What is the treatment for a non-displaced fractured coccyx?

Treatment of Non-Displaced Coccyx Fracture

Conservative management with multimodal analgesia, activity modification, and specialized cushioning is the definitive treatment for non-displaced coccyx fractures, as the vast majority of these injuries heal successfully without surgical intervention. 1, 2, 3

Initial Management Approach

Conservative therapy is the standard of care and should be implemented immediately:

• Multimodal analgesia forms the cornerstone of treatment, including NSAIDs and oral analgesics as needed for pain control 1, 2
• Activity modification during the healing period (typically 4-8 weeks), specifically avoiding prolonged sitting, bicycling, rowing, and other activities that load the coccyx 2, 3
• Specialized coccyx cushion (donut-shaped or wedge cushion) to offload pressure when sitting is unavoidable 2, 3
• Rest in lateral recumbency position when possible to minimize direct pressure on the fracture site 3

Additional Conservative Modalities for Persistent Pain

If initial conservative measures provide inadequate relief after 2-4 weeks, escalate to:

• Physical therapy including manual therapy with massage and stretching of the levator ani muscle, plus mobilization of the coccyx 2
• Local injections of anesthetic and corticosteroid into painful structures (sacrococcygeal disc, intercoccygeal disc, or muscle attachments) 2, 3
• Pulsed radiofrequency therapy targeting coccygeal discs and Walther's ganglion 2, 3
• Extracorporeal shockwave therapy as an emerging treatment option 3
• Laser acupuncture has shown promise in case reports for refractory cases, though evidence is limited 4

Imaging Considerations

Initial radiographic assessment is not always necessary for non-displaced fractures with typical trauma history, but consider imaging if:

• Pain persists beyond 2 months despite conservative treatment 4, 2
• Dynamic lateral X-rays (standing and sitting positions) can identify abnormal coccygeal mobility (>25% posterior subluxation or >25° flexion while sitting), which occurs in 70% of patients with chronic coccydynia 2, 5
• MRI or CT should be obtained if plain films are inconclusive but clinical suspicion remains high, as these can reveal fracture details, disc degeneration, or bony spicules not visible on X-ray 6

Surgical Intervention

Coccygectomy is reserved only for refractory cases that fail conservative management after several months:

• Indicated primarily when abnormal coccygeal mobility or bony spicules are documented on imaging and conservative therapy has failed for >6 months 2, 3
• Success rates are high for pain reduction in properly selected patients, though complication rates are notable 4, 2
• Partial coccygectomy may be sufficient depending on the location of pathology 6

Expected Outcomes

The prognosis is excellent with conservative management:

• Most non-displaced coccyx fractures heal within 4-8 weeks with appropriate conservative treatment 2, 3
• Satisfactory results are achieved in the majority of patients using various conservative modalities 2
• Only 30% of coccydynia cases are idiopathic (no identifiable cause), and even fewer require surgical intervention 2

Critical Pitfall to Avoid

Do not rush to surgery. Coccygectomy should only be considered after exhausting all conservative options over several months, as it carries significant complication risks and is irreversible 4, 2. The stepwise approach—starting with simple analgesia and cushioning, then escalating to injections and advanced therapies—yields success in the vast majority of cases 2, 3.