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Objective. To delineate the clinical spectrum and treatment choice of sacral fractures.Methods. In this series, 39 sacral fractures were retrospectively reviewed and classified utilizing Denis′ classification. There were 21 Zone Ⅰ fractures, 6 Zone Ⅱ fractures and 12 Zone Ⅲ fractures. Neurological deficits were present in seven patients. Thirty seven patients were treated conservatively and two underwent surgical management.Results.Thirty eight patients were followed up for three months to 19 years. Thirty three have recovered, four improved, and one remained disabled.Conclusion.The treatment of sacral fractures requires assessment of pelvic stability and existing nerve injury. The patients with pelvic ring instability and neurological deficits should be treated with fracture reduction and stability reconstruction. When the patients with pelvic fracture are complicated with neurological deficits, sacral fracture should be first suspected. Once the diagnosis of sacral fracture is made, fracture reduction should be indicated. Conservative treatment usually permits satisfactory results.