2.  56yo female presenting to
urgent care center, c/o
pain in her “tailbone”,
occurring after she
tripped over a root while
stepping backwards,
landing on her buttocks.
She has difficulty sitting
up. Pain worse during
defecation.
 AFVSS
 Gen: WDWN, A&Ox4
 GI: Abd NT/ND. Rectal
exam with sig pain on
posterior compression.
Heme neg.
 Neuro: CNs 2-12 intact,
Nml 5/5 motor strength
and sensation x 4. Nml
reflexes.
 MSK: TTP over sacrum,
Sacral pain with hip
flexion. No SI joint
tenderness.

4. Coccyx Fracture
Coccyx often difficult to view on AP

5.  Conservative Management
 Analgesics (narcotics/NSAIDs)
 Stool softeners - docusate (Dulcolax or Colace)
 Bed rest, Sitz baths, Donut-ring cushion
 Discharge with Orthopedic f/u 2-3 weeks
 Surgical excision of fragment for chronic pain (rare).

6.  Coccyx is considered a weight-bearing bone; pain can
be severe and debilitating.
 Pain can last for months (sometimes years).
 Mostly occurs when landing in the seated position, but
also during childbirth.
 Diagnosis is clinical, with tenderness palpated rectally
or externally over coccyx.
 Often not visualized radiographically.

8.  Northwestern University Feinberg School of Medicine.
Emergency Medicine Residency Orthopedic Files.
http://www.feinberg.northwestern.edu/emergencyme
d/residency/ortho-teaching/pelvis-hip/case92/
 Simon RR, Sherman SC: Emergency Orthopedics, 6th
ed. Chapter 17: Pelvis.
www.accessemergencymedicine.com
 Tintinalli’s Emergency Medicine: A Comprehensive
Study Guide, 7th ed. Chapter 269: Pelvis Injuries