Sacral insufficiency fractures are an easily overlooked injury of the elderly, leading to severe and debilitating low back pain. Percutaneous vertebroplasty with polymethylmethacrylate (PMMA) has become the treatment of choice for painful osteoporotic vertebral compression fractures. This is mainly due to the excellent results in pain relief, combined with a low morbidity of the procedure and the possibility of performing it in an outpatient setting. This well-known technique can be transferred to the treatment of sacral insufficiency fractures for which no active therapy is currently available. This so-called sacroplasty was first reported in 2002 as a single case report. Six other cases with this indication have been reported in the Anglo-American literature so far. This article is the first description of this technique in the German literature. It comprises the description of two typical cases highlighting the difficulties in diagnosis, surgical technique, and possible complications. Both patients were treated successfully and had a dramatic pain relief within several hours.