Bareback Equestrian Trauma: Pubic Symphysiolysis and Abdominal Arterial Hemorrhage

David Spelt, Herman Frima, Lijckle van der Laan
DOI: 10.4236/ss.2011.210108                

Abstract

Pubic symphysiolysis and retroperitoneal arterial vessel rupture after bareback horse riding is a rare traumatic combination. We report a case of a 59-year-old man who experienced severe pubic, abdominal and lower back pain due to a bounce after a asynchronous rhythm of horseback riding without a saddle. The patient was referred to our Emergency Department because of a suspected ruptured abdominal aortic aneurysm. Computer tomography demonstrated diastasis of the pubic symphysis, active bleeding of a branch of the left internal iliac artery and a massive retroperitoneal haematoma. The arterial bleeding was directly coiled in the emergency setting, the stable pubic symphysiolysis was treated conservatively and the haematoma was surgically drained after three days. Bareback horse riding can lead to a pelvic fracture and severe bleeding leading to haemodynamical instability and life threatening situations. Using proper protective equipment including a saddle to prevent equestrian injury should be emphasized.

Keywords

Equestrian, Pubic Symphysiolysis, Hemorrhage, Trauma

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	M. Tile, “Pelvic Ring Fractures: Should They Be Fixed?” British Journal of Bone and Joint Surgery, Vol. 70, No. 1, 1988, pp. 1-12.
[2]	I. Smith, E. V. Jamieson, J. K. Davey and I. J. McDonald, “Pelvic Diastasis from the Saddle: Not to Be Forgotten,” Journal of Trauma, Vol. 53, No. 6, 2002, pp. 1179-1182. doi:10.1097/00005373-200212000-00026
[3]	T. G. Walker, “Acute Gastrointestinal Hemorrhage,” Techniques in Vascular and Interventional Radiology, Vol. 12, No. 2, 2009, pp. 80-91. doi:10.1053/j.tvir.2009.08.002
[4]	J. E. Ball, R. H. Mulloy, I. Datta and A. W. Kirkpatrick, “Ten Years of Major Equestrian injury: are we addressing functional outcomes?” Journal Trauma Management & Outcomes, Vol. 3, No. 2, 2009, p. 2.
[5]	K. A. Thomas, J. L. Annest, J. D. M. Gilchrist, Bixby- Hammett, “Non-Fatal Horse Related Injuries Treated in Emergency Departments in the United States 2001- 2003,” British Journal of Sport Medicine, Vol. 40, No. 7, 2006, pp. 619-626. doi:10.1136/bjsm.2006.025858
[6]	J. C. Mayberry, T. E. Pearson, K. J. Wiger, B. S. Diggs, R. J. Mullins, “Equestrian Injury Prevention Efforts Need More Attention to Novice Riders,” Journal of Trauma, Vol. 62, No. 3, 2007, pp. 735-739. doi:10.1097/ta.0b013e318031b5d4
[7]	E. H. Carrillo, D. Varnagy, S. M. Bragg, J. Levy, K. Riordan, “Traumatic Injuries Associated with Horseback Riding,” Scandinavian Journal of Surgery, Vol. 96, No. 1, 2007, pp. 79-82
[8]	T. L. Loder, “The Demographics of Equestrian-Related Injuries in the United States: Injury Patters, Orthopedic Specific Injuries, and Avenues for Injury Prevention,” Journal of Trauma, Vol. 65, No. 2, 2008, pp. 447-460. doi:10.1097/TA.0b013e31817dac43
[9]	R. McRae and M. Esser, “Practical Fracture Treatment,” 4th Edition, Churchill Livingstone, Philadelphia, 2002.
[10]	A. van Nieuwenhoven, C. van Laarhoven and C. van der Werken, “Pelvic Injuries in Equestrians on Buck Jumping Horses,” Journal of Trauma, Vol. 43, No. 5, 1997, pp. 867-868. doi:10.1097/00005373-199711000-00024
[11]	M. Flynn, “Disruption of Symphysis Pubis While Horse Riding: A Report of Two Cases,” Injury, Vol. 4, No. 4, 1972, pp. 357-358. doi:10.1016/0020-1383(73)90017-X
[12]	J. M. Sorli, “Equestrian Injuries: A Five Year Review of Hospital Admissions in British Columbia, Canada,” Injury Prevention, Vol. 6, 2000, pp. 59-61.
[13]	P. S. Moss, A. Man and M. R. Whitlock, “A Changing Pattern of Injuries to Horse Riders,” Emergency Medicine Journal, Vol. 19, No. 5, 2002, pp. 412-414. doi:10.1136/emj.19.5.412
[14]	G. L. Christey, D. E. Nelson, F. P. Rivara, S. M. Smith and C. Condie, “Horseback Riding Injuries among children And Young Adults,” Journal of Family Practice, Vol. 39, No. 2, 1994, pp. 148-152.