A 56-year-old female presented to urgent care with pain in her tailbone after tripping and landing on her buttocks. On examination, she had tenderness over her sacrum and pain with hip flexion and defecation. A rectal exam also caused significant pain on posterior compression, suggesting a coccyx fracture. Conservative management including analgesics, stool softeners, bed rest, and follow-up in 2-3 weeks was recommended.

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