REVIEW ARTICLE Comparison between posterior sacral plate stabilization versus minimally invasive transiliac-transsacral lag-screw fixation in fractures of sacrum: a single-centre experience Francesco Liuzza 1 & Noemi Silluzio 2,3 & Michela Florio 2 & Omar El Ezzo 4 & Gianpiero Cazzato 4 & Gianluca Ciolli 4 & Carlo Perisano 4 & Giulio Maccauro 4 Received: 24 July 2018 /Accepted: 3 September 2018 # SICOT aisbl 2018 Abstract Purpose The sacrum is a mechanical nucleus working as the base for the spinal column, as well as the keystone of the pelvic ring. Thus, injuries of the sacrum can lead to biomechanical instability and nerve conduction abnormality. Methods The common classification is the Denis classification, but these fractures are often part of a lesion of the posterior pelvic ring and therefore the Tile classification is very useful. The goals of operative intervention are to reduce fracture fragments, protect neurological structures, and provide adequate stability for early mobilization. Results The stabilization of these injuries can be difficult even in a patient with adequate bone stock and concomitant medical comorbidities. The posterior-ring tension-band metallic plate and sacroiliac joint screw are two commonly used methods for posterior internal fixation of the pelvis. Conclusions In this study, we evaluate the differences, in the treatment of sacral fractures, between the two techniques, revising the literature and our experience. Keywords Sacral fractures . Fixation fractures . Danis’classification . Pelvic ring posterior . Sacral plate . Transiliac-transsacral screw . Review . Clinical outcame . Comparision treatment Introduction Sacral fractures are often due to high-energy traumas and are connected to fractures of the pelvic ring (pubic symphysis, sacroiliac joint). They are rarely associated with acetabular fracture [1]. The diagnosis of isolated sacral fracture is often unknown since patients show faint pain, which is often taken for low back pain, and appear neurologically intact [2]. Actually, since patients show no neurological symptoms, in 75% of cases, treatment of these fractures is conservative [3, 4]. Therefore, accurate clinical examination and I and II level imaging exams (X rays, CT imaging and RMN) are fundamental in order to classify and frame the fracture pattern and choose the type of treatment. The aims of our article are to review the literature on the subject and study our casuistry by evaluating remote results according to the type of fracture and surgical treatment. Retrospective clinical evaluation was performed through two scores (Hannover Poltrauma Score and Sf 36) from January 2012 to December 2017. The sacrum bone consists of five vertebrae which fuse gradually and completely during adulthood [5]. The only joints that do not fuse are L5-S1 with intervertebral disc inter- position, the sacroiliac joint and finally, the sacrum coccyx joint between S5 and the coccyx. With this regard, however, several anatomical variables should be examined while plan- ning synthesis in this anatomical region [6]. The lumbosacral articulation is the part of the vertebral column with most anatomical variables. Such sacral dysmorphiais found in 30%– 40% of patients [ 6 , 7 ]. * Noemi Silluzio noemisilluzio11@gmail.com 1 Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy 2 Università degli Studi di Messina, Policlinico Universitario G. Martino, Messina, Italy 3 Orthopedic and Traumatology Institute, University Hospital G. Martino, Messina, Italy 4 Fondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy International Orthopaedics https://doi.org/10.1007/s00264-018-4144-z