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Part 9 > Chapter 104　Coccyx Fracture(Tailbone Fracture)

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著者：Katherine Dolbec and Joe Ravera
 
Abstract
Coccygeal fractures (tailbone fractures) typically occur during a direct blow such as a fall. Radiographs are typically not indicated, and the diagnosis can be made by physical exam with exquisite tenderness over the coccyx. Treatment for the initial injury involves removing pressure of the affected area (sitting doughnut) and analgesics. Avoid narcotics, as these can cause constipation and make the pain worse. For pain refractory to conservative measures, consider a course of steroids or even surgical referral.
 
Keywords
coccydynia
coccygeoplasty
coccyx
Coccyx fracture
fall
fracture
sacrococcygeal injury
sitting doughnut
tailbone fracture

Presentation  
    The patient presents after falling onto the buttocks or getting kicked in the sacrococcygeal synchondrosis during an athletic activity, complaining of pain at the tip of the spine that is worse with sitting and perhaps with defecation owing to the use of the levator ani and the anococcygeal muscles. There is little or no pain with standing, but walking may be uncomfortable. Because part of the gluteus maximus inserts on the coccyx, pain can also occur when rising from a seated position.
     
    On physical examination, there is point tenderness and perhaps deformity of the coccyx that may be best palpated by examining through the rectum with a gloved finger (Fig. 104.1).
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