Spine Injury: Coccyx, Emergency Medicine
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Spine Injury: Coccyx, Emergency Medicine
Basics
Description
Patient or witness to provide full history of accident including any earlier events that might influence mechanism of fall or insult
Most often isolated injury, but if other spinal injury of concern, spinal immobilization should be instituted.
Routine radiographic imaging unnecessary:
Recommend donut-shaped seat cushion for comfort.
Reduction may be attempted if displaced coccygeal fracture evident, but rarely needed or successful.
Admission is generally not required.
Coccygeal fracture can be managed on an outpatient basis unless other intercurrent injury makes admission necessary.
- Usually results from a fall that ends with the victim in sitting position
- Fall usually occurs from standing height
- Can occur during childbirth
- More common in women
Etiology
Diagnosis
Signs and Symptoms
- Tenderness localized over the coccyx
- Ecchymosis over the gluteal fold
- Pain with sitting, especially when leaning forward, and with defecation
- Including rectal exam to assess tenderness or mobility of coccyx
- No evidence of neurologic deficit should be found in isolated coccygeal fractures.
Essential Workup
Diagnosis Tests & Interpretation
- Concern about unnecessary radiation to gonads when diagnosis can be made clinically
- Imaging is indicated if concern for other spine injuries.
- Radiographs can be hard to interpret because coccyx has normal variant positions that can be confused with fracture.
- Lateral radiograph is a best view for fracture and dislocation.
Differential Diagnosis
- Coccygodynia
- Levator ani syndrome
- Pilonidal cyst
- Perirectal abscess
Treatment
Pre-Hospital
- Pain management
- Assess for other injuries
Initial Stabilization/Therapy
- Usually none required; if patient unstable, consider other diagnoses.
- Medicate for pain.
Ed Treatment/Procedures
- Pain medication
- Reduction of displaced coccygeal fracture, but rarely necessary.
Treatment General Measures
Medication
- Medication for pain if and as needed
- Stool softener
Surgery/Other Procedures
Follow-Up
Disposition
Additional Reading
- Cwinn AA. Pelvis. In: Marx J, ed. Rosens Emergency Medicine: Concepts and Clinical Practice. 5th ed. St. Louis, MO: Mosby; 2002:632 " 633.
- Gutierrez PR, M ‘s Mart nez JJ, Arenas J. Salter-Harris type I fracture of the sacro-coccygeal joint. Pediatr Radiol. 1998;28:734.
- Traub S, Glaser J, Manino B. Coccygectomy for the treatment of therapy-resistant coccygodynia. J Surg Orthop Adv. 2009;18(3):147 " 149.
Codes
ICD9
- 805.6 Closed fracture of sacrum and coccyx without mention of spinal cord injury
- 847.4 Sprain of coccyx
- 959.19 Other injury of other sites of trunk
- 665.61 Damage to pelvic joints and ligaments, delivered, with or without mention of antepartum condition
ICD10
- S32.2XXA Fracture of coccyx, initial encounter for closed fracture
- S33.8XXA Sprain of oth parts of lumbar spine and pelvis, init encntr
- S39.92XA Unspecified injury of lower back, initial encounter
- O71.6 Obstetric damage to pelvic joints and ligaments
SNOMED
- 282764008 Injury of coccyx (disorder)
- 209571002 Coccyx sprain (disorder)
- 125871005 fracture of coccyx (disorder)
- 49815007 Damage to coccyx during delivery (disorder)