Abstract
Purpose
To describe a classification of fractures of the coccyx, according to their mechanism.
Methods
A series of 104 consecutive patients with a fracture of the coccyx was studied. The mechanism, level, characteristics of the fracture line and complications were recorded.
Results
Three mechanisms are proposed to describe these fractures: flexion, compression and extension (types 1, 2 and 3, respectively). Flexion fractures (38 cases) involved the upper coccyx in 35 cases, and in 3 cases with a perineal trauma, it was the lower coccyx; compression fractures (24 cases) involved the middle coccyx and occurred only when Co2 was square or cuneiform and Co3 was long and straight, hence a nutcracker mechanism; four patients were adolescents with a compression of the sacrum extremity and were labeled adolescent compression fracture of S5 (type 2b); extension fractures (38 cases) were obstetrical and involved the lower coccyx; their key feature was a progressive separation of the fragments with time. Flexion fractures usually healed spontaneously, but an associated intermittent luxation was possible. Nutcracker and obstetrical fractures were instable in their majority.
Conclusions
For the first time, a classification of fractures of the coccyx is presented. Each type exhibits specific features. This should help the clinician in the management of these patients.
Graphic abstract
These slides can be retrieved under Electronic Supplementary Material.
Similar content being viewed by others
References
Howorth B (1959) The painful coccyx. Clin Orthop Relat Res 14:145–161
Maigne JY, Doursounian L, Chatellier G (2000) Causes and mechanisms of common coccydynia: role of body mass index and coccygeal trauma. Spine 25:3072–3079
Gutierrez PR, Mas Martinez JJ, Arenas J (1998) Salter-Harris type I fracture of the sacro-coccygeal joint. Pediatr Radiol 28:734
Kaushal R, Bhanot A, Luthra S, Gupta PN, Sharma RB (2005) Intrapartum coccygeal fracture, a cause for postpartum coccydynia: a case report. J Surg Orthop Adv 14:136–137
Hamoud K, Abbas J (2015) Fracture dislocation of the sacro-coccygeal joint in a 12-year-old boy. A case report and literature review. Orthop Traumatol Surg Res 101:871–873
Raissaki MT, Williamson JB (1999) Fracture dislocation of the sacro-coccygeal joint: MRI evaluation. Pediatr Radiol 29:642–643
Tekin L, Yilmaz B, Alaca R, Ozçakar L, Dinçer K (2010) Coccyx fractures in patients with spinal cord injury. Eur J Phys Rehabil Med 46:43–46
Maigne JY, Guedj S, Straus C (1994) Idiopathic coccygodynia. Lateral roentgenograms in the sitting position and coccygeal discography. Spine 19:930–934
Woon JT, Perumal V, Maigne JY, Stringer MD (2013) CT morphology and morphometry of the normal adult coccyx. Eur Spine J 22:863–870
Miles J (2017) A history of coccydynia. In: Maigne J-Y, Doursounian L (ed) Coccyx disorders. Minutes of the 1st international symposium on coccyx pain, Maîtrise Orthopédique, pp 87–93
Beckmann NM, Chinapuvvula NR (2017) Sacral fractures: classification and management. Emerg Radiol 24:605–617
Hermel MB, Gershon-Cohen J (1953) The nutcracker fracture of the cuboid by indirect violence. Radiology 60:850–854
Maigne JY, Rusakiewicz F, Diouf M (2012) Postpartum coccydynia: a case series study of 57 women. Eur J Phys Rehabil Med 48:387–392
Kim NH, Suk KS (1999) Clinical and radiological differences between traumatic and idiopathic coccygodynia. Yonsei Med J 40:215–220
Maigne JY, Tamalet B (1996) Standardized radiologic protocol for the study of common coccygodynia and characteristics of the lesions observed in the sitting position. Clinical elements differentiating luxation, hypermobility, and normal mobility. Spine 21:2588–2593
Acknowledgements
The authors want to thank Dr. Christelle Nguyen (Spinal Rehabilitation, Universitary Hospital Cochin, Paris, France) for her valuable help in the statistical part of this study.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Electronic supplementary material
Below is the link to the electronic supplementary material.
Rights and permissions
About this article
Cite this article
Maigne, JY., Doursounian, L. & Jacquot, F. Classification of fractures of the coccyx from a series of 104 patients. Eur Spine J 29, 2534–2542 (2020). https://doi.org/10.1007/s00586-019-06188-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-019-06188-7