Coccyx Fracture (Tailbone Fracture)

9.07 Coccyx Fracture (Tailbone Fracture)

Presentation
The patient fell on his tailbone and now complains of pain which is worse with sitting, and perhaps with defecation. There should be little or no pain with standing but walking may be uncomfortable. On physical examination, there is point tenderness, and perhaps deformity of the coccyx, which is best palpated by a finger in the rectum.
What to do:



Verify the history (was this actually a straddle injury?) and examine thoroughly, including the lumbar spine, pelvis, and the legs. Palpate the coccyx from inside and out, feeling primarily for point tenderness and/or pain on motion. Picture



X rays are optional. Any noticed variation can be an old fracture or an anatomic variant, and a fractured coccyx can appear within normal limits.



Instruct the patient in how to sit forward, resting his weight upon ischial tuberosities and thighs, instead of on the coccyx. A foam rubber doughnut cushion may help. If necessary, prescribe anti-inflammatory pain medications or stool softeners.



Inform the patient that the pain will gradually improve over a week, as bony callus forms and motion decreases, and arrange for followup as needed. Chronic pain is rare but treatable by surgically remiving the coccyx.