Boston Medical and Surgical Journal
1893, Volume 129, number 5, page 106.
Professor of Surgery, Harvard University.
Lectures on surgery: XI, Special fractures
Fracture of the Coccyx
Fracture of the coccyx presents no external signs except that the patient can not sit down without great distress, and complains of a hard or straining passage from the bowels. Fracture of the coccyx can hardly be overlooked, if we examine properly by the rectum. Passing one finger well up into the rectum and having the thumb outside on the coccyx, you have complete control, and can tell whether there is mobility or crepitus. In addition, we often find that the coccyx is abnormally tipped in; and we can push it back into place. Usually it can be pushed back, temporarily at least, into place. It is important to rectify the position, inasmuch as if left, it interferes with the action of the bowels, causes tenesmus, and is apt to produce neuralgic pain. Coccyodynia is apt to result, and sometimes requires operation to relieve it. I have seen one or two cases of fracture of the coccyx do well under the following treatment: clear out the bowels thoroughly; replace the coccyx into position by the finger in the rectum; keep the patient on the side in bed, and do not let him lie on the back; keep the stools perfectly soft, which is best done by daily small doses of castor-oil.
The slight injuries of the coccyx which happen from persons being thrown from a carriage or sleigh, or falling on some sharp substance, the top of a chair for instance, produce a bending of the coccyx without fracture. They strain the ligaments, bruise the parts, lead to subsequent spasm of the little coccygeal muscles, and to a rheumatic condition, or to some sort of an inflammation of the ligaments of the coccyx itself. This is frequently the seat of long-continued neuralgic pain, and is sometimes relieved by dividing the ligaments; sometimes it has to be treated by excising the coccyx itself, which is not a dangerous operation, if properly conducted, although the hole that is left will surprise you by its depth and size, and take some time to heal up.
The average results of any operative interference are not very encouraging.