From the Research
Management of acute nondisplaced coccygeal fractures primarily involves conservative treatment focused on pain relief and comfort measures. Initial management includes rest, ice application for the first 24-48 hours to reduce swelling, and pain control with oral analgesics such as acetaminophen (500-1000 mg every 6 hours, not exceeding 4000 mg daily) or NSAIDs like ibuprofen (400-600 mg every 6-8 hours with food) 1. For more severe pain, a short course of opioid analgesics may be prescribed. Patients should use cushions with cutouts or donut-shaped pillows when sitting to reduce pressure on the coccyx. Physical therapy modalities including ultrasound, electrical stimulation, and manual therapy can help manage pain and improve function. Most fractures heal within 8-12 weeks without surgical intervention. Patients should gradually increase activities as pain allows, avoiding prolonged sitting when possible. Surgery is rarely indicated for nondisplaced fractures and is reserved for cases with persistent severe pain despite conservative management for 6 months or longer, with some evidence supporting coccygectomy for chronic/refractory coccydynia 1. Conservative treatment is preferred because the coccyx naturally heals well with time, and the area's complex anatomy and high infection risk make surgery challenging. Some studies suggest that interventions such as local injections with steroids and local anesthetic, pulsed radiofrequency ablation of ganglion impar, and extracorporeal shock wave therapy may be effective in treating coccygodynia, but the evidence is not strong enough to recommend these as first-line treatments 2, 1. Overall, the goal of treatment is to manage pain and improve function, with a focus on conservative measures and careful consideration of the risks and benefits of surgical intervention. Key points to consider in management include:
- Conservative treatment as the primary approach
- Pain control with oral analgesics and other measures as needed
- Use of cushions and other supportive devices to reduce pressure on the coccyx
- Gradual increase in activities as pain allows
- Consideration of surgical intervention for persistent severe pain despite conservative management.