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Coccygeal fractures are generally low-severity injuries, which nonetheless can be diagnostically challenging. Diagnosis may be delayed or missed due to coccygeal anatomy and patient/technical factors (e.g. obesity, overlying bowel gas/feces).
Given that management of coccygeal fractures is nearly always non-operative, some radiology literature suggests that x-ray evaluation for coccygodynia is a waste of resources and exposes patients to unnecessary ionizing radiation, without having measurable impact on clinical outcome 1.
Coccygeal fractures in younger adults tend to be after high-energy trauma. In elderly patients, these can represent insufficiency-type fractures 1.
Within the AO classification system, coccygeal fractures are classified as a subset of the sacrococcygeal fractures (classification A1).
Most coccygeal fractures have a transverse orientation 2. Displacement of the fracture fragment is variable.
- best demonstrated on the lateral projection 2
Treatment and prognosis
As a rule, coccygeal fracture/dislocations are treated with non-operative management (e.g. cushioning and analgesia). Significant angulation or displacement may require closed reduction, often intra-anal manipulation.
Surgery is generally reserved for open injuries requiring soft tissue debridement, or chronic symptomatic injuries. In these cases, the fractured component is generally resected (coccygectomy).
- 1. Tarek N. Hanna, Mahniya Sadiq, Noah Ditkofsky, Marc Benayoun, Abhijit Datir, Saurabh Rohatgi, Faisal Khosa. Sacrum and Coccyx Radiographs Have Limited Clinical Impact in the Emergency Department. (2016) American Journal of Roentgenology. 206 (4): 681-6. doi:10.2214/AJR.15.15095 - Pubmed
- 2. Terry R. Yochum. Yochum and Rowe's Essentials of Skeletal Radiology. (2019) ISBN: 9780781739467
- 3. Bellabarba C. Eds: Vialle L. Sacral Trauma, A1: General considerations. AO Foundation