# Intrapartum Coccygeal Fracture in a Young Female: A Case of Prolonged Postpartum Coccygodynia

## TL;DR

A young woman experienced long-term tailbone pain after childbirth, which was later diagnosed as a rare coccygeal fracture.

## Contribution

This paper presents a rare case of a delayed-diagnosed intrapartum coccygeal fracture and its management challenges.

## Key findings

- Intrapartum coccygeal fractures are rare and often misdiagnosed as postpartum discomfort.
- Delayed diagnosis can lead to prolonged pain and significant impact on daily life.
- Conservative treatments may provide limited relief, necessitating surgical or alternative interventions.

## Abstract

Intrapartum coccygeal fractures are rare but significant injuries occurring during childbirth. The coccyx, or tailbone, is vulnerable to trauma during labor, especially in difficult or instrument-assisted deliveries. The exact incidence is unclear due to underreporting and misdiagnosis, often mistaken for common postpartum discomforts. Risk factors include macrosomia, instrument-assisted deliveries, prolonged labor, previous pelvic trauma, and variations in maternal pelvic anatomy. Clinical presentation typically involves localized pain, swelling, tenderness, bruising, and difficulty in movement. Diagnosis is based on clinical evaluation and imaging, with MRI being particularly useful. Management is primarily conservative, focusing on pain relief, physical therapy, and activity modification. In persistent cases, surgical intervention may be necessary. Most patients recover well, though some may experience prolonged discomfort.

We report a rare case of a 31-year-old p1+0 experiencing severe lower back pain post-vaginal delivery that was reassured in the postpartum visit as inflammation and coccydynia. However, despite initial conservative management for presumed inflammation/coccydynia, the pain persisted, severely affecting her daily activities and professional life as a dental hygienist. After one and a half year, she was seen by an orthopedic surgeon, and thorough detailed history, physical examination, and MRI confirmed a transverse fracture of the second coccygeal segment. Accordingly, the patient was counselled and started on conservative treatments including analgesia and physiotherapy sessions, which provided limited relief. Therefore, the patient was recommended for surgical intervention (excision of the coccyx), but she refused. She sought alternative treatments abroad, receiving shock wave therapy and caudal block injections, which successfully controlled her pain. This case underscores the importance of prompt diagnosis and personalized management strategies for intrapartum coccygeal fractures to optimize patient outcomes.