Horse Related Injuries
Sonya Melville, MD
University of Kentucky Chandler Hospital
Purpose
• To understand the incidence and
prevalence of horse related injuries
occurring in Kentucky and the U.S.
• To compare horse related injury patterns
from the World Equestrian Games in fall
2010 to previous data.
• To identify injury patterns associated with
horse related injuries.
2
Background
• 5,003 horse- related injuries in the United
States 2002-2004.
– Contusion/Abrasion 31%
– Fractures 28%
– Sprains/Strains 18%
– Traumatic Brain Injury (TBI) 12%
– Lacerations 6%
(Loder, 2008)
3
Horse-related injury
• Fractures and TBI cause of hospital
admission
• TBI most common injury when no helmet
worn by rider
• Cost of TBI associated with horse related
head injuries from $600,000 to 1.8 million
(Mayberry et al., 2007)
4
Causality of Horse Related Injury
• Lack of protective gear- helmets in
particular
• 27% of injuries to riders were due to
demands the rider was placing on the
horse - - that is asking the horse to
perform a maneuver outside of its skill set
• Half of the patients in the study believed
the injuries were preventable and were the
fault of the rider (Ball and Ball, 2007)
5
UK Data Analysis
• Retrospective review using trauma registry
data.
• IRB approval obtained
6
Specific Aims:
1. Define the incidence and prevalence of horse related human
injuries seen at the University of Kentucky.
2. Compare the UK incidence and prevalence of horse related human
injuries to the United States incidence and prevalence.
3. Identify at least 2 strategies to reduce the incidence of horse
related human injuries.
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2
Sample
• All patients entered in the UK Trauma
Registry Data Base from 2006-2008 with
horse related injuries.
• All trauma patients 2006-2008 N = 8668
• Horse related injuries 2006-2008 n = 223
(UK Trauma Registry, 2009)
8
Patients Hospitalized at UK HealthCare
First Seen in the Emergency Department for
a Horse-Related Injury
81
74
68
2006
2007
2008
(UK Trauma Registry, 2009)
9
Cause of Injuries of Patients Admitted to UK
Hospital via Emergency Department
Cause of Injuries of Patients Admitted to UK Hospital
Via Emergency Room 2006-2008
Fell from horse
86
40%
Kicked by horse
40
19%
Thrown/bucked off
39
18%
Horse fell on rider
28
13%
Stepped on
11
5%
Foot caught in stirrup/dragged
4
2%
Bitten by horse
1
1%
Other
(hit by car, saddle broke, hit fence
rolled ankle dismounting)
4
2%
213
100%
Total
(UK Trauma Registry, 2009)
10
5
Examples of Typical Horse-Related Patient
Injuries Requiring Hospitalization
•
•
•
•
•
•
•
•
•
•
•
•
•
Crushed spine/spine fractures
Broken shoulder blades
Liver lacerated
Bruised, bleeding, punctured lungs
Right rib fractures
Chest bone dislocated
Collarbone fractures
Broken/fractured arms, legs, hands, feet
Traumatic brain injury (TBI)
Fractured cheek
Fracture eye socket
Nose fracture
Fractured jaw
(UK Trauma Registry, 2009)
11
6
Cause of Hospitalization of Patient
with Horse-Related Injuries at UK
Cause of Hospitalization of Patients with Horse-Related
Injuries at UK
2006-2008
Fractures of Arms & Legs
117
55%
Head & Neck Injuries
60
28%
Chest Injuries
54
25%
Spine Injuries
50
23%
Abdominal Injuries
32
15%
Based on 223 Total Patients
*
*Does not add up to 100% as many of the 223 patients in this analysis had
multiple injuries
(UK Trauma Registry, 2009)
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7
Horse Related Injury ISS
50
46
45
42
41
40
35
30
2006
25
2007
21
20
2008
18
15
13
13
12
10
10
8
4
5
5
0
1
0
0
ISS 1-9
ISS 10-15
ISS 16-24
ISS > 24
NA
(UK Trauma Registry, 2009)
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Top Ten Sports for Traumatic Brain Injuries
Percentage of emergency department visits for nonfatal traumatic brain injuries
by activity:
•
•
•
•
•
•
•
•
•
•
Horseback riding
Ice skating
All-terrain vehicles (ATV’s)
Sledding
Bicycling
Hockey
Playground
Moped/dirt-bike
Golf
Amusement Parks
11.7%
10.4%
8.4%
8.3%
7.7%
7.4%
7.1%
6.6%
6.6%
6.5%
(CDC, 2007)
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3
Implications
• TBI risk increases without helmet.
• Protective Gear needs to be worn at all
times by all riders.
• Injury Prevention Education essential.
• Equestrian professional associations must
require appropriate protective apparel.
15
The WEG and Injury Concerns
• Simultaneous competitions
• Competitive venues with athletes from
around the world
• Athletes had varying levels of skill
• Length of event had the potential to
increase injuries seen
• What is different about an equestrian
athlete?
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The Equestrian Athlete
• Commonly exposed
to repetitive trauma
• Head and back
injuries very common.
• At least 13 riders in
the past four years
have been killed and
several others
seriously injured.
WEG 2010
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History of the Games
• Prior to first WEG, each discipline held their own
championships.
– KY Horse Park hosted the Eventing World Championship
in 1978.
– The Championships were held every 4 years
• The concept for the WEG was first proposed in 1983
• First WEG was help in Stockholm in 1990
– Six events: Jumping, Dressage, Eventing, Driving,
Endurance and Vaulting
– Reining was added in 2002
– Para Dressage is new this year to the competition
• This will be the first time the games will be hosted
outside of Europe.
DRESSAGE
DRIVING
ENDURANCE
JUMPING
PARA DRESSAGE
REINING
VAULTING
EVENTING
Eventing
• All around test for the horse and rider
• Three Day Event comprises of
– Dressage Test
– Cross Country Test
– Jumping Test (Stadium jumping)
Cross-Country Eventing
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Injury Potential
31
Primary and Secondary Injuries
32
Chest and Spinal Trauma
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Rider Outcome
• Open Mandible Fracture
• Rib Fractures with Bilateral
Hemopneumothorax
• Scapula and clavicle fractures
• Facial Fractures
• Discharged home after 17 days
• Resumed riding shortly after injury
34
Protective Gear- Air Vest
• Ripcord tethered to horse- when rider
ejected/separated from horse air vest
deployed.
• Inflates when ripcord pulled from CO2
canister.
• Difficult for the rider to breath when the vest
inflates- need to release vest clips as soon
as possible.
• Example from Rolex 2010 – to follow
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Inflatable Vest
Lessons Learned
• Main medical and satellite sites saw 956
patients- mostly minor complaints
• 37 transports- mostly spectators
• Trauma- spectator and athletes
• Cross- country eventing- 8 falls
– 3 athlete transports
• 5 total athlete injuries over course of
event- all non-life threatening
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References
Ball, C. E., Ball, J. E., Kirkpatrick, A. W., & Mulloy, R. H. (2007). Equestrian injuries,
injury patterns, and risk factors for 10 years of major traumatic injuries. The
American Journal of Surgery, 193 (5): 636-640.
Carrillo, E.H., Varnagy, D., Bragg, S. M., Levy. J., & Riordan, K. (2007). Traumatic
injuries associated with horseback riding. Scandinavian Journal of Surgery,96 (1):
79–82.
Centers for Disease Control and Prevention. (2007). Nonfatal traumatic brain injuries
from sports and recreation activities – United States, 2001-2005. Morbidity and
Mortality Weekly Report, July 27, 2007: 29.
Ceroni, D. (2007). Support and safety features in preventing foot and ankle injuries in
equestrian sports. International Sports Medicine Journal, 8(3):166-178.
Loder, R. T. (2008). The demographics of equestrian-related Injuries in the United States:
Injury patterns, orthopedic specific injuries and avenues for injury prevention. The
Journal of Trauma, Injury, Infection and Critical Care, 65(2):447-460.
Mayberry, J. C., Pearson, T.E., Wiger, K.J., Diggs, B. S., & Mullins, R. T. (2007).
Equestrian injury prevention efforts need more attention to novice riders. The
Journal of Trauma, Infection and Critical Care. 62(3):735-739.
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