Sacral and Coccygeal Fractures

Fractures of the coccyx and the triangular bone above it (sacrum); most coccygeal fractures heal without surgery.

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Spinal Trauma

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1Overview

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What is this Condition?

The sacrum is a triangular bone formed by the fusion of five vertebrae that connects the posterior pelvis to the spine; the coccyx is the tailbone at its tip. Sacral fractures typically occur in high-energy trauma such as motor vehicle accidents or falls from height and often occur with other pelvic injuries. Coccygeal fractures usually result from falling while sitting and are more common. Since nerves passing through the sacrum go to the legs, bladder, and bowel, the location of the fracture is important; particularly in fractures involving the spinal canal, weakness in the legs or problems with urinary and bowel control may be seen. About one-fifth of sacral fractures may have nerve injury; this rate varies depending on the location of the fracture. Nerve injury is not expected with coccygeal fractures, but prolonged tailbone pain (coccygodynia) may develop. Treatment varies depending on the type of fracture and nerve status.

Symptoms

Pain in the tailbone or sacral region, increasing with sitting

Inability to sit on hard surfaces, need for cushioned seating

Marked tenderness on palpation of the area and bruising

Weakness in the legs, difficulty lifting the foot, or numbness

Problems with urinary and bowel control (in fractures compressing the spinal canal)

Saddle-shaped numbness in the genital-anal region

Diagnosis Methods

Diagnosis uses imaging along with physician examination; examination assesses regional tenderness, neurological findings in the legs, and urinary and bowel function. Plain radiographs are practical for initial evaluation but may miss some sacral fractures. The most valuable imaging method is pelvic CT scan; it clearly shows all sacral fractures, the location of the fracture, its effect on the spinal canal, and associated pelvic injuries. If neurological findings are present or spinal cord compression is suspected, MRI evaluates nerve roots and soft tissues. Additional imaging may be needed in high-energy trauma to assess bladder-urethra and vascular injuries.

Treatment Methods

In sacral fractures, treatment is planned based on whether the fracture is stable or unstable and the status of the nerves. In stable, non-displaced fractures without nerve injury, non-operative treatment is used: a period of rest, gradual mobilization, pain control, and thrombosis prophylaxis while awaiting bone healing. Unstable fractures, those with nerve compression, progressive findings, or open fractures require surgery; the spine and pelvis are stabilized with screws and rods, and if necessary, compressed nerves are decompressed. In coccygeal fractures, non-operative treatment is almost always sufficient: cushioned seating, avoiding hard surfaces, analgesics, and physical therapy. For prolonged tailbone pain, regional injections may be considered, and in resistant cases, surgical removal of the coccyx is a last resort option.

Percutaneous screw fixation in sacral fracture

Spinal-pelvic fixation surgery in unstable fractures

Decompression in fractures with nerve compression

Cushioned seating, pain control, and physical therapy in coccygeal fracture

Treatment Path

Related Treatments

The procedures and interventions most commonly explored with this condition.

3 links

Lomber posterior enstrümantasyon ve greft

Lomber posterior enstrümantasyon ve greft procedure

Open treatment detail

Lomber laminektomi ile dekompresyon + posterior enstrümantasyon + greft

Lomber laminektomi ile dekompresyon + posterior enstrümantasyon + greft procedure

Open treatment detail

Transforaminal Anterior Epidural Block

Injection for pain control and treatment at the spinal canal level

Open treatment detail

References

Greenberg MS. Handbook of Neurosurgery. 10th ed. Thieme; 2023.
Winn HR, ed. Youmans and Winn Neurological Surgery. 6th ed. Elsevier; 2011.
Steinmetz MP, Benzel EC, eds. Benzel's Spine Surgery. 5th ed. Elsevier; 2022.

This content is for informational purposes and based on academic sources; consult your physician for diagnosis and treatment.

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Sacral and Coccygeal Fractures

Spinal Trauma

1Overview

What is this Condition?

Symptoms

Diagnosis Methods

Treatment Methods

Related Treatments

Lomber posterior enstrümantasyon ve greft

Lomber laminektomi ile dekompresyon + posterior enstrümantasyon + greft

Transforaminal Anterior Epidural Block

References

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Lomber posterior enstrümantasyon ve greft

Lomber laminektomi ile dekompresyon + posterior enstrümantasyon + greft

Transforaminal Anterior Epidural Block

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