Treatment of Slightly Displaced Coccyx Fracture in Older Adults
Conservative management with pain control, activity modification, and cushioning is the definitive treatment for slightly displaced coccyx fractures, with surgery reserved only for refractory cases after prolonged conservative therapy failure.
Initial Conservative Management
The vast majority of coccyx fractures, including those with slight displacement, heal successfully with conservative therapy and should be managed non-operatively initially 1, 2, 3.
Primary treatment approach includes:
- Pain management: NSAIDs as first-line analgesics for pain control 1, 2
- Activity modification: Avoid prolonged sitting and activities that increase coccygeal pressure 2, 3
- Coccyx cushion: Use of specialized cushioning devices to reduce pressure on the coccyx during sitting 2
- Physical therapy: Manual therapy including massage and stretching of the levator ani muscle, along with coccyx mobilization 2
Duration and Expected Outcomes
Most patients achieve satisfactory pain relief with conservative modalities within 2-3 months 1, 2. The fracture typically demonstrates radiographic healing during this timeframe 1.
Advanced Conservative Options for Persistent Pain
If pain persists beyond 2 months despite standard conservative measures, consider these interventions before surgical referral 1, 2, 3:
- Local injections: Corticosteroid and local anesthetic injections into painful structures (sacrococcygeal disc, intercoccygeal disc, or muscle attachments) 2
- Laser acupuncture/low-level laser therapy: Weekly sessions can provide significant analgesic effects in refractory cases 1
- Pulsed radiofrequency therapy: Radiofrequency ablation of coccygeal discs and Walther's ganglion 2, 3
- Extracorporeal shockwave therapy: Alternative modality for persistent symptoms 3, 4
- Bimanual coccyx manipulation: For cases with documented coccygeal instability 5
Surgical Consideration
Coccygectomy should only be considered after:
- Failure of comprehensive conservative therapy for at least 2-6 months 1, 2, 5
- Documented abnormal coccygeal mobility on dynamic radiographs (lateral X-rays in standing and sitting positions) 2, 5
- Confirmed coccygeal origin of pain via diagnostic local anesthetic injections 2
Coccygectomy provides effective pain relief in properly selected patients but carries risks including wound infection and delayed healing 5. Most patients who undergo surgery show improvement, but this should remain a last resort 1, 5.
Critical Pitfalls to Avoid
Do not rush to surgery: Even in cases labeled as "refractory," exhaust all conservative and interventional options first, as surgical complications can be significant 1, 2, 5.
Rule out alternative diagnoses: Ensure pain is truly coccygeal in origin and not from pilonidal cyst, perianal abscess, hemorrhoids, pelvic organ disease, lumbosacral spine pathology, or sacroiliac joint dysfunction 2.