Coccygeal fracture

Case contributed by Dr Daniel J Bell

Presentation

1 week ago, slipped on ice and landed onto her buttocks. Sacrococcygeal pain since. No focal neurological deficit.

Patient Data

Age: 40 years
Gender: Female
X-ray

Fracture through the first coccygeal vertebra (Co1) with no displacement. A1 type under the AO classification of sacrococcygeal fractures. Unremarkable sacrum.

X-ray

Magnified views o the coccygeal fracture. 

Case Discussion

Generally performing radiographs for sacrococcygeal fractures is a waste of resources and exposes patients to unnecessary ionizing radiation. In one recent American study, they had no measurable impact on clinical outcome 1.

Indeed it has been best practice in the UK for many years to refuse to perform them for trauma. Anyone experiencing high-energy trauma will have a CT anyway, precluding the necessity of performing these pointless studies.

This particular case "slipped through the net" and was performed despite being contrary to departmental guidelines. No doubt the patient was pleased to have their diagnosis confirmed however it would have had no meaningful consequences for their management as the current standard is discharge home with analgesia.

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Case information

rID: 66293
Published: 19th Feb 2019
Last edited: 14th Aug 2019
Inclusion in quiz mode: Included
Institution: North Middlesex University Hospital

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