Sacral fractures are rare entities and the management of sacral fractures are yet challenging with the complex anatomical structure of sacrum, diagnostic problems, technical difficulties in the treatment. There is very little Level 1 or 2 supportive literature published to date on diagnosis, classification and treatment. Also, the information about the long-term results of surgical treatment of sacral fractures is inadequate. The treatment plan has to include exploration of whether there is concomitant pelvic ring fracture, lumbosacral facet injury, lumbosacral dislocation and neurological injury is important. Surgical intervention should be performed in patients with neurological deficits and lumbosacral instability for goals of neural decompression and stabilization. In initial evaluation, attention should be directed primarily to the presence of active and life-threatening bleeding, open fractures, neurological damage, and the pattern and stability of skeletal injury. Systemic damage due to the severity of the trauma and the general medical condition of the patient should be considered. It should be kept in mind that sacral fractures can often coexist with complex pelvic ring fractures, nerve root injuries, cauda equina syndrome, and direct and indirect damage to the spinal segments.