Place the patient in the supine position on a radiolucent table.
A urinary catheter should be inserted prior to beginning the procedure.
The legs should be accessible for possible reduction maneuvers, but not necessarily prepped and draped. A pillow to flex the hip can help to relax the neurovascular structures and iliopsoas muscle if desired for anterior pelvic approach. All pressure points should be padded.
General anesthesia with endotracheal intubation is required.
Pulse-Oximetry should be placed on the left great toe.
Antibiotics should be administered well prior to the incision and also at intervals during the procedure or when the blood loss exceeds 2 liters.
A cephalosporin antibiotic with good gram positive coverage is generally recommended. Local bacterial spectrum will need to be taken into account; this should be discussed with the hospital microbiologist.
Spinal cord monitoring is optional.
Preoperative fluoroscopy is mandatory. Before draping, one should ensure that both AP and lateral fluoroscopy views are possible with the C-arm. Once the patient is positioned, the fractured sacrum is checked with the image intensifier to ensure it is seen clearly in both AP and lateral planes.