Fracture, Coccyx

Fall landing in sitting position is most common.

Also can occur during childbirth

Surgical procedures performed in area of coccyx

Fractures of the coccyx are usually transverse.

More common in women

Predominantly occur in females because the female pelvis is broader, and the coccyx is more exposed.

Advanced age

Osteoporosis

Decreased balance causing more falls

Congenital bone disorder such as osteogenesis imperfecta

Involvement in activities such as skating or skateboarding

Calcium and vitamin D supplements to prevent osteoporosis

Refraining from activities that would predispose to falling on the buttocks, especially if elderly or if underlying medical conditions such as osteogenesis imperfecta are present

The coccyx is made up of 3–5 fused vertebrae with attachments of several important muscles and ligaments. The muscles include the levator ani group, which supports the pelvic floor and aids in maintaining fecal continence, and the gluteus maximus, which aids in thigh extension.

The coccyx has limited movement at the sacrococcygeal junction and a curvature such that the tip curves into the pelvis.

Coccyx injuries are often belittled by physicians, but it should be kept in mind that the pain can be extremely severe and debilitating to the patient. Additionally, the coccyx is a weight-bearing structure in the seated position, and an ill-managed coccyx fracture can cause the patient to apply more weight on the ischial tuberosities, causing bursitis.

Mechanism of injury (fall vs assault vs childbirth)

Factors leading up to the fall (mechanical fall vs syncope)

Other associated injuries (other potential life-threatening injuries such as head injuries may be missed if the patient is focusing on the pain from the coccyx injury)

Use of blood thinners (for severity of injury)

The PQRST of pain: Palliative or Precipitating factors, Quality, Region or Radiation, Severity (1–10), and Timing

Risk for cancer (pathologic fracture): Bright Red Blood Per Rectum (BRBPR), abnormal vaginal bleeding, weight loss

Low back pain, buttock pain, rectal bleeding (if associated rectal tear)

Pain when sitting or defecating

Palpation of the sacrococcygeal joint for pain

Digital rectal examination can be diagnostic with mobility and/or crepitus of the coccyx.

Assess sacrococcygeal joint mobility by palpating the coccyx anteriorly (digital rectal exam) and posteriorly (externally).

Anoscopy should be performed if gross blood is present to evaluate for possible rectal perforation (very rare).

Examination of entire spine is necessary to evaluate for concomitant injury.

Neurologic exam of the lower extremities to assess radiculopathy

Radiographs will identify other suspected spinal injuries.

Displaced coccyx fractures can be seen best on the lateral view.

Radiographs are not necessary if isolated coccyx fracture is apparent on rectal exam.

Nondisplaced fractures are difficult to see on x-ray.

When x-rays are used in the diagnosis, 3 views needed: anteroposterior (AP), lateral, and cone-down (focused) coccyx view.

More extensive diagnostic imaging is unnecessary in traumatic coccyx injuries.

Contusion, hematoma

Coccyx dislocation

Pilonidal cyst

Healing is slow.

Pain may become chronic.

Orthopedic consultation and possible coccygectomy may be required in severe cases.

Avoid activities requiring prolonged sitting such as horseback riding, long travel, biking, etc.

Lean forward while sitting to avoid weight bearing on the coccyx.

805.6 Closed fracture of sacrum and coccyx without mention of spinal cord injury

805.7 Open fracture of sacrum and coccyx without mention of spinal cord injury