Coccyx fracture is a violation of the integrity of the coccyx bones as a result of traumatic exposure. It is manifested by local soreness. Patients cannot sit because of pain, pain is less common when walking. The diagnosis is made on the basis of a characteristic anamnesis, clinical picture and X-ray examination data. If necessary, a CT scan is prescribed. Treatment is usually conservative. The impossibility of stable reposition of fragments and prolonged pain (coccygodynia) in the long-term period are indications for surgical intervention.
ICD 10
S32.2 Coccyx fracture
Meaning
Coccyx fracture, as a rule, occurs in people older than 20 years. In children and adolescents, such trauma is extremely rare, dislocations of the coccygeal bones are more typical for this age. Often, a combination of various injuries of the coccyx is detected: fractures, dislocations, ligament ruptures, etc. Fractures of the coccyx are usually isolated, in 3-7% of cases they are detected with pelvic fractures, in 2.5% of cases – with spinal fractures. In the long-term period, some patients develop post-traumatic coccygodynia, accompanied by persistent pain syndrome.
Causes
According to the observations of specialists in the field of traumatology and orthopedics, a coccyx fracture is formed as a result of direct trauma:
- In the vast majority of cases, damage occurs as a result of falling on the buttocks, the traumatic effect is directed at the tip of the coccyx.
- Less often, the cause of injury is a blow with a blunt object on the outer surface of the coccyx, the traumatic force acts on the dorsal surface of the bone.
- Relatively rarely, the coccyx breaks when the child passes through the birth canal, the application of traumatic force is noted on the ventral surface of the bone.
Factors that increase the likelihood of a coccyx fracture in childbirth are a large fetus, an incorrect fetal position, a narrow pelvis and previous coccyx injuries.
Pathogenesis
The coccyx is the lower part of the spine. It consists of 4-5, less often – 3-6 undeveloped vertebrae and is a curved pyramid, the base of which is turned upwards, and the top – anteriorly and downwards. In childhood and adolescence, the vertebrae are interconnected by layers of cartilage tissue and are sufficiently mobile, and as they grow older, they fuse to form a single bone. From the outer surface, the coccyx is protected by an array of gluteal muscles, so its damage is infrequent.
Usually the fracture occurs in the area of the ossified sacrococcygeal joint. There may also be a rupture of synchondrosis between the coccygeal vertebrae and a displacement of the vertebrae relative to each other. True coccyx fractures (that is, damage to the vertebrae themselves, and not the ossified joints between them) are very rarely detected. A large number of nerve fibers are located around the coccyx, which can cause pain in the long term after injury, especially with improper fusion of bone fragments.
Symptoms of coccyx fracture
At the moment of injury, there is a piercing pain in the coccyx area. Subsequently, the pain becomes less intense, but sharply increases with defecation, an attempt to take a sitting position and the transition from a sitting position to a standing position. There may be pain when walking. Movements are difficult, some caution is noticeable due to fears of provoking an increase in pain syndrome.
During the visual examination, minor or moderate local edema is detected. Bruises are often absent. When pressing on the top of the coccyx, there is a sharp pain. During rectal or vaginal examination, the mobility and crepitation of bone fragments, a “step” at the level of the fracture can be determined. Palpation of the coccyx during finger examination is sharply painful.
Complications
Coccyx fractures are not accompanied by the development of life-threatening complications. A common negative consequence is post-traumatic coccygodynia, which can occur months or even years after the fracture. According to researchers, the prevalence of this complication in patients who have suffered a coccyx injury reaches 65-66%.
Usually, the pain syndrome with coccygodynia appears or increases in a sitting position and during defecation, but sometimes it is felt for no apparent reason, at rest. There may be discomfort, burning or a feeling of heaviness in the coccyx area. Persistent persistent or paroxysmal pains disrupt the ability to work, reduce the quality of life of patients, and can cause neurotic disorders.
Diagnostics
A coccyx fracture is diagnosed by a traumatologist on the basis of anamnesis (clarification of the mechanism of injury), complaints, results of external examination and data from radiation studies. The following techniques are used:
- Objective examination. Plays a significant role in the diagnosis due to the frequent ambiguous results of imaging methods. The doctor takes into account the location of the swelling, the nature and severity of soreness. During vaginal and rectal examination, it is sometimes possible to feel the crepitation of bone fragments, but these manipulations are not carried out unnecessarily because of the rather low information content and discomfort for the patient.
- Coccyx x-ray. It is the main method of diagnosis of coccyx fractures, performed in direct and lateral projections. The thin bones of the coccyx, hidden by a large array of soft tissues, are often not very clearly visible on radiographs, especially since the fracture line often passes not through the body of the coccygeal vertebrae, but along the sacrococcygeal joint. To increase the information content, it is recommended to take pictures after an enema.
- Other visualization techniques. In doubtful cases, a CT scan of the spine is additionally prescribed, which allows better detailing of dense structures. If CT is unavailable, functional radiography of the coccyx is used, which makes it possible to confirm the excessive mobility of the coccygeal segments, but does not differentiate the coccyx fracture from hypermobility syndrome.
Treatment of coccyx fracture
Treatment tactics are determined by the type of damage. Immobilization is not required, the basis of the therapeutic program is compliance with the regime and diet. The duration of the period of disability for coccyx fractures ranges from 2 to 3 months, depending on the severity of the injury.
Treatment of fractures without displacement
Patients are observed in the emergency room. Conservative therapy is carried out, aimed at reducing pain, relieving swelling and inflammation. Patients are prescribed painkillers and bed rest for a period of 2-3 weeks, the optimal position is on the side. If you need to sit down, it is recommended to put a rubber circle under the buttocks. Subsequently, patients are gradually activated.
You should choose food that does not provoke constipation, if necessary, you need to take laxatives. Analgesics can be used not only in the form of tablets, but also in the form of rectal candles. Local cryotherapy is used to reduce the severity of pain, UHF to reduce the severity of inflammation. In addition, they prescribe:
- electrophoresis with analgesics and anti-inflammatory drugs;
- interference therapy;
- diadynamic currents;
- magnetic therapy.
During the recovery period, physical therapy classes are recommended.
Treatment of fractures with displacement
In case of fractures with displacement, patients are hospitalized in the trauma department, anesthesia of the affected area is performed with a 2% solution of novocaine, and then reposition is carried out through the rectum. The impact on the fragments should be soft, gentle, so as not to injure the posterior wall of the rectum. In most cases, coccyx fractures are well repositioned, but fragments are not always held in the correct position.
The management plan after reposition is the same as for coccyx fractures without displacement. With repeated displacement of the fragments, an operation is shown – removal of the distal part of the coccyx. Surgical intervention is performed by a traumatologist under general anesthesia. In the postoperative period, analgesics, antibiotics, physical therapy and physiotherapy are prescribed.
Forecast
The prognosis for coccyx fractures is quite favorable. Damage without displacement fuses well, in the absence of coccygodynia, there are no residual effects. Unrepaired and improperly fused fractures with the displacement of the fragment towards the pelvis in women can make it difficult for the fetus to pass through the birth canal. With coccygodynia, long-term conservative treatment or surgery to remove the coccyx is often required.
Prevention
Prevention of coccyx fractures consists in the prevention of domestic and street injuries, the correct choice of delivery tactics. During the period of ice, you should choose shoes with non-slip soles, limit movement on the street. In everyday life, it is necessary to be careful when walking on a wet floor, performing various manipulations on a ladder or stool.