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Horse-related injuries in children: A review

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Abstract

Horseback riding is an increasingly popular activity among today's youth, providing them with the opportunity to learn responsibility and respect for animals. However, it can also be associated with severe injury, of which many physicians are unaware. In 2002, there were an estimated 13,400 emergency department visits nationwide for horse-related injuries among children younger than 15 years. When using a severity score to compare it with other childhood injuries, equestrian-related injury ranked second only to pedestrians being struck by a car, and had a higher score than all terrain vehicle, bicycle, and passenger motor vehicle crash injuries. Most serious injuries occur when a rider is thrown from a horse, which is often accompanied by being dragged or crushed by the horse. However, hoof kick injuries to an unmounted child represent about 30% of horse-related injuries and may result in more severe injury. Head injury is the injury most likely to result in hospitalization or death. The effectiveness of helmets in preventing serious head injury in horse-related accidents has been very well established. Recommendations for the prevention of horse-related injury include requiring helmet use on and near a horse, use of safety stirrups to prevent drag injury, matching rider skill with the appropriate horse, and providing close adult supervision.

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... However, for patients who sustained injuries due to horseback riding, 15.3% also exhibited TBI [3] . Surprisingly, injury severity scores associated with accidents involving equestrian activities are higher than those involving bicycles, motorcycles, ATVs, and motor vehicles [4][5][6][7] . In addition, equestrian activities demonstrate higher mortality rates than football, rugby, motor racing, and skiing [4] . ...
... The majority of pediatric patients brought to the ED for equestrian-related injuries have been females [1,6,[11][12][13] . This observation may be related to the higher participation rates by females in equestrian sports/activities [6,7] . Many critical injuries are sustained when riders fall from horses, where they can also be subsequently crushed or hauled against the ground [7] . ...
... This observation may be related to the higher participation rates by females in equestrian sports/activities [6,7] . Many critical injuries are sustained when riders fall from horses, where they can also be subsequently crushed or hauled against the ground [7] . Injuries may also occur during nonriding activities. ...
Article
Background: Equestrian activities can be undertaken for competition or leisure. Accidents can lead to bodily injuries. In particular, traumatic brain injury (TBI) can be devastating. Limited data exist regarding the pediatric population with respect to patterns of injury and related neurosurgical intervention. Methods: We retrospectively reviewed data for all pediatric patients diagnosed with equestrian-related injuries with neurological injuries from 2005 through June 2015. Results: Nine patients (1 male and 8 females) had neurological injuries. Their mean age was 10.4 years (range 2.9-16.8 years). Intracranial pathologies ranged from small punctate hemorrhages to large surgical extra-axial hematomas. Five patients also had concurrent skull fractures; 2 exhibited open lesions. Two patients required a decompressive craniotomy with placement of an external ventricular drain. Three patients exhibited other minor injuries; none had thoracic/abdominal/pelvic injuries. At discharge, all had good recovery; 1 patient who had a craniotomy did have a persistent right third-nerve palsy. Conclusion: Equestrian activities can present with dangerous and unpredictable situations, which can lead to profound neurological injury. Caution should be observed for all involved members, as both riders and nonriders are susceptible to harm. Protective gear (such as helmets), adequate training, and extensive experience are encouraged.
... The rising in popularity of equestrian sports in recent years, especially in urban communities, has been accompanied by an increase in horse-related injuries [1][2][3][4][5][6]. In the 5-14 year age group, the predicted annual incidence is 56/100,000 children [7]. However, data on the nature, causes and actual frequency of equestrian injuries in the total population, and the pediatric population in particular, remain sparse. ...
... As in other sports, passive preventive measures are a major factor in reducing the severity of injury. A properly fitted helmet should be worn at all times (even by bystanders, themselves the subject of a significant number of accidents) [7,11,13,18,19]. Proper clothing, knee and elbow pads and riding boots are necessary as well [16]. ...
... Proper clothing, knee and elbow pads and riding boots are necessary as well [16]. The stirrup should be a few centimeters wider than the boot and be equipped with a release bar to prevent drag injury should the rider fall off [7]. For children, the release bar should be individually adapted to account for their lighter weight [4]. ...
... I n recent years horse riding among children has become more and more popular, as both a recreational activity and a therapeutic modality [1]. As a result, injuries related to horses are increasing in prevalence [1][2][3][4]. ...
... I n recent years horse riding among children has become more and more popular, as both a recreational activity and a therapeutic modality [1]. As a result, injuries related to horses are increasing in prevalence [1][2][3][4]. The horse's size and the kine-matics of the injuries may cause substantial damage, such as internal organ damage [5,6], and head [7] and spine injuries [4]. ...
... The horse's size and the kine-matics of the injuries may cause substantial damage, such as internal organ damage [5,6], and head [7] and spine injuries [4]. These injuries result in significant morbidity and even mortality [1,2]. It was previously shown that the leading risk factors, such as lack of supervision, lack of experience, and non-usage of protective gear (e.g., helmets, kneepads, and hand protectors) lead to increased severity of these injuries [1,3]. ...
Article
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Background: Horse riding has become increasingly popular in recent years and is a common activity among children. As a result, pediatric horse-related injuries are frequently encountered in emergency departments. Objectives: To examine the characteristics of horse-related injuries in the pediatric population. Methods: We collected and analyzed the data on all pediatric horse-related injuries presented to a tertiary hospital, level one trauma center, during the years 2006-2016. Results: A total of 53 children with horse-related injuries were documented. Forty-two patients were male (79%) and their mean age was 11.13 ± 4.72 years. The most common mechanism of injury was falling off a horse (31 patients, 58%) and the most common type of injury was skeletal (32 patients, 60%). Head injuries occurred in 16 patients (30%) and facial injuries in 12 (23%). The mean Injury Severity Score (ISS) was 10.5 ± 6.32, and 15 patients (28%) had severe trauma (ISS > 15). Twenty-nine patients (55%) required trauma team intervention, 12 (23%) were admitted to the intensive care unit, and 24 (45%) required surgery. The mean length of hospitalization was 4.3 ± 3.14 days. Conclusions: Our study suggests that horse-related trauma may involve serious injuries and it exhibits typical injury patterns. Young boys are at highest risk. The potential severity of these injuries merits a thorough evaluation. We suggest that these injuries be triaged appropriately, preferably to a medical facility with proper trauma capabilities.
... Multiple studies have reported that equestrian activities are riskier than motorcycles, automobile racing, skiing, and football [4]. Data from Cuenca et al. [5] reported a higher rate of hospitalization among children without helmets (64% vs. 39%, p b 0.05) and others [6] have reported posttraumatic amnesia as high as 46% in children hospitalized for equestrian injuries. Persistent neurologic symptoms occurred in 13% of those riders following discharge [6]. ...
... Data from Cuenca et al. [5] reported a higher rate of hospitalization among children without helmets (64% vs. 39%, p b 0.05) and others [6] have reported posttraumatic amnesia as high as 46% in children hospitalized for equestrian injuries. Persistent neurologic symptoms occurred in 13% of those riders following discharge [6]. Moreover, injuries are common among equestrian athletes with 44% suffering from a concussion during their career and many reporting neck pain, headaches, dizziness, poor balance, poor concentration, fatigue, and irritability [7]. ...
... The United States Pony Club requires helmets for all activities and the AAP recommends helmets for all mounted activities. However, others including the National High School Rodeo Association only require helmet use in specific events such as bull riding and allow Western hats in many of the activities [6]. While our data suggest that these recommendations have had some impact on helmet use at places of recreation, rates of use remain shockingly low and are even lower when activities occur at home. ...
Article
Purpose: Awareness of equestrian related injury remains limited. Studies evaluating children after equestrian injury report underutilization of safety equipment and rates of operative intervention as high as 33%. Methods: We hypothesized that helmets are underutilized during equestrian activity and lack of use is associated with increased traumatic brain injury. We queried the trauma database of a level one pediatric trauma center for all cases of equestrian and rodeo related injury from 2005 to 2015. Analysis was conducted using SAS 9.4. Results: Of 312 children identified, 142 were assessed for use of a helmet. Only 28 children (19.7%) had documented use of a helmet. Most injuries occurred while riding a horse (83%) or bull (13%) with traumatic brain injury being the most common injury (51%). Helmet use was associated with decreased ISS (7.1 vs. 11.3, p<0.01), TBI (32.4% vs. 55.3%, p=0.03), and ICU admission (10.7% vs. 29%, p=0.05). Multivariable analysis reveals lack of helmet use to be an independent predictor of TBI (OR 2.5, 95% CI 1.1-6.3). Conclusion: Helmets are underutilized by children during equestrian related activity. Increased awareness of TBI and education encouraging helmet use may decrease morbidity associated with equestrian activities. Level of evidence: Retrospective comparative study, Level III.
... Empirically, many injures in equitation -especially those that happen while handling a horse from the ground [16] can be avoided by wearing security gear, i.e. stable shoes with adaequate toe protection [1,18,29] and careful analysis of possibly dangerous situations before they even occur [30][31][32]. ...
... For safety stirrups which are sold for many years already, there is no clinical study which would prove that either or the other design really reduces the number of falls with entangling the foot in stirrups or the amount/severity of foot injuries or general injury severity [5,29,[33][34][35][36] (Fig. 51.5). ...
... When looking at the complex midfoot injuries that occur in falls from or with the horse, one can guess that shoes with a better resistance against axial and longitudinal forces across the midfoot area might help to reduce the severity of resultant injuries [16]. A heel is important to prevent the rider's foot from slipping through the stirrup and being dragged behind the horse [18,29]. ...
Chapter
Statistically, riding is a dangerous sport despite many prevention campaigns and improved safety gear. This is – and always will be – because equitation is about the interaction between a human and an unpredictable large animal. Most injuries sustained in equitation are of minor severity and most of them probably do not lead to a doctor’s visit. However, those that are admitted to hospital are severe and have a poor outcome. Concerning specific foot injuries in equitation, literature is limited to just a few case reports. The most common foot injures are soft tissue injuries, such as bruises and contusions from horses standing on the feets or kicks with hoofs. Injuries to ligaments and bones can result from falls from the horse or due to trapping the foot under the horses’ body in falls with the horse.
... Equitation has readily gained acceptance as an enjoyable form of physical activity among women (Watt and Finch 1996;Pugh and Bolin 2004;Jagodzinski and Demuri 2005). Equestrian sports have existed for centuries, and as early as 1860, horseback riding was considered an adequate form of exercise in physical education curriculums (Lewis 1860). ...
... Since health and performance are inversely related to excess body fat (McCleod et al. 1983;ACSM 2006), from a clinical or practical perspective, the non-signiWcant 6.4% lower body fat values and 2.9% increase in FFM observed among the equitation group following training still indicate some promise regarding the potential for using equitation as an adjunct source of physical conditioning when combined with other modes of exercise. Numerous studies have extolled the grueling challenges of working with equine of dissimilar size and power on a daily basis (Lloyd 1987;Meyers et al. 1992;Pugh and Bolin 2004;Banks et al. 2005;Jagodzinski and Demuri 2005). Following 14-weeks of equitation, however, signiWcant improvements were observed in muscular power, but not in muscular strength. ...
Article
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Background. Physiological testing is extensively used to assess current physical status, target strengths/deficiencies, and determine predisposition to injury in athletes. No studies exist regarding these isues on equestrian athletes. The purpose of this study was to quantify the physical, hematological, and exercise response of female equestrian athletes in order to provide greater insight into the health fitness of this unique competitor, and to compare results to other better studiend sport athletes. Methods. Following written informed consent, physiological assessments were performed on 24 college female equestrian athletes to quantify aerobic power (VO2max, VEmax, Timemax), anaerobic power (peak power, total work ouiput. fatigue index). body composition (%BF, LBM), muscular strength (curl-ups, reverse sit-ups, pushups, handgrip strength), blood chemistries, and cor­onary risk profile. Results. Data indicated that mean LBM and BMI fell within reported alhletic norms for females. Percent body fat, however, was above average. Mean VO2max, treadmill time, and VEmax were lower that predicted values. Observed peak power, total work output, fatigue index, and handgrip strenth were also lower than established norms for young females. Mean curl-up, reverse sit-up, and pushup responses were considered average to above average for this age group. Mean resting blood chemistry values were WNL. When analyzing BP, body composition, and serum lipid data, results indicate an average to low risk for coronary heart disease in this population. Wide variatjon in lipid profiles in this group as compared to athletes in other sports is a concern. Conclusions. .Although working with equine poses a constant danger, the lack of adequate physical conditioning of the equestrian may be a contributing factor in the growing number of injuries. When compared to female athletes in other sports, exercise performance was found to be lower. Equestrians athletes need to supplement conventional sport activity with tradition­al aerobic and anaerobic training regimens.
... The mechanisms of injury in our patient population are similar to those in prior studies, with 83.2% resulting from falls and 8.1% from kicks compared to 43-82 and 8-29%, respectively [5,6,14,15]. The demographics of our patients are also similar with prior studies reporting 59-88% of injuries occurring to females compared to 72.5% in our study [10,[16][17][18][19]. Mean age in our study was 38.5 years, at the higher end of the age range of 30-38 years reported in prior studies [18][19][20]. ...
... The demographics of our patients are also similar with prior studies reporting 59-88% of injuries occurring to females compared to 72.5% in our study [10,[16][17][18][19]. Mean age in our study was 38.5 years, at the higher end of the age range of 30-38 years reported in prior studies [18][19][20]. In our study, both torso and spine injuries occurred iñ 25% of patients, whereas prior studies have reported torso injury rates between 9 and 16% and spine injuries between 12 and 29% [10,16,17,20]. This incidence at the upper range of the prior studies is likely due to the older age of our patients. ...
Article
Objective Report the incidence, pattern, and severity of equestrian-related injuries presenting to a rural level 1 trauma center and detail the total radiation dose, imaging, and hospital charges related to those injuries. Methods An IRB-approved retrospective review of patients presenting to our facility following equine-related trauma was conducted. Demographics, mechanism of injury, types and number of imaging exams, approximate radiation dose administered, imaging findings, Injury Severity Score (ISS), rate/length of hospitalization, and approximate cost of care were recorded. Results A total of 222 patients (161 F:61 M; mean age 38.5 years (range 4–79)) presented to our emergency department following horse-related injury. Mechanisms of injury included the following: fall (n = 186), kick (n = 18), stepped on (n = 9), and other (n = 9). Body part injured included extremity (26.1%), torso (26.6%), spine (25.7%), and head/neck (18.5%). Longer hospital admission, higher expenditure, increased CT/MR imaging, higher ISS, and radiation dose were noted in older patients and those injured by a fall or kick. Head injuries were more frequent following a horse kick (p = 0.006). Spinal and torso injuries were more common in patients older than 54 years (p = < 0.001) and those with falls (p < 0.04). Extremity injuries were more common in older patients (p < 0.001). Conclusion Patient age greater than 54 years and mechanism of injury are strong predictors of the ISS, injury localization, healthcare expenditure, and mean hospital stay. With the exception of obvious minor wounds, full trauma work-ups (CT chest/abdomen/pelvis and cervical spine) are encouraged for equestrian-related injuries in older patients and those injured by a fall.
... The other mechanisms of injuries include those due to a kick or bite, or being dragged. [1][2][3][4][5] We herein present a rare case of injury induced by a horse kick and a review of published reports. ...
... Among the 33 human reports of a horse kick injury, 20 were case reports, while the other 13 included one prospective study, seven retrospective studies, three surveys using questionnaires, and two reviews. 4, The case reports are summarized in Table 2, [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35] and all reports other than case reports are summarized in Table 3. 4,36-47 Cardiac rupture and/or lethal head injuries induced by horse kicks have not been previously reported in Japan, although these injuries have been documented in other countries. 18,37 In a case report concerning hepatic injury, Horwitz et al. reported the successful treatment of an 8-year-old male with a devitalized right lobe of the liver and avulsion of the right hepatic vein using venovenous bypass to obtain a stabilized circulation and bloodless operative field. ...
Article
A 16-year-old male was transported to our emergency department after he was kicked in the abdomen by a horse. He was diagnosed with injury of the liver and abdominal rectus muscle, and was cured by observational treatment. An Ichushi search was undertaken to identify articles published from 1983 to 2013 using the key words “horse” and “trauma”. We found 13 cases that described horse-related injuries and summarized these cases, including our case. There were 10 males, three females and one patient of an undescribed sex. The patients ranged in age from 16 to 58 years old, with an average age of 33 years. The injured sites were predominantly the face (mandible) and upper abdomen, indicating that a projecting part of the body may be more likely to be injured. Cardiac rupture, aortic head injury, or lethality induced by a horse kick have not been reported in Japan, but such injuries have been reported in other countries. Ten of 15 cases (67%) required surgical treatment for severe injuries. Horse kick injuries tend to be severe, because the transfer of energy from the end of the hoof, with a small cross-sectional area, to a small field, leads to internal organic injuries that are more severe than predicted, similar to a handlebar injury. Accordingly, we advocate the close observation of patients with horse kick injuries, which may be regarded as being similar to blunt stab wounds or hidden speared injuries.
... Het is al langer bekend dat hoofd-, hersen-, nek-en aangezichtsletsel veel voorkomt bij mensen die paardrijden. 7,11 Recent onderzoek laat zien dat in Nederland jaarlijks 70 ruiters ernstig schedelhersenletsel oplopen door het paardrijden. 1 Bij kinderen komt dit type letsel vaker voor, doordat zij een andere lichaamsverhouding hebben dan volwassenen; door het in verhouding grotere hoofd komen kinderen bij een val vaker op hun hoofd terecht. 12 Een preventiemiddel tegen hoofdletsel is het dragen van een cap. ...
... 2 Ook een studie uit 2002 laat zien dat een ruiter minder ernstig letsel heeft als hij of zij met een cap ten val komt. De onderzoekers merken op dat 35% van de het gebruik van een 'body protector' was niet significant gerelateerd aan een verlaagd risico op torsoletsel (oddsratio: 1,18; 95%-BI: 0,50-2,81; p = 0,707) Jagodzinski et al. 7 2005 review niet van toepassing 35% van de letsels trad op terwijl de ruiter niet op het paard zat patiënten met een cap hadden minder hersenletsel dan patiënten die geen cap droegen veiligheidsstijgbeugels en adequaat schoeisel voorkwamen beklemming van de voet en daarmee samenhangend letsel Kiss et al. 8 2008 retrospectieve gegevensanalyse 112 patiënten (< 18 jaar) 9/23 ruiters met hoofdletsel droegen een cap tijdens het ongeval er kon geen significant verband worden aangetoond tussen de ernst van het letsel en het dragen van een cap 4/112 patiënten droegen een bodyprotector tijdens het ongeval Lim et al. 9 2003 prospectieve en retrospectieve gegevensverzameling 429 patiënten (alle leeftijden) capgebruik resulteerde in een lager percentage ziekenhuisopnames (27% vs. 55%; p < 0,0001) recreatieve ruiters hadden vaker letsel aan het hoofd en CzS dan professionele ruiters (56 vs. 33%; p < 0,01) Moss et al. 10 2002 retrospectieve gegevensanalyse tector op het moment van het ongeluk. 6 In Nederland draagt naar schatting 1 op de 12-13 ruiters een bodyprotector tijdens het paardrijden. 1 Lange tijd werd gedacht dat een bodyprotector torsoletsel kan voorkomen. ...
Article
- Each year 9,900 equestrians present at Accident and Emergency Departments, 40% of them 10-19 year old females.- The most common horse-riding injuries are to the head, brain, neck and face, torso and extremities. - Because of the relatively larger head, children more often fall on their head. Wearing a helmet gives considerable protection. - Despite the common use of a helmet by horseback riders, serious head injury still occurs regularly. Further research into improvement of the protective function of the helmet is indicated.- The current safety vest (body protector) does not significantly reduce the risk of torso injury. Improvement of its protective function is necessary.- Injury to the lower extremities is caused when they become trapped in the stirrup in a fall from or with the horse. Safety stirrups and sturdy footwear are possible preventive measures. - Investment in the quality and promotion of preventive measures could reduce the frequency and severity of equestrian injuries.
... Montar a caballo incluye riesgos de accidentes 21 , por lo que esta actividad no puede realizarse sin tener en cuenta el empleo de medios de protección como los cascos, y que el equino terapeuta conozca ampliamente la conducta del animal y sepa actuar en consonancia, protegiendo al niño discapacitado de cualquier accidente. Se ha demostrado que más del 50 % de los accidentes durante la práctica de la actividad [22][23][24] pueden ser prevenidos, especialmente cuando se toman medidas oportunas y existe una estrecha vigilancia del personal capacitado que supervisa la actividad. En Camagüey con limitados recursos se desarrolla esta actividad hace tres años, se emplea en la atención a niños con diferentes formas de discapacidad entre otras la parálisis cerebral infantil, el autismo, el retraso mental y el síndrome de Down, con resultados favorables. ...
... In addition a kick from a horses' hoof has been shown to deliver over 10,000 Newtons of force to its victim or 1.8 times its body weight [5,6]. It is not surprising therefore that although liver injuries constituted less than 1% of all equestrian injuries in several studies in the literature these injuries can be severe and carry life-threatening consequences for the patients involved [7,8]. The morbidity and mortality resulting from liver trauma are often a product of associated chest and other intra-abdominal injuries as well as complications such as haemorrhage and sepsis [4,9]. ...
Article
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Background Equestrian sports are common outdoor activities that may carry a risk of liver injury. Due to the relative infrequency of equestrian accidents the injury patterns and outcomes associated with liver trauma in these patients have not been well characterized. Methods We examined our experience of the management of equestrian liver trauma in our regional hepatopancreaticobiliary unit at a tertiary referral center. The medical records of patients who sustained liver trauma secondary to equestrian activities were analysed for parameters such as demographic data, liver function tests, patterns of injury, radiological findings, the need for intervention and outcomes. Results 20 patients sustained liver trauma after falling from or being kicked by a horse. The majority of patients were haemodynamically stable on admission. Alanine transaminase (ALT) levels were elevated in all patients and right-sided rib fractures were a frequently associated finding. CT demonstrated laceration of the liver in 12 patients, contusion in 3 and subcapsular haematoma in 2. The right lobe of the liver was most commonly affected. Only two patients required laparotomy and liver resection; the remaining 18 were successfully managed conservatively. Conclusions The risk of liver injury following a horse kick or falling off a horse should not be overlooked. Early CT imaging is advised in these patients, particularly in the presence of high ALT levels and concomitant chest injuries such as rib fractures. Despite significant liver trauma, conservative management in the form of close observation, ideally in a high-dependency setting, is often sufficient. Laparotomy is only rarely warranted and associated with a significantly higher risk of post-operative bile leaks.
... The benefits from horse riding include learning to take responsibility and in calculating a greater respect for animals, however there are risks of injuries [3]. Former studies have postulated that the risk of injury during horse riding is at the same level as for most other sports performed by children (e.g. ...
Article
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IntroductionHorse riding, with almost 200,000 participants, is the eighth most popular sport in Sweden. Severe injuries can occur with horse riding accidents which is well documented. This study was undertaken to investigate if injuries associated with horse riding are common, which type of injuries occur, what mechanisms are involved and to estimate the costs to the society.Material and methodsAll patients attending the emergency department at Linköping University Hospital, during the years 2003-2004, due to horse related trauma were prospectively recorded. The patients were divided into two groups according to age, 147 children and 141 adults. The medical records were retrospectively scrutinized.ResultsThe most common mechanism of injury was falling from the horse. Most commonly, minor sprains and soft tissue injuries were seen, but also minor head injuries and fractures, mainly located in the upper limb. In total 26 adults and 37 children were admitted. Of these 63 patients 19 were considered having a serious injury. In total, four patients needed treatment in intensive care units.The total cost in each group was 200,000 Euro/year.Conclusion Horse riding is a sport with well known risks. Our results corresponds to the literature, however we have not observed the same incidence of serious injuries. In contrast we find these to be fairly uncommon. The injuries are mainly minor, with a small risk of long term morbidity. Over time regulations and safety equipment seem to have decreased the number of serious accidents.
... Physical handicaps after horse-related accidents are also documented on occasion (Ball et al., 2009;Dekker et al., 2004). In certain extreme circumstances, horse-related injuries can result in the death of the rider (Ball et al., 2007;Ghosh et al., 2000;Kiuru et al., 2002;Whitlock, 1999) most commonly due to severe head injuries (Griffen et al., 2002;Hessler et al., 2010;Jagodzinski & DeMuri, 2005). ...
Article
Horse-related injuries are manifold and can involve the upper and lower limbs, the trunk, spine or head. Cervical spine injuries are not among the most common injuries. However, they can be fatal and often result in neurological symptoms. This study investigated the influence of the posture of the cervical spine on the ultimate strength and the pattern of vertebrae failure with the aim to provide some guidance for protective clothing design. Eighteen human cervical spines, each divided into two specimens (three vertebrae each), were subjected to a simulator test designed to mimic a spinal trauma in different postures of the specimen (neutral, flexion, extension). The stress-to-failure, the deformation at the time of fracture and the fracture patterns assessed based on CT scans were analysed. Stress-to-failure of the superior specimens was lower for the flexion group compared to the others (P=0.027). The superior specimens demonstrated higher stress-to-failure in comparison to the inferior specimens (P<0.001). Compression in a neutral or flexed position generated mild or moderate fracture patterns. On the contrary, the placement of the spine in extension resulted in severe fractures mostly associated with narrowing of the spinal canal. The results imply that a neutral cervical spine position during an impaction can be beneficial. In this position, the failure loads are high, and even if a vertebral fracture occurs, the generated injury patterns are expected to be mild or moderate. Copyright © 2015 Elsevier Ltd. All rights reserved.
... This number is impossible to calculate and without this, the true prevalence of the spectrum of neurologic injury cannot truly be estimated. This likely underestimates the true prevalence of injuries and based on the data published in other series, 2,5,[7][8][9][10]14,17,29 we estimate the true rates of injury from equestrian sports to be much higher in the Rochester, NY area than what is presented in our series. ...
Article
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Objectives Equestrian sports can result in a variety of injuries to the nervous system due to many factors. We describe our series of 80 patients with injuries sustained during participation in equestrian sports. Methods and Results All patients seen at the regional trauma center with injuries associated with equestrian sports between 2003 and 2011 were reviewed; 80 patients were identified. Fifty-four per cent were female and the average age was 37 years (2·2–79·3). The mean injury severity score (ISS) was 9·9 ± 0·7. Only two patients had documented helmet use. Glasgow coma score (GCS) was 15 in 93% of patients. The most common neurosurgical injuries were to the cranial vault (28%), including concussions, intracranial hematomas and hemorrhages, and skull, facial, and spine fractures (10%), with the majority (63%) being transverse process fractures. The mechanisms of injury varied: 55% were kicked or stepped on, 28% were thrown or fell off, and 21% were injured by the horse falling on them. The causes ranged from carelessness and lack of attention to animal factors including inadequate training of horses and animal fear. Fourteen per cent required surgery. There were no mortalities and average length of stay was 3·7 ± 0·35 days. All patients were discharged home with 95% requiring no services. Discussion Equestrian sports convey special risks for its participants. With proper protection and precautions, a decrease in the incidence of central nervous system injuries may be achieved. Neurosurgeons can play key roles in advocating for neurologic safety in equestrian sports.
... In combination with high popularity, horseback riding is considered a perilous sport both regarding number and severity of injuries (e.g. Jagodzinski & DeMuri, 2005). In a study on hospital records of horse-related accidents, Keeling et al. (1999) identified misunderstandings between horse and rider as an important risk of accidents. ...
Article
In the present study, a web-based questionnaire was used with the aim to investigate perceived relevance of 14 behavioural traits in horses regarding quality of match between horse and rider. The responses of approximately 2800 participants indicate a high interest in the topic. All traits were considered relevant by at least 50% of the respondents. ‘Easy to bring to new environments’ was the trait indicated as relevant by the highest proportion (85%) of respondents, followed by ‘spirited and forward’ (84%) and ‘tolerant towards humans’ (80%). Respondents’ age as well as preferred equitation discipline was shown to have a profound influence on perception of relevance (P < 0.05). The results suggest a need for methods to objectively evaluate individual differences in behavioural traits to enable selection of horses to optimize horse–rider match.
... The risk of injury during equestrian activities is estimated higher than in other high-risk sports, such as for instance football, hockey, baseball, motorcycling and automobile sport (13,14). Persons alien to equestrian sports are largely unaware of this fact (5,26). Riders, however, recognize this fact, but refrain from using protective gear such as helmets (14) and mouthguards (27). ...
Article
Aim: Showjumping is one of the sporting activities with a high injury risk. Unpredictable behaviour of the horse, considerable speed and the height of the rider in the saddle make this sport to one of the most dangerous, with the highest risk of injury and the highest mortality rate per competitor. The aim of this study was to determine the frequency of dental trauma, the wearing of protective gear such as helmet, back protector and mouthguard as well as the knowledge of primary care after dental trauma. Material and methods: Within the framework of this study, 608 female and male showjumpers from Switzerland, France and Germany were questioned in a personal interview consisting of 14 questions about general injuries, dental injuries and the usage of protective gear. The competitors were subdivided into different categories according to amateur or professional level, gender and age. Results: Of the 608 competitors, 189 (31.1%) had witnessed an accident involving tooth injury and 91 (15.0%) had suffered one themselves. The prevalence of dental trauma rose with increasing age and more riding experience. A total of 436 (71.1%) of the competitors were familiar with mouthguards, of which only three owned one. The main reasons for not wearing a mouthguard were both doubtful necessity (22.5%) and a generally low acceptance among the riders (26.3%). Less than half of the competitors (44.4%) knew that an avulsed tooth can be replanted and only 4.1% had knowledge about the existence of a tooth rescue box. Conclusion: The results of this study show that in equestrian sports still little is known about dental trauma and protective measures.
... A horse can weigh over 1,000 lb (450 kg) and reach speeds approaching 40 mph (65 km/h), both accounting for the inherent dangers of this sport. This danger is amplified for young children where the injury rate for children in horseback riding is nearly twice that of adults from both falls and kicks from horses (Jagodzinski and DeMuri 2005). A Mexican proverb states "It is not enough for a man to learn to ride; he also must learn how to fall," alluding to the danger admixed with the joy of this sport. ...
Article
Injury, both intentional and accidental, is the most common cause of death in children throughout the world. Many injury patterns that are seen in children are similar to those in adult populations; however, others differ, reflecting the age, stature, and development of children. This chapter focuses on differences in injury patterns of children across the spectrum of childhood development and growth, including injuries and fatalities that primarily occur in infancy and early childhood. Risk factors for injury and death are identified within the context of childhood development. Topics covered include deaths associated with motorized and nonmotorized vehicles including pedestrian, occupant, and operator fatalities; farming and ranching deaths; drowning, boating, and diving deaths; fires and burns, including electrical deaths; animal-related deaths; falls; and airway-associated deaths. There are significant disparities in childhood injury and death among racial, ethnic, geographic, and socioeconomic groups. A brief consideration of these differences is provided to assist in forensic case examination. © 2014 Springer Science+Business Media New York. All rights are reserved.
... In combination with high popularity, horseback riding is considered a perilous sport both regarding number and severity of injuries (e.g. Jagodzinski & DeMuri, 2005). In a study on hospital records of horse-related accidents, Keeling et al. (1999) identified misunderstandings between horse and rider as an important risk of accidents. ...
... We estimate that farm injury is responsible for approximately 500-600 admissions per year in Queensland. In children, injury severity has been calculated to be greater than bicycle injury and passenger motor vehicle injury 9 . ...
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Farms are associated with high rates of injury to both workers and non-workers. Children account for 21% of all farm injuries. Horse related injury is the most common cause of injury, repre-senting 17% of all farm injury and over one third of serious farm injuries. Motorbikes and All Terrain Vehi-cles (ATVs) are the next most common cause of injury (11% of farm injury), predominantly young males. The majority of farm fatalities are due to tractor related injuries (rollovers or run-overs). The farm environment and work procedures should be reviewed regularly to identify potential hazards. Fence an area adjacent to the farmhouse to provide a safe play area for young children. Legislation should be introduced requiring helmet use when riding horses or using motorbikes and ATVs. Children should not use adult sized ATVs.
... This was largely supported in the literature, in addition to injuries occurring on farms, in paddocks, near roads and at public riding facilities. [3][4][5]8,9,38,39 While it is advocated that all children wear helmets when riding horses on farms, 40 there is a greater need for equestrian and government organisations to educate parents on supervising children to ensure appropriate safety attire is worn and precautions taken in all settings. Furthermore, all three deaths in Queensland occurred in regional and remote locations. ...
... In Germany, in 4 months period, in 9 trauma centers, there were 22 accidents related to horse contact with riders and most of them had head injuries [6]. Injury associated with contact with a horse in children assessed on the Modified Injury Severity Scale occupy the second place in terms of heaviness after injuries as a result of the pedestrian's car hit [5,7]. Research conducted by Canadian physicians shows that work with horses and horse riding is more dangerous than riding a motorcycle, skiing, playing football or rugby [12]. ...
Article
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Kicking by the horse can cause very serious injuries to the victim. The groups of people particularly vulnerable to such an injury are: veterinarians, farmers, sport riders and stables. The aim of this article is to present the proceedings with the victim, who was kicked by a horse with special attention to abdominal injuries. Injuries caused as a result of horse kick are paradoxically quite frequent. Early call for help, precise gathering of the interview according to the SAMPLE algorithm and patient’s observation in the direction of shock symptoms may later help the ambulance crew and emergency medicine physician in treatment and in faster, targeted diagnostics in the emergency department.
... Helmet usage is frequently a topic of debate amongst equestrians, horse-related disciplines, and other sports, with the perception that if the lid (helmet) is on your safe to ride [112]. Research supports the wearing of helmets as a safety tool [113][114][115][116][117] however, not all equestrians wear one. ...
Article
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The equestrian industry reports high rates of serious injuries, illness and fatalities when compared to other high-risk sports and work environments. To address these ongoing safety concerns, a greater understanding of the relationship between human risk perception, values and safety behaviours is required. This paper presents results from an international survey that explored relationships between a respondents’ willingness to take risk during daily activities along with, their perceptions of risk and behaviours during horse-related interactions. Respondents’ comments around risk management principles and safety-first inspirations were also analysed. We examined what humans think about hazardous situations or activities and how they managed risk with suitable controls. Analysis identified three important findings. First, safe behaviours around horses were associated with safety training (formal and/or informal). Second, unsafe behaviours around horses were associated with higher levels of equestrian experience as well as income from horse-related work. Finally, findings revealed a general acceptance of danger and imminent injury during horse interactions. This may explain why some respondents de-emphasised or ‘talked-down’ the importance of safety-first principles. In this paper we predominantly reported quantitative findings of respondents self-reported safety behaviours, general and horse-related risk perceptions despite injury or illness. We discussed the benefits of improved safety-first principles like training, risk assessments, rider-horse match with enriched safety communications to enhance risk-mitigation during human–horse interactions.
... However, evidence from general equestrian literature highlights the role of downward pressure on the stirrups and leg pressure around the horse to decelerate, turn and effectively communicate rider intent [21]. Proper foot positioning further serves to minimize risk of dismount, entrapment and injury to the rider [37]. More experienced riders demonstrate dorsiflexion at the ankle in comparison to the plantar flexed position of novice riders [9,38] and are better able to attenuate the increased vertical forces imparted by increasing horse gait speeds [9]. ...
Article
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Polo is an equestrian team sport consisting of four players per team, with level of play determined by cumulative player handicap (−2 to +10 goals), with a higher handicap denoting a better player. There is minimal literature investigating Polo players' physical attributes, hence the understanding of the physical characteristics that may contribute to an improved handicap are unknown. This study sought to identify the relationship between pertinent strength measures (left and right hand grip strength; absolute and relative isometric mid-thigh pull) and reaction time in Polo handicap in 19 New Zealand Polo players, and ascertain whether handicap could be predicted by these measures. Correlation coefficients were expressed using R values, accompanying descriptors and 90% confidence intervals (C.I.). Variance explained was expressed via the R 2 statistic, and statistical significance set at p < 0.05. Right hand grip strength, isometric mid-thigh pull values were found to significantly correlate to and explain variance within Polo player handicap (all moderate to large correlations; p < 0.05). Whereas left hand grip strength (R: 0.380; 90% C.I. −0.011 to 0.670) and reaction time (0.020; −0.372 to 0.406) were non-significant, moderate and trivial correlates and predictors of handicap respectively. Practically, these findings highlight the differing roles between rein and mallet hands of Polo players and emphasise the importance of a strong and stable platform when riding and striking the ball. Lack of association with reaction time may be explained in part by higher handicapped Polo players employing a more proactive approach to the game.
... Equestrian-related injuries caused by stirrups are not uncommon in modern medical reports (O'Farrell et al., 1997;Jagodzinski and DeMuri, 2005;Ceroni et al., 2007). In one Joseon historical text, a rider similarly suffered fatal head injury after becoming hung up in his stirrups. ...
Article
Only a few osteological reports describe bone injuries thought to have been caused by falls from horses. Nevertheless, anthropological study alone is insufficient for establishing the correlates of such equestrian accidents. We therefore reviewed the records in Seungjeongwon ilgi (Diaries of the Royal Secretariat) and Joseon wangjo silrok (Annals of the Joseon Dynasty) of the Korea's Joseon period (1392-1910 CE). Although the mechanisms of trauma were diverse, the Joseon documents recorded many injuries caused by horse-riding accidents. During 1625-1872 CE, equestrian-related accidents occurred almost every year, overwhelming other causes of trauma. In all horse-riding accidents (n=142), 37.77% of the records offer detailed data about the traumatic mechanism. Injuries occurred most frequently to the extremities (79.58%), which were followed by the trunk (34.5%) and head (4.92%). Although we do not think that this attempt can explain every paleopathological case, our historical review shows that equestrian-related injuries could be considered as one of the major causes for the bone trauma observed among ancient equestrian people.
... 12,13 -Evidence -Level 4: It is assumed, but not proven, that horse-related injuries might be prevented if: horses and activities are properly matched to the child's capabilities; children avoid standing in positions where they might be kicked; and there is parental supervision. 14,15 c. Downhill skiing may be safer than snowboarding. ...
Article
Résumé Introduction Dans la population pédiatrique, les fractures du col du radius représentent 1 % de l’ensemble des fractures et leurs conséquences peuvent être sévères. Compte tenu de la popularité croissante de la pratique de l’équitation et des traumatismes à haute énergie que celle-ci peut engendrer, nous avons cherché à évaluer le pronostic des fractures du col radial survenues en pratique équestre. Hypothèse Les fractures, survenues à la suite d’un traumatisme équestre, sont plus sévères et plus fréquemment associées à d’autre lésions ostéoarticulaires du membre supérieur ipsilatéral, grevant leur pronostic. Matériel et méthode Nous avons réalisé une étude rétrospective, multicentrique, comparative, dans une série continue de 39 patients. Les critères d’inclusion étaient l’existence d’une fracture du col du radius chez des enfants de moins de quinze ans. Les critères de jugement principaux étaient l’existence de lésions associées au moment du traumatisme et l’arc de mobilité en pronosupination et en flexion/extension du coude au dernier suivi. Résultats Comparativement à celles causées par d’autres mécanismes, les fractures du col radial survenues à la suite d’un accident d’équitation étaient plus fréquemment associées à d’autres lésions ostéoarticulaires (p = 0,0002), nécessitaient plus de chirurgie à ciel ouvert (p = 0,0409) et plus de rééducation postopératoire (p = 0,041). Cependant, il ne fut pas constaté de différence significative de mobilité au dernier recul, dans tous les mouvements étudiés (p > 0,05). Discussion Les fractures du col du radius liées à la pratique de l’équitation chez l’enfant semblent plus sévères que celle causées par d’autres mécanismes. Des campagnes de sensibilisation dans les centres équestres ainsi que le développement de protections spécifiques devraient être envisagés afin de limiter leur survenue. Niveau de preuve Thérapeutique III – étude comparative rétrospective.
Article
Horse riding is a common leisure activity associated with a significant rate of injury. Helicopter emergency medical services (HEMS) may be called to equestrian accidents. Accurate HEMS tasking is important to ensure appropriate use of this valuable medical resource. We sought to review HEMS response to equestrian accidents and identify factors associated with the need for HEMS intervention or transport of the patient to a major trauma centre. Retrospective case review of all missions flown by Kent, Surrey & Sussex Air Ambulance Trust over a 1-year period (1 July 2011 to 1 July 2012). All missions were screened for accidents involving a horse. Call details, patient demographics, suspected injuries, clinical interventions and patient disposition were all analysed. In the 12-month data collection period there were 47 equestrian accidents, representing ∼3% of the total annual missions. Of the 42 cases HEMS attended, one patient was pronounced life extinct at the scene. In 15 (36%) cases the patient was airlifted to hospital. In four (10%) cases, the patient underwent prehospital anaesthesia. There were no specific predictors of HEMS intervention. Admission to a major trauma centre was associated with the rider not wearing a helmet, a fall onto their head or the horse falling onto the rider. Equestrian accidents represent a significant proportion of HEMS missions. The majority of patients injured in equestrian accidents do not require HEMS intervention, however, a small proportion have life-threatening injuries, requiring immediate critical intervention. Further research is warranted, particularly regarding HEMS dispatch, to further improve accuracy of tasking to equestrian accidents.
Article
Introduction: In the pediatric population, fractures of the radial neck account for approximately 1% of all fractures and can have substantial consequences. Given the growing popularity of horse riding and the high-energy traumas that this can entail, we sought to assess prognosis for radial neck fracture sustained in horse riding. Hypothesis: Radial neck fracture sustained in horse riding is more severe and more frequently associated with other ipsilateral osteoarticular lesions which worsen prognosis. Material and method: We performed a multicenter retrospective comparative study in a continuous series of 39 patients. The inclusion criteria consisted of radius neck fracture in children under the age of 15 years. Endpoints comprised associated lesions at time of trauma, and ranges of elbow motion in pronation/supination and flexion/extension at last follow-up. Results: Compared to other etiologies, radial neck fractures following horse-riding accidents were more frequently associated with other ipsilateral osteoarticular lesions (p=0.0002), and more often required open reduction (p=0.0409) and postoperative rehabilitation (p=0.041). However, there were no significant differences in any ranges of motion at last follow-up (p>0.05). Conclusion: Radial neck fractures following horse-riding accidents in children were more severe than those caused by other mechanisms. Awareness campaigns in riding clubs and development of specific protective equipment should be considered to reduce occurrence. Level of evidence: Therapeutic III - Retrospective comparative study.
Article
A 4-year-old female with prior cranial vault remodeling for nonsyndromic bilateral coronal craniosynostosis sustained a severe traumatic brain injury with open skull fractures from a horse kick. Her post-traumatic course was complicated by persistently elevated intracranial pressure despite neurosurgical decompressions, maximum medical therapy, and trial of multiple pressure monitoring devices. She eventually had improvement in her intracranial pressures and made a full neurologic recovery. This case highlights the potential severity of horse kick injuries, the possible etiology of persistent intracranial hypertension in cranial vault remodeling patients following traumatic brain injury, the importance of a multi-team approach in the initial evaluation and postoperative follow-up of all craniosynostosis patients, and the necessity of helmet utilization.
Article
Sports-related concussions (SRC) and traumatic brain injury (TBI) represent a growing public health concern. We reviewed the literature regarding equestrian-related brain injury (ERBI), ranging from concussion to severe TBI. A literature review was performed to address the epidemiology of SRC and TBI in equestrian-related sports. MEDLINE and PUBMED databases were searched to identify all studies pertaining to brain injury in equestrian-related sports. We included two broad types of brain injury using a distinction established in the literature: 1) TBI with functional impairment, including concussion, or mild TBI, with negative imaging findings; 2) TBI with structural impairment, with positive imaging and at least one of the following pathologies identified: subdural hemorrhage (SDH), epidural hemorrhage (EDH), subarachnoid hemorrhage (SAH), intraparenchymal hemorrhage (IPH), cerebral contusions, and skull fractures. Our literature search yielded 199 results. We found 26 studies describing functional TBI and 25 mentioning structural TBI, and 8 including both. Of all modern sporting activities, equestrian sports were found to cause some of the highest rates of total bodily injury, severe brain injury, and mortality. Concussions comprise approximately 9.7-15% of all equestrian-related injuries brought to hospitals for evaluation. Structural TBI was rare, and documentation of these injuries was poor. While demographic risk factors like age and sex are minimally discussed in the literature, two studies identified a protective effect of increasing rider experience on all forms of bodily injury. However it remains unclear if increasing rider experience protects specifically against head injury. Finally, rates of helmet use in horseback riding remain dismally low - ranging from 9-25%, depending on the activity. These low rates have persisted over time, despite evidence in this literature that helmets lead to an absolute risk reduction for head injury of 40-50% in equestrian sports. Equestrian-related functional and structural TBI, represents a significant public health burden. Rider and horse characteristics make the sport uniquely dangerous, as the athlete has limited control over an animal weighing over a thousand pounds. Helmet use rates remain very low despite clear evidence of risk reduction. Healthcare providers are strongly urged to lobby professional and governmental organizations for mandatory helmet use in all equestrian sports. Copyright © 2014 Elsevier Inc. All rights reserved.
Article
Horseback riding and related activities bring risks for serious injury. Extant literature focuses largely on moderate to severe horse-related injuries resulting in a need for medical care. Yet incidents deemed as less severe are also important, with potential to impact subsequent safety precautions and behaviors of parents and children. The study objectives were to gather preliminary information about: (1) the prevalence of a range of horse-related painful incidents experienced by children, (2) children's helmet use and supervision, and (3) the subsequent impact of horse-related painful incidents. The methodological approach was based on a questionnaire. One hundred and twenty four child (120 Female; Mage: 11.82 years; rangeage: 8–18; SDage: 2.26) and parent (103 mothers; 16 fathers; 5 other legal guardians) dyads completed a brief 5 minute researcher-generated questionnaire. The results show, that painful incidents are common for children when handling and riding horses, with the majority of children having experienced these incidents more than once. Helmet use and supervision (typically by parents and coaches) were reported to occur consistently during riding, but less commonly during handling (e.g., grooming). Despite the high prevalence of painful incidents, these incidents largely do not impact children's ability to participate in other activities, result in access to specialized medical attention, or alter children's perceptions or behavior around horses. Findings may have implications for safety and education initiatives. Management implications Findings from this work suggest several implications. First, in acknowledging the range and frequency of incidents that occur during horse-related activities, educational initiatives should target a broad range of incident types when teaching about horse safety and injury prevention. Second, in recognizing primary caregivers and riding coaches as the most common supervisors of horse-related activities, they should also be targeted in educational initiatives (e.g., horse and safety knowledge, first aid, supervision guidelines). Finally, in developing and implementing targeted safety and injury prevention initiatives, reported benefits of the sport (e.g., improved problem-solving skills) could be used and supported in safety programming.
Article
The purpose of this study was to analyze of the rider postural alignments according to the fitting of stirrups lengths during walk of high level riders. Participants selected as subject were consisted of horse riders of high level (age: 47.66±3.51yrs, height: 168.40±4.84cm, body weight: 73.36±15.58kg, low extremity length: 94.76±3.98cm, career: 23.33±5.77yrs) and walk with 3 types of stirrup lengths(ratio of low extremity 68.04%, 73.25%, 78.48%). The variables analyzed were consisted of the displacement of Y axis (center of mass, head, thigh, shank and foot), FR angle, LR angle, dynamic postural stability index (DPSI), coefficient of variation (CV%), and distance (X axis) of low extremity limb between right and left. The displacement of Y axis in COM, thigh, shank, foot limbs were not statistically significant, but movements of head showed greater distance of B type and C type than that of A type during 1 stride of walk. The FR and LR angle in trunk of horse rider, dynamic postural stability index and, coefficient of variation didn`t show significant difference statistically according to the fitting of stirrup lengths. Also the distance (X axis) of low extremity in thigh and shank didn`t show significant difference statistically in between right and left, but right and left foot showed greater distance in C type than that of B and A types during walk in horse back riding. The hip and ankle joint angle not statistically significant according to stirrups lengths, But knee joint angle showed more extended according to the increase of stirrups lengths during stance and swing phase in walk.
Article
Inleiding: Per jaar belanden 9900 ruiters op de Spoedeisende Hulp (SEH). Blessures uit de paardensport zijn ernstiger dan blessures uit andere sporten. De meest voorkomende paardrijletsels zijn hoofd/hersen-, neken aangezichtsletsel (HNF), torsoletsel en letsel aan de bovenste en onderste extremiteiten. De huidige beschikbare preventiemiddelen zijn een cap, een bodyprotector, veiligheidsstijgbeugels en aangepast schoeisel. Methode: Met behulp van een enquête werd de mening onderzocht van ruiters van 14 jaar of jonger, hun ouders en manegehouders ten aanzien van veiligheid van paardrijden en de huidige preventiemiddelen. Resultaten: De enquête werd ingevuld door 119 kinderen, 134 ouders en negentien manegehouders. Hieruit bleek dat, op één respondent na, iedereen een cap droeg. Een bodyprotector werd gedragen door 19,3% van de kinderen en 30,0% van de kinderen van de ouderrespondenten, met als voornaamste reden dat deze niet fijn zit. Rijervaring bleek geen rol te spelen in het gebruik van een bodyprotector, de veiligheids- of risicoperceptie. Ruim driekwart van alle respondenten vond paardrijden veilig of zeer veilig; het risico op botbreuken werd het grootst geacht. Als verbeterpunten voor de veiligheid werden genoemd: verbeteren/verplichten van beschermingsmateriaal, verbeteren van lesmethode met leren anticiperen op het gedrag van het paard en aanbieden van valtraining. Manegehouders benoemden lesmethode en valtraining als verbeterpunten. Een minderheid van alle groepen achtte het verplichten van het ruiterbewijs een positief preventiemiddel. Conclusie: Een cap wordt door de doelgroep veel gebruikt en ook als effectief beschouwd. Een bodyprotector wordt aanzienlijk minder gedragen, met als voornaamste reden discomfort en twijfel over de effectiviteit. Paardrijden wordt als veilig beschouwd. Verbeterpunten liggen bij het beschermingsmateriaal, de lesmethode en de valtraining.
Article
The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities. We sought to examine the mechanism, severity, frequency, body regions affected, surgical requirements, rehabilitation needs, safety equipment utilization, and outcomes of equine-related injured patients. Records of inpatients who sustained an equine-related injury from 2002-2011 with International Classification of Diseases, Ninth Revision codes E828 and E906 were retrospectively reviewed for pertinent data. Ninety patients, 70% female, age (mean ± SD) 37.3 ± 19.4 years, length of stay 3.7 ± 4.5 days, Injury Severity Score 12.9 ± 8.4. Predominant mechanism of injury was fall from horse (46.7%). The chest (23%) was most frequently injured, followed by brain/head (21.5%). Thirty patients (33%) required 57 surgical procedures. Twenty percent of patients required occupational therapy and 33.3% required physical therapy while hospitalized. Only 3% required rehabilitation, with 90% discharged directly home. Safety equipment was not used in 91.9% of patients. One patient sustained a cord injury. Six patients expired, all from extensive head injuries. The majority of equine-related injuries occur while pursuing recreational activities and are due to falls. Our patients experienced more severe injuries to the trunk and head and required more surgical intervention for pelvic, facial, and brain injuries than previously reported. Failure to use safety equipment contributes to the risk of severe injury. Education and injury prevention is essential. The need for complex surgical intervention by multiple specialties supports transfer to Level I trauma centers. Copyright © 2015 Elsevier Inc. All rights reserved.
Article
Background Accidents with serious injuries occur regularly in equestrian sports; however, risks, injury patterns and the consequences of equestrian sports are still underestimated. There are no data for the intensive medical care of injured equestrians in the literature. This was the reason for undertaking this study. Methods As part of this retrospective study, injured equestrians in the emergency department of a university hospital between 2006 and 2013 were identified and managed in a database. The statistical analysis of the data was done with the statistical software IBM SPSS. Results with a p-value of <0.05 were considered as significant. Results A total of 43 patients received intensive medical care at the beginning or during the inpatient stay. In this study 32 horse riders (74%) were injured by falling from the horse. The average Glasgow coma scale (GCS) score was 12.6 (min. 8.5; max. 15) The injury severity score (ISS) averaged 18.9 ± 8.4. The main types of injury were head, spinal and thoracic injuries. The average intensive care treatment duration was 10 ± 8.5 days. The average ventilation duration was 41.4 ± 41.4 h. Discussion The most common injuries are head injuries. The further development and research in the field of riding helmets and in particular, strategies to increase the willingness to wear a riding helmet, promise the greatest benefits for the prevention of riding accidents. As a special risk group, patients over the age of 40 years were identified. Special attention with respect to intensive care medicine should be paid to patients who have suffered serious head, thoracic and abdominal injuries in riding sports.
Article
Objective: Explore the perceived risks and benefits of hippotherapy among parents of children currently engaged in or waiting rehabilitation using hippotherapy. Method: Phenomenological qualitative exploratory pilot study. An interview guide validated by experts was used to conduct the interviews. Summaries were written to capture first impressions. One team member coded the transcripts and the coding was validated by the research team through discussion until consensus was reached. Results: The average age of the participants (n = 4) was 37.3 ± 6.6 years. The few risks they perceived related to physical injuries. Lack of knowledge of contraindications, lack of fear, minimization of risks, and risk-attenuation factors also emerged as important themes. Benefits accounted for a large part of the content of the interviews and were grouped under 13 themes, including motor and postural control, enjoyment and the development of a special relationship. Conclusion: Minimization of the perceived risks compared to the numerous perceived benefits could create clinical issues such as the client putting self at risk of injuries (e.g., bites, falls, and kicks) if not cautious enough or complications insufficiently prevented, which suggests the need to develop educational activities for an informed consent to this type of rehabilitation.
Article
Background: Equestrian sports are one of the most popular forms of sport in Germany, while also being one of the most accident-prone sports. Furthermore, riding accidents are frequently associated with a high degree of severity of injuries and mortality. Nevertheless, there are insufficient data regarding incidences, demographics, mechanisms of accidents, injury severity and patterns and outcome of injured persons in amateur equestrian sports. Accordingly, it was the aim of the present study to retrospectively analyze these aspects. Methods: A total of 503 patients were treated in the emergency room of the Hannover Medical School because of an accident during recreational horse riding between 2006 and 2011. The female gender was predominantly affected with 89.5 %. The mean age of the patients was 26.2 ± 14.9 years and women (24.5 ± 12.5 years) were on average younger than men (40.2 ± 23.9 years). A special risk group was girls and young women aged between 10 and 39 years. The overall injury severity was measured using the injury severity score (ISS). Results: Based on the total population, head injuries were the most common location of injuries with 17.3 % followed by injuries to the upper extremities with 15.2 % and the thoracic and lumbar spine with 10.9 %. The three most common injury locations after falling from a horse were the head (17.5 %), the upper extremities (17.4 %), the thoracic and lumbar spine (12.9 %). The most frequent injuries while handling horses were foot injuries (17.2 %), followed by head (16.6 %) and mid-facial injuries (15.0 %). With respect to the mechanism of injury accidents while riding were predominant (74 %), while accidents when handling horses accounted for only 26 %. The median ISS was 9.8 points. The proportion of multiple trauma patients (ISS > 16) was 18.1 %. Based on the total sample, the average in-hospital patient stay was 5.3 ± 5.4 days with a significantly higher proportion of hospitalized patients in the group of riding accidents. Fatal cases were not found in this study but the danger of riding is not to be underestimated. The large number of sometimes severe injuries with ISS values up to 62 points can be interpreted as an indication that recreational riding can easily result in life-threatening situations. Conclusion: Girls and young women could be identified as a group at particular risk. It has been demonstrated in this study that the three most common injury locations after falling from a horse were the head, the upper extremities, the thoracic and lumbar spine. The most frequent injury locations while handling horses were foot injuries, followed by head and mid-facial injuries.
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Background: Despite the common nature of orthopaedic injuries in equestrian sports, there is no published review to specifically characterize orthopaedic injuries in equestrian athletes. Purpose: To characterize orthopaedic injury patterns in equine sports-related injuries and their treatment. Study design: Systematic review; Level of evidence, 4. Methods: This review was performed through a PubMed, EMBASE, and Scopus query (from 1978 to June 2014) in the English literature using search terms "(equine-related OR equestrian-related OR horse-related OR equestrian OR equestrians) AND (injury OR injuries)." Only full-text studies reporting on orthopaedic injury patterns pertinent to equestrian sports in the United States (US) and the United Kingdom (UK) were included. Orthopaedic injuries were defined as those resulting in a fracture or dislocation. In all, 182 studies were excluded, leaving a total of 27 studies for evaluation. The studies included were analyzed for demographic and epidemiological data for orthopaedic injuries, including fractures and dislocations. Cranial and facial injuries were excluded from analysis. Results: The majority of those injured in the US were female (64.5%). The leading cause of injury in the US was falling from a horse. The use of protective equipment seemed to vary widely, with helmet use ranging from less than 6% up to 66.7%. In the UK, fractures were found to account for 17.4% of reported injures, compared with 33.6% of injuries in the US. The majority of fractures in US riders occurred in the upper extremities (50.7%). Conclusion: This review helps characterize the epidemiology of equestrian injuries based on currently available data.
Article
Introduction: Horse-related injuries account for one quarter of all paediatric sports fatalities. It is not known whether the pattern of injury spectrum and severity differ between children injured whilst mounted, compared with those injured unmounted around horses. We aimed to identify any distinctions between the demographic features, spectrum and severity of injuries for mounted versus unmounted patients. Patients and methods: Trauma registry data were reviewed for 505 consecutive paediatric patients (aged<16years) admitted to a large paediatric trauma centre with horse-related injuries over a 16-year period. Patients were classified into mounted and unmounted groups, and demographics, injury spectrum, injury severity, and helmet usage compared using odds ratios and Wilcoxon rank-sum tests. Results: More patients (56%) were injured in a private setting than in a sporting or supervised context (23%). Overall, head injuries were the most common horse-related injury. Mounted patients comprised 77% of the cohort. Mounted patients were more likely to sustain upper limb fractures or spinal injuries, and more likely to wear helmets. Unmounted were more likely to be younger males, and more likely to sustain facial or abdominal injuries. Strikingly, unmounted children had significantly more severe and critical Injury Severity Scores (OR 2.6; 95% CI 1.5, 4.6) and longer hospital stay (2.0days vs 1.1days; p<0.001). Unmounted patients were twice as likely to require intensive care or surgery, and eight times more likely to sustain a severe head injury. Conclusions: Horse-related injuries in children are serious. Unmounted patients are distinct from mounted patients in terms of gender, age, likelihood of personal protective equipment use, severity of injuries, and requirement for intensive or invasive care. This study highlights the importance of vigilance and other safety behaviours when unmounted and around horses, and proposes specific targets for future injury prevention campaigns, both in setting of organised and private equestrian activity.
Article
Objective : The purposes of this study was to analyze the effects of the stirrup length fitted to the rider's lower limb length and it's impact on less skilled riders during trot in equestrian events. Methods : Participants selected as subjects consisted of less skilled riders(n=5, mean age: 40.02?10.75yrs, mean heights: 169.77?2.08cm, mean body weights: 67.65?7.76kg, lower limb lengths: 97.26?2.35cm, mean horse heights: 164.00?5.74cm with 2 type of stirrups lengths(lower limb ratio 74.04%, and 79.18%) during trot. The variables analyzed consisted of the displacement for Y axis and Z axis(head, and center of mass[COM]) with asymmetric index, trunk front-rear angle(consistency index), lower limb joint(Right hip, knee, and ankle), and average vertical forces of horse rider during 1 stride in trot. The 4 camcorder(HDR-HC7/HDV 1080i, Spony Corp, Japan) was used to capture horse riding motion at a rate of 60 frames/sec. Raw data was collected from Kwon3D XP motion analysis package ver 4.0 program(Visol, Korea) during trot. Results : The movements and asymmetric index didn't show significant difference at head and COM, Also, 74.04% stirrups lengths in trunk tilting angle showed significant difference with higher consistency than that of 79.18% stirrups lengths. Hip and knee joint angle showed significant difference with more extended posture than that of 74.04% stirrups lengths during trot. Ankle angle of 79.18% stirrups length showed more plantarflexion than that of 74.04% stirrups lengths. Average vertical force of rider showed significant difference with higher force at 79.18% stirrups lengths than that of 74.04% stirrups lengths during stance phase. Conclusion : When considering the above, 74.04% stirrups length could be effective in impulse reduction with consistent posture in rather less skilled horse riders.
Article
The cervical spine is considered fragile and vulnerable to injuries in equestrian sport. This retrospective study investigates the injury pattern and severity. Patients of the medical university in Hannover from the years 2006-2011, who had an equestrian accident, were identified. Patients who had been injured in the course of their work were excluded. Results counted with a p-value < 0.05 were considered significant. In 13.1% of patients, there were 71 cervical spine injuries (92.4% female; 7.6% male). The mean age was 27.1 ± 13.2 years. Of these, 86.4% associated the injury to the riding accident. In 56 cases, it concerned falls from the horse. In 13.6% of the cases, the injury was caused while handling the horse. Sprains were most common (70.4%). Fractures of the neck vertebrae were found in 22.5% of the cases. The mean ISS was 7.0 ± 5.8 pts. Polytrauma was identified in 6.1% of patients (ISS ≥ 16 Pkt). The most common accompanying injury presented was an injury to the head (29.2%; p = 0.003). Of the 30 hospitalized patients, 13.3% were admitted to intensive medical care for 2.3 ± 15.4 d. The mortality was 0%. Injuries of the cervical spine are not to be underestimated in their frequency and severity. It is shown that, especially with injuries of the head and thoracic and lumbar spine area, patients are at increased risk of concurrent cervical lesions. The prevention of neck injuries is currently done in the form of riding helmets, airbag jackets, riding behavior and education. Further study of the prevention of neck injuries is required.
Chapter
Die Notfallversorgung von Patienten, die noch sehr jung sind, stellt die Rettungskräfte häufig vor eine besondere Herausforderung. Und, wie dieser Fall zeigt, es gilt einmal mehr sehr genau abzuwägen, welche folgenden Schritte die richtigen sein könnten.
Article
Equinetherapy has been a procedure used throughout the history of Medicine in the treatment of several diseases. Since 1990 its use in the treatment of children disability has increased. The documented scientific evidence until present does not allow definite conclusions as far as its value in the treatment of children disability, although the experiences reported by different authors show that is a non-invasive procedure, a beneficial alternative in children disability care, improving the cognitive and socialization, emotional, and motor aspects. A bibliographical review is made taking into account the experience of different authors on the matter
Chapter
Die Notfallversorgung von Patienten, die noch sehr jung sind, stellt die Rettungskräfte häufig vor eine besondere Herausforderung. Und, wie dieser Fall zeigt, es gilt einmal mehr sehr genau abzuwägen, welche folgenden Schritte die richtigen sein könnten.
Article
Horseback riding is associated with a high risk of accidents. Accidents can occur either during horseback riding or while handling a horse. With regards to the mechanism of injury there are many more falls from a horse than accidents handling a horse. Children are a special risk group in equestrian sport as 50 % of all horseback riding accident-related hospital consultations are in the age of 0–18 years. In a retrospective analysis we include all patients (age 0–18) treated in our level I trauma center between 2006 and 2011, resulting in 197 patients. We analyzed the overall injury severity score (ISS) and the abbreviated injury scale (AIS). In addition, we analyzed the type of treatment (outpatient vs. inpatient), duration of mechanical ventilation, length of stay in our intensive care unit, the total length of stay and the incidence of posttraumatic complications. The most common injury locations resulting from accidents when riding a horse are the upper extremity, followed by injuries to the head and lower extremity. The most common injury when handling a horse are injuries to the head. The average ISS was 4.8 ± 4.6 and 3.6 % of the children had multiple traumas. Treatment after falling from a horse accounted for 57.1 % of the children with a mean ISS of 23.6 ± 6.8.
Article
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Horses involved in road traffic accidents (RTAs) are commonly presented to veterinarians with varying types of injuries. The aim of this study was describe the pattern and severity of traffic accident-related injuries in horses in a single hospital population. Medical records of horses either hit by a motorized vehicle or involved in RTAs whilst being transported from 1993 to 2015 were retrospectively reviewed and the following data was extracted: Signalement, hospitalisation time, month in which the accident happened, cause of the accident, place of the accident and type of vehicle hitting the horse. Further the different body sites injured (head, neck, breast, fore limb, abdomen, back and spine, pelvis and ileosacral region, hind limb, tail and genital region), the type of injury (wounds, musculoskeletal lesions and internal lesions) and the presence of neurological signs were retrieved from the medical records. 34 horses hit by motorized vehicles and 13 horses involved in RTAs whilst being transported were included in the study. Most of the accidents where horses were hit by motorized vehicles occurred during December (14.7%) and October (14.7%), horses were most commonly hit by cars (85.3%) and the majority of accidents occurred on main roads (26.5%). In 29.4% of the cases, horses had escaped from their paddock and then collided with a motorized vehicle. Most of the accidents with horses involved in RTAs whilst being transported occurred during April (30.8%) and June (23.1%). In 76.9% of the cases the accident happened on a freeway. In the horses hit by motorized vehicles the proximal hind limbs were the body site most commonly affected (44.1%), followed by the proximal front limbs (38.2%) and the head (32.4%). When horses were involved in RTAs whilst being transported the proximal fore limbs (61.5%), the proximal hind limbs (53.8%) and the distal hind limbs, back and head (38.5% each) were the most common injured body sites. Wounds were the most common type of injury in both groups(85.3% hit by motorized vehicle, 76.9% transported ones). In horses hit by a motorized vehicle 35.3% suffered from fractures, in 20.6% a synovial structure was involved and in 5.9% a tendon lesion was present. 14.7% suffered from internal lesions and 14.7% showed neurologic symptoms (40% peripheral, 60% central neurologic deficits). On the other hand, in horses involved in a RTA whilst being transported 30.8% suffered from fractures. There were no synovial structures injured and no tendon injuries were present. Furthermore there were no internal lesions present and only one horse involved in a RTA showed central neurologic symptoms. Injuries of horses being hit by a motorized vehicle were more severe than when horses were protected by a trailer and involved in an RTA whilst being transported. The study has been able to identify the different injury types of traffic accident-related injuries in horses. Awareness of the nature of these injuries is important, to avoid underestimation of their severity.
Chapter
Every year, across the world, children and adults are injured and occasionally killed during recreational and professional activities related to horses. This, as Roe et al suggest, is not unexpected considering that this involves two animals of dynamically different species [2]. It may come to some readers’ surprise to be informed that equestrian related hospital admissions are in fact more common than those related to motorcycles, skiing or other sports [3–5].
Article
The effect of the sex of horses in personality studies seems an underestimated aspect, specifically for the social dependence personality trait. A simple two-choice test could be a promising tool to address the strength of social dependence in riding horses. The present study aimed, at exploring the effect of sex on social dependence, hypothesising that females will react with more anxiety than castrated males when exposed to social separation. We examined whether a two-choice test will predict social dependence in horses. Twenty-four experienced leisure horses (7 mares and 17 geldings) were tested with a simple two-choice (food vs equine companion) preference and subsequent social dependence test in three sessions within the test (Session1: separation with a preferred companion; Session2: isolation, and Session3: social stimulus, i.e. conspecific passing nearby). During the test, six horses chose the companion (companion-motivated, CM), and 18 horses chose the treats (food-motivated, FM). The choice was skewed for mares, as significantly more mares than geldings preferred the companion over the food (CM: Nmares=4, Ngeldings=2 and FM: Nmares=3, Ngeldings=15). In isolation, CM horses displayed significantly reduced feeding duration and standing still towards increased arousal, i.e. locomotor activity: trotting, cantering, pawing and vocalizations, as compared to FM horses that were calmer and more comfortable without companions than CM horses. Our results indicate that mares, compared to geldings, showed weaker interest in feeding, and longer bouts of movement (walk and trot), which indicated the prevailing willingness to reunite with the companions and were more socially dependent compared to castrated male horses. The authors propose that this simple two-choice test can be used as another test to assess social dependence in horses.
Article
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The aim of this study was to describe the characteristics, nature, severity and outcome of injuries from horse-related trauma in pediatric patients, aged of 19 years or younger. Retrospective analysis was conducted of 315 patients recorded in the National Pediatric Trauma Registry from February 1995 to August 1999. A total of 62% of the 315 patients were girls. The median age of injury was 10 years. Sixty-five percent of the patients were injured while mounted on a horse, and the most common mechanism of injury was falling off the horse. The most frequent reason for hospital admission was skeletal fractures followed by head injuries. The head, neck, and face area was the most commonly injured anatomic site, followed by the upper extremity, the abdomen, and then the lower extremity. The median length of stay in the hospital was 2 days. Forty percent of the patients needed treatment in the intensive care unit with a median length of stay of 2 days. Thirty-nine percent of patients underwent surgical procedures. The Injury Severity Score ranged from moderate to critical in 31.5% of the children. There were 8 deaths, 2.5% of the injured children. The most common cause of mortality was head injuries. Of the 307 survivors, 3% were discharged to a rehabilitation center, and 2% of the children had 1 or more functional impairments lasting longer than 7 months after discharge. Horse-related trauma is frequent in children and can cause severe injuries resulting in death and long-term disability. Awareness of the nature of injuries is important to avoid underestimation of their severity.
Article
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To describe the demographics and nature of injuries occurring on or around horses, to examine the nature of protective clothing in relation to these injuries, and to compare our data with previously published work in this area. Patients were identified using the term "sports injury-horse riding" from the departmental database for one calendar year from February 2000. Data were collected regarding demographics, injuries, protective clothing, and outcome. The data were then analysed and compared with the previously published literature. 260 patients' records were analysed. The patients were mostly young (median age 26) and female (84.6%). The majority of patients had a single injury (88.8%). Seventeen per cent had an isolated head injury, all of which proved to be minor. Multiple injuries including the head accounted for 8.5% of all injuries. These again proved minor, bar one fatality where the helmet came off before impact. Upper limb injuries accounted for 29.2% of all injuries of which 61.8% sustained a fracture of which 36.2% were to the wrist. When compared with previous work the incidence and severity of head injury continues to decline while the relative number and severity of upper limb injuries increases. The majority of head injured riders are wearing approved helmets and sustaining only minor injury. There is currently no protective gear recommended for the upper limb and more specifically the wrist. This paper identifies the potential need for research and development of such protection.
Article
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To assess injury patterns attributable to horse kicks, to raise the issue of preventive measures, and to evaluate the role of modern accident and emergency department computer software. Data analysis using a new kind of full electronic medical record. Seventeen kicked equestrians were unmounted at the time of injury. Eight of seventeen patients sustained contusions of the extremities, the back, and the trunk. In nine patients an isolated facial injury was diagnosed. Five of nine patients needed referrals to the department of plastic surgery because of the complexity of the facial soft tissue wounds. Three underwent maxillofacial surgery. Clinical: the equestrian community may underestimate the risk of severe injuries attributable to hoof kicks, especially while handling the horse. Educational lectures and the distribution of educational literature should be promoted. The introduction of additional face shields may be protective. Software related issue: the handling of an increasing amount of medical data makes a development in computerisation of emergency units necessary. Thus the increasing utilisation of new computer technology could have a significant influence on accident analysis and prevention and the quality of research in the future.
Article
In a five-year study, 160 accidents occurred among 46,351 six-through 21-year-olds engaged in horse activities. Of these, 130 were riding accidents, 20 were horse-related and 10 did not involve horses. Bruises and abrasions were the most frequent injuries, and the area of the body most commonly injured was the head and face. The low accident rate may result from the requirement that riders wear approved protective headgear.
Article
To assess the impact of helmet use on the pattern, and severity of pediatric equestrian injuries. A prospective observational study of all children less than 15 years of age who were brought to the University of Virginia children's Emergency Department with horse-related injuries. During the two-year period of the study, 32 children were evaluated. Two children were injured when a horse stepped on them. Thirty children fell from or were thrown from a horse. Of these, 20 were wearing a helmet. Head injuries were more frequent in those patients not wearing helmets. The mean Modified Injury Severity Scale (MISS) score for riders without a helmet (12.9) was significantly higher (more severe) than that for helmeted riders (2.8). All three patients with a Glascow Coma Score < 15 on arrival were not wearing a helmet at the time of injury. The frequency of hospitalization was significantly higher for those not wearing a helmet. Compared with other common mechanisms of childhood injury the mean Modified Injury Severity Scale score of injured riders was exceeded only by that of pedestrians struck by a car. Equestrian injuries are more severe than those suffered from other common pediatric mechanisms. Helmet use is associated with decreased frequency and severity of central nervous system injury.
Article
Horseback riding injuries are responsible for an estimated 2300 hospital admissions annually among persons younger than 25 years of age in the United States, but injury rates, patterns of injury, and risk factors for this population have not been well studied. Study participants were selected from a list provided by a national mail-order company that sells riding equipment. A total of 557 persons younger than 25 years of age who rode horses at least six times a year completed survey questionnaires. Among the study participants, 34 (6.1%) had been hospitalized at least once because of a riding injury and 153 (27.5%) had been treated by a physician within the previous 2 years for such an injury. The overall injury rate was 0.6 per 1000 riding hours. Among those injured, sprains or strains (41.8%), lacerations or bruises (40.0%), and fractures or dislocations (33.3%) were the most common types of injury. A total of 27.5% of those injured sustained concussions or other head injuries. Riding 15 to 24 hours per month (odds ratio [OR] = 2.04), being female (OR = 1.81), and riding English style (OR = 1.77) were the characteristics most strongly correlated with injury. Horseback riding injuries among participants in this study tended to be serious. Family physicians should inform their patients who ride horses about the risks associated with equestrian activities and should emphasize helmet use.
Article
A retrospective chart review was conducted to define the demographic and injury patterns of patients presenting to the emergency department (ED). The setting is a rural/small urban tertiary care center with approximately 40,000 visits per year. All patients presenting to the ED from January 1986 through December 1990 with equestrian-related injuries were enrolled in the study. Measurements included age, sex, mechanism of injury, injury or injuries diagnosed, admission to the hospital, morbidity, and mortality. A total of 142 patients met the inclusion criteria. The majority of injuries occurred when the patient fell from a horse. There were also a large number of injuries associated with handling the horse. Most injuries were minor, but 15% required hospital admission. There were no deaths. In conclusion, equestrian activities are associated with a risk of serious injury to both riders and handlers of horses. Education of both the public and primary care physicians should focus on injury prevention.
Article
To provide data on the magnitude and patterns of animal related on-farm injuries to youth in the United States. A survey of 26,000 farm households conducted for the National Institute for Occupational Safety and Health by the United States Department of Agriculture in 1998. Youth younger than 20 years of age. There were an estimated 6,438 animal related on-farm injuries to youth in 1998. 70% occurred to farm residents; 69% were work related. Males accounted for 64% and approximately 41% occurred to those younger than 10; 37% involved horses and 31% cattle. Most horse related injuries occurred to females and a majority of the cattle related injuries were to males. Additionally, most of the cattle related injuries were work related, while horse related injuries were mainly nonwork. One out of every five youth injuries occurring on farms in the United States is animal related. These animal related injuries were due to both work and non-work related exposures. The large number of horse and cattle related injuries highlights a need for intervention strategies based on the injury circumstances common to these animals.
Article
The objective of this study was to examine equine-related trauma at a trauma center servicing a region in which there is significant contact between horses and humans. Data were collected on all patients admitted to the University of Kentucky Medical Center from January 1994 to December 1998 for treatment of horse-related injuries. Seventy-five patients were admitted to our center after injuries due to contact with horses (0.75% of all trauma admissions). There were 42 men (55%). The mean age was 37 years (range, 3 to 81 years). The majority of patients (67/75) were injured during recreational activities, and most fell or were thrown (40/75). Only 14% of patients were wearing helmets. The most common injuries were extremity fractures and head injuries, but thoracic and abdominal injuries were not rare. Of the 75 patients, 34 required surgery. Five patients (6.7%) died, all of head injury. During the study period, 11 people died in Kentucky due to contact with horses. Injury due to contact with horses is uncommon even at a center servicing a region with a large equine population. However, injuries are often serious and lead to significant morbidity and occasional mortality. Prevention of death from horse-related trauma is synonymous with prevention of head injury.
Article
Horse riding and handling are uniquely dangerous. Knowledge of the risk factors of horse-related injuries is essential to prevent them. We aimed to define the factors that affect the severity of horse-related injuries and the length of hospital stay. A number of 231 patients (136 females and 95 males) with horse-related injuries were studied. A generalized linear model was used to test the effect of age, sex, cause of injury, complexity of the mechanism of injury, year, place of injury and profession of the injured, on the injury severity score (ISS) and the hospital stay. Fall from a horse was the most common cause of injury (67%). Most of the patients were non-professional (153, 66%). Females were significantly younger than males (P<0.001, t-test). Statistical analysis showed that the primary mechanism of injury (F=2.73, P=0.014) and the complexity of this mechanism (F=4.47, P=0.013) significantly affected the duration of hospital stay. None of the studied variables affected the injury severity score. The mechanism of the horse-related injuries and their complexity significantly affected the duration of hospital stay but not the injury severity score.
Hook kick injuries in unmounted equestrians
  • Ak Exadaktylos
  • S Eggli
  • P Inden
  • Zimmerman
Exadaktylos AK, Eggli S, Inden P, Zimmerman H. Hook kick injuries in unmounted equestrians. Emerg Med J. 2002;19:573-575