Overview
Coccyx fracture, also known as tailbone fracture, is a break in the small bone located at the end of the spine. It typically results from direct trauma, such as a fall onto the buttocks.Diagnosis
Diagnosis is primarily clinical, based on a history of trauma and localized pain at the coccyx.
Physical examination may reveal tenderness and pain with palpation of the coccyx.
Radiography (X-ray) of the pelvis or coccyx can confirm the fracture, though it may not always be necessary if symptoms are mild and resolve with conservative management.Management
Pain management:
* Over-the-counter analgesics such as acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) are recommended for pain relief 1.
* Opioid analgesics may be prescribed for severe pain 1.
* Topical analgesics may also provide relief.
Conservative measures:
* Avoiding activities that exacerbate pain, such as prolonged sitting 1.
* Using a donut-shaped cushion or a wedge cushion to relieve direct pressure on the coccyx while sitting 1.
* Stool softeners to prevent constipation and straining, which can worsen pain 1.
Physical therapy: May include exercises to strengthen pelvic floor muscles and improve posture.
Injections: In some cases, local corticosteroid injections around the coccyx may be considered for persistent pain.
Surgery: Surgical removal of the coccyx (coccygectomy) is rarely indicated and reserved for cases of chronic, intractable pain unresponsive to conservative treatment.Special Populations
No specific information regarding special populations (pregnancy, pediatrics, elderly, comorbidities) was found in the provided abstracts.Key Recommendations
Conservative management, including pain relief with analgesics and avoidance of direct pressure, is the mainstay of treatment for coccyx fractures 1. (Evidence: Moderate)
Stool softeners should be used to prevent constipation and straining, which can aggravate coccyx pain 1. (Evidence: Expert opinion)
Radiographic confirmation of a coccyx fracture is not always necessary, especially in cases of mild trauma and symptoms, as management is typically conservative 1. (Evidence: Expert opinion)References
1 Bhaumik S, Beri D, Tyagi J, Clarke M, Sharma SK, Williamson PR et al.. Outcomes in intervention research on snakebite envenomation: a systematic review. F1000Research 2022. link