unstable (type C) fractures.

Therapy depends on fracture type, displacement, and neurological status. Nondisplaced fractures may be treated conservatively, whereas unstable or neurologically symptomatic injuries often require surgical stabilization. A structured radiology report that is understandable across specialties is crucial for effective treatment planning.