Coccygeal Fracture-Dislocation in a Young Female: An Open Reduction Approach

Reports of traumatic coccygeal dislocations or fracture-dislocations are rare, and there is no established consensus regarding their treatment. We report a case of traumatic anterior dislocating coccygeal fracture in a young female patient who initially underwent closed reduction, which was not feasible. A 17-year-old girl sustained an injury after falling backward down the stairs. Radiographs revealed anterior dislocation of the second coccygeal vertebra and distal segments, accompanied by small bone fragments, leading to the diagnosis of a traumatic coccygeal fracture-dislocation. An attempt at closed perianal reduction was made, but the dislocated second coccygeal vertebra was displaced proximally and overlapped with the first coccygeal vertebra. Furthermore, its distance from the anus was too large to prevent reduction. The approach was switched to open surgery. Reduction was achieved via a small incision using a technique similar to intrafocal pinning, and stability was achieved by applying axial compression. The pain resolved rapidly postoperatively. Although a mild alignment abnormality remained, the patient returned to sports activities eight weeks postoperatively without symptoms. Although correction of coccygeal alignment abnormalities is preferred, favorable reports exist regarding conservative treatment. Treatment selection should consider factors such as sex, age, and activity level.