Coccygeal Fracture¶

Definition¶

A coccygeal fracture (coccyx fracture) is a fracture of the small, triangular bone at the caudal end of the vertebral column. The coccyx typically consists of 3–5 fused or semi-fused segments. Coccygeal fractures are common injuries, frequently resulting from falls onto the buttocks, and are often a source of chronic pain (coccydynia).

Mechanism of Injury¶

• Fall onto the buttocks — The most common mechanism, typically a backward fall onto a hard surface
• Direct trauma — Kick, blow to the coccyx, or contact sports
• Childbirth — The coccyx may be fractured or dislocated during vaginal delivery, particularly with a large fetus or instrumental delivery

Imaging Findings¶

Radiography¶

• Lateral view of the coccyx — Fracture line through one of the coccygeal segments, anterior angulation or displacement, or widening of an intercoccygeal joint
• Normal coccygeal morphology is highly variable — anterior curvature, hypermobility, and congenital segmentation anomalies are common and can mimic fracture

CT¶

• Provides superior fracture detection compared to radiography
• Fracture lines, displacement, and angulation are clearly delineated
• Useful when radiographic findings are equivocal

MRI¶

• Bone marrow edema on STIR sequences confirms an acute fracture when radiographic findings are subtle
• Evaluates soft tissue injury and pre-coccygeal edema
• Not routinely necessary but useful in refractory coccydynia to exclude other pathology

Management¶

Treatment is almost always conservative:

• Analgesics (NSAIDs, acetaminophen)
• Coccyx cushion (ring or wedge cushion) to offload pressure while sitting
• Sitz baths and local ice application
• Activity modification — avoid prolonged sitting on hard surfaces
• Most fractures heal within 4–8 weeks

For refractory coccydynia (persistent pain beyond 8–12 weeks), options include:

• Ganglion impar block or coccygeal nerve block
• Manual manipulation under anesthesia
• Coccygectomy (surgical removal) — reserved for severe, refractory cases unresponsive to conservative measures

Key Points¶

• Coccygeal fractures most commonly result from falls onto the buttocks
• Lateral coccyx radiograph is the initial study; CT provides better fracture delineation
• Normal coccygeal morphology is highly variable — clinical correlation is essential
• Treatment is conservative with analgesics and cushioning
• Coccydynia can become chronic; ganglion impar block and coccygectomy are options for refractory cases

References¶

1. Skalski MR, Matcuk GR, Patel DB, Tomasian A, White EA, Gross JS. Imaging Coccygeal Trauma and Coccydynia. RadioGraphics. 2020;40(4):1090-1106. https://pubmed.ncbi.nlm.nih.gov/32609598/
2. Garg B, Ahuja K. Coccydynia — A comprehensive review on etiology, radiological features and management options. Journal of Clinical Orthopaedics and Trauma. 2021;12(1):123-129. https://pmc.ncbi.nlm.nih.gov/articles/PMC7920198/
3. Maigne JY, Pigeau I, Roger B. Magnetic resonance imaging findings in the painful adult coccyx. European Spine Journal. 2012;21(10):2097-2104. https://pmc.ncbi.nlm.nih.gov/articles/PMC3463700/
4. Zhang Y, Gao G. Progress in the diagnosis and treatment of fracture-dislocation of the coccyx (Review). Experimental and Therapeutic Medicine. 2025;30(1):127. https://pmc.ncbi.nlm.nih.gov/articles/PMC12086318/
5. Bain HL, Mabrouk A, Foye P. Coccyx Pain. In: StatPearls. Treasure Island (FL): StatPearls Publishing; updated August 2025. https://www.ncbi.nlm.nih.gov/books/NBK563139/
6. Coccygeal fracture. Radiopaedia.org. https://radiopaedia.org/articles/coccygeal-fracture
7. Coccydynia. Radiopaedia.org. https://radiopaedia.org/articles/coccydynia

Related Articles¶

• Sacral Fractures
• Sacrum and Coccyx