Surgical management of a thoracolumbar fracture varies according to many factors. Fracture morphology, neurologic status, and surgeon preference play major roles in deciding on an anterior, a posterior, or a combined approach. The goal is to optimize neural decompression while providing stable internal fixation over the least number of spinal segments. Short-segment constructs through a single-stage approach (anterior or posterior) have become viable options with advances in instrumentation and techniques. Unstable burst fractures can be treated with anterior-only fixation using a strut graft and a modern thoracolumbar plating system or with a posterior-only construct using pedicle screws and possibly hooks. A circumferential construct is considered for extremely unstable injuries.