Lumbo-sacral Junction Instability by Traumatic Sacral Fractures: Isler's Classification Revisited - A Narrative Review.

A review of various classifications indicates that sacral fractures have three important bio-mechanical implications, namely, pelvic ring continuity (vertical fractures), spino-pelvic alignment (high transverse fractures) and lumbo-sacral joint integrity (Isler's fractures). Though there is a universal recognition of Isler's fractures and its impact on LSJ integrity, there is a lack of clinical and bio-mechanical evidence regarding the concept of instability caused by a unilateral Isler fracture.