A coccyx fracture is a fracture of the

coccyx The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and othe ...

, commonly called a broken tailbone or ‘puzzle fracture.’ The coccyx is located at the base of the spine, under the sacrum. It is the last section of the ape vertebral column. Most commonly in

humans Humans (''Homo sapiens'') are the most abundant and widespread species of primate, characterized by bipedalism and exceptional cognitive skills due to a large and complex brain. This has enabled the development of advanced tools, culture, ...

it comprises 3 to 5 fused (or, more rarely, separate)

vertebrae The spinal column, a defining synapomorphy shared by nearly all vertebrates, Hagfish are believed to have secondarily lost their spinal column is a moderately flexible series of vertebrae (singular vertebra), each constituting a characteristi ...

, and is approximately 4 to 10 cm in length. The coccyx is attached to the sacrum by a fibrocartilaginous joint, called the

sacrococcygeal symphysis The sacrococcygeal symphysis (sacrococcygeal articulation, articulation of the sacrum and coccyx) is an amphiarthrodial joint, formed between the oval surface at the apex of the sacrum, and the base of the coccyx. It is a slightly moveable joint ...

, allowing for some (but little) movement. Gray100

Causes

Causes of coccyx fracture can vary greatly, but are most commonly confined to falls into the seated position, or

childbirth Childbirth, also known as labour and delivery, is the ending of pregnancy where one or more babies exits the internal environment of the mother via vaginal delivery or caesarean section. In 2019, there were about 140.11 million births glob ...

Risk factors

The following risk factors have been identified for coccyx fracture: * Lack of/reduced muscle mass * Advanced age * Osteoporosis * Being of the

female Female ( symbol: ♀) is the sex of an organism that produces the large non-motile ova (egg cells), the type of gamete (sex cell) that fuses with the male gamete during sexual reproduction. A female has larger gametes than a male. Females ...

sex (due to the wider pelvis typically found in females) *

Violence Violence is the use of physical force so as to injure, abuse, damage, or destroy. Other definitions are also used, such as the World Health Organization's definition of violence as "the intentional use of physical force or power, threatened ...

Symptoms of coccyx fracture include: * Pain that increases in severity when sitting or getting up from a chair, or when experiencing

bowel movement Defecation (or defaecation) follows digestion, and is a necessary process by which organisms eliminate a solid, semisolid, or liquid waste material known as feces from the digestive tract via the anus. The act has a variety of names ranging fro ...

* Provoked pain over the

tailbone The coccyx ( : coccyges or coccyxes), commonly referred to as the tailbone, is the final segment of the vertebral column in all apes, and analogous structures in certain other mammals such as horses. In tailless primates (e.g. humans and othe ...

Nausea Nausea is a diffuse sensation of unease and discomfort, sometimes perceived as an urge to vomit. While not painful, it can be a debilitating symptom if prolonged and has been described as placing discomfort on the chest, abdomen, or back of the ...

Bruising A bruise, also known as a contusion, is a type of hematoma of tissue, the most common cause being capillaries damaged by trauma, causing localized bleeding that extravasates into the surrounding interstitial tissues. Most bruises occur clos ...

or swelling in the tailbone area

Diagnosis

The standard workup of a suspected coccyx fracture includes

medical history The medical history, case history, or anamnesis (from Greek: ἀνά, ''aná'', "open", and μνήσις, ''mnesis'', "memory") of a patient is information gained by a physician by asking specific questions, either to the patient or to other peo ...

and a

physical examination In a physical examination, medical examination, or clinical examination, a medical practitioner examines a patient for any possible medical signs or symptoms of a medical condition. It generally consists of a series of questions about the pati ...

including a

rectal examination Digital rectal examination (DRE; la, palpatio per anum, PPA) is an internal examination of the rectum, performed by a healthcare provider. Prior to a 2018 report from the U.S. Preventive Services Task Force, the DRE was a common and "dreaded" co ...

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

has no quantifiable clinical impact, and is regarded as a waste of resources and unnecessary exposure to ionizing radiation.

Treatment

If the coccyx fracture is severe enough, short-term hospitalisation may be required, although this is extremely rare. More often, self-care at home is administered. Sitting on soft surfaces is recommended, as this reduces

pressure Pressure (symbol: ''p'' or ''P'') is the force applied perpendicular to the surface of an object per unit area over which that force is distributed. Gauge pressure (also spelled ''gage'' pressure)The preferred spelling varies by country and e ...

on the coccyx. A 'donut' or 'wedge' cushion may be purchased – these are simply

cushion A cushion is a soft bag of some ornamental material, usually stuffed with wool, hair, feathers, polyester staple fiber, non-woven material, cotton, or even paper torn into fragments. It may be used for sitting or kneeling upon, or to soften th ...

s with a hole in them to ensure that no weight is placed in the injured tailbone.

Painkillers An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It i ...

such as ibuprofen are also recommended, as is a diet high in fibre to soften stools and avoid constipation. Doctors will not usually attempt to correct a bad alignment, as muscles in the area are powerful and can pull the bone back into the 'bad' position. The bone is also very difficult to immobilise simply due to the sheer number of muscles attached to it, as well as the position.

Surgery

Following a coccyx fracture, surgery is not usually required. However, if the pain continues even after the fracture has healed, and is severe enough to cause serious

disability Disability is the experience of any condition that makes it more difficult for a person to do certain activities or have equitable access within a given society. Disabilities may be cognitive, developmental, intellectual, mental, physical, ...

, surgical removal of the coccyx (

coccygectomy Coccygectomy is a surgical procedure in which the coccyx or tailbone is removed. It is considered a required treatment for sacrococcygeal teratoma and other germ cell tumors arising from the coccyx. Coccygectomy is the treatment of last resort for ...

) may be required.

References