9.07 Coccyx Fracture (Tailbone Fracture)
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agk's Library of Common Simple Emergencies

Presentation
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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 deform- 
ity of the coccyx, which is best palpated by a 
finger in the rectum.

What to do:
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- 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.
- 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 tuberosit- 
    ies 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 
    removing the coccyx.

Illustration
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img/cse0907.gif

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 from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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