Sacral fractures in young and elderly patients. One fracture, two different clinical identities with many treatment options

Sacral fractures have always been a challenging treatment pathology, as they mostly concerned high-energy traumata with several coexisting fractures and injuries. In recent years, however, as the population ages more but remains active, diagnostic options have become more popular and widely used, leading to the appearance of the terms sacral insufficiency fracture or low energy sacral fracture in clinical practice.  Although the terms refer to the same bone, the injury mechanism, complications, and treatment options do not overlap with high energy sacral fractures. This article reviews the two different fracture identities and suggests treatment options.