Coccyx Fracture

MANUAL MINORS

A coccyx fracture refers to the break or fissure of the coccygeal bone, which is the final segment of the spine. This type of fracture is commonly the result of a fall onto the coccyx area, direct trauma, or, in some cases, difficult childbirth. While coccyx fractures are not usually serious, they can cause significant pain, known as coccydynia, and impact the patient’s quality of life, especially when sitting or performing certain movements.

Diagnosis

The diagnosis of a coccyx fracture is primarily based on the clinical history, typically involving a fall onto the buttocks or direct trauma. The patient reports localised pain in the coccygeal region, especially when sitting or changing position. Physical examination may reveal tenderness over the coccyx.

Lateral pelvic X-rays can confirm the diagnosis, although fractures are sometimes not easily visible. In more complex cases, magnetic resonance imaging (MRI) may be considered to rule out additional injuries or better assess the extent of the fracture.

Differential Diagnosis

Condition	Key Differentiation
Non-traumatic coccydynia	Pain in the coccyx without a history of trauma or visible fracture on imaging
Sacral fracture	Pain in the lower back, affecting the sacrum rather than the coccyx
Lumbar disc herniation	Pain radiating to the legs, not localised solely in the coccyx
Soft tissue contusion	Pain following trauma but no fracture visible on imaging
Pelvic pain from muscular dysfunction	Chronic pain in the lower pelvic region without acute trauma history

Emergency Management

Initial management in emergencies focuses on pain relief. Analgesics such as NSAIDs (ibuprofen or naproxen) are the first line of treatment. Using ring or “donut” cushions can help reduce pressure on the coccyx when sitting, alleviating pain. In cases of severe pain, local nerve blocks or local anaesthesia may be used. No specific immobilisation is required for coccyx fractures.

Definitive Treatment

Definitive treatment is typically conservative. This includes regular pain relief, modifying sitting habits (avoiding prolonged sitting, using cushions), and physiotherapy to improve mobility and reduce tension in the pelvic and pelvic floor muscles.

Most cases resolve within weeks or months. In rare cases of chronic severe pain that does not respond to conservative treatment, coccygectomy (surgical removal of the coccyx) may be considered, though this is a last-resort option. Early rehabilitation and appropriate follow-up help minimise complications, such as chronic coccydynia.