Classification of fractures of the coccyx from a series of 104 patients
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ORIGINAL ARTICLE
Classification of fractures of the coccyx from a series of 104 patients Jean‑Yves Maigne1 · Levon Doursounian2 · Frédéric Jacquot2 Received: 9 May 2019 / Revised: 2 October 2019 / Accepted: 13 October 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019
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.
Key points 1. Three major intervening mechanisms: flexion, compression and extension (obstetrical fractures) 2. Each mechanism involves one specific level: upper, middle and lower coccyx respectively
Flexion fractures
Compression fractures
Extension fractures
Adults
Adolescents
Obstetrical
N=104
38
24
4
38
Female ra o
84.2%*
54.2%*
50%
100%
Mean age (Yrs)
49.2 ± 12
45.8 ± 11
15.3 ± 3
32.4 ± 5
3. Two complications: associated luxation and non union
1. Flexion fractures always consolidate. There is a moderate risk of associated dislocation occurring in the sitting position. 2. Compression fractures are sometimes difficult to diagnose at the beginning and highly instable. 3. Extension fractures show a progressive separation of the fragments with time. They may be not visible at the beginning, and later confounded with a normal disc space.
Table 1: Constitution of the groups *p-value 0.01, Pearson chi-square test
Maigne J-Y, Doursounian L, Jacquot F (2019) Classification of fractures of the coccyx from a series of 104 patients. Eur Spine J;
Take Home Messages
Maigne J-Y, Doursounian L, Jacquot F (2019) Classification of fractures of the coccyx from a series of 104 patients. Eur Spine J;
Maigne J-Y, Doursounian L, Jacquot F (2019) Classification of fractures o
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