ABSTRACT
I INTRODUCTION The sacrum is the distal spinal segment, less commonly injured than the more cephalad spinal segments. However, injury to the sacrum may be a source of significant and complex disability. In this chapter we will present the spectrum of sacral and coccygeal trauma, classification schemes, radiological diagnoses, treatment, both operative and nonoperative, and any associated complications. The first section deals with higher intensity sacral trauma resulting in fracture; the second reviews sacral insufficiency fractures-a frequent cause of acute low back pain in the elderlyand sacral stress fractures wherein normal sacral bone fails under repetitive elevated stresses; finally, fractures of the distal coccyx are described.
