Factors affecting the severity of horse-related injuries

Neurosurgical Injuries Associated with Recreational Horseback Riding: A 6-year Retrospective Analysis

INTRODUCTION

Horseback riding can cause severe brain and spinal injuries. This study aimed to identify the spectrum of neurosurgical injuries related to recreational horseback riding.

METHODS

A retrospective study was performed utilizing the University of Puerto Rico neurosurgery database to identify patients who were consulted to the neurosurgery service between 2018 and 2023 after a horse fall during recreational activities. The outcome upon discharge using the modified Rankin scale (mRS) was documented. Descriptive statistics were used to report frequency and median values.

RESULTS

The neurosurgery service evaluated and managed 112 patients with a horseback riding fall-related injury during 6 years. Ninety-eight (87.5%) patients were male. The patients' median age was 31.5 (IQR 22-40). There were 89 head injuries (79.5%), 19 spinal injuries (17%), and 4 combined head/spine injuries (3.5%). Forty percent of the patients were admitted to inpatient care with a median length of stay of 7 days (IQR 3-17). Twenty-four patients (21%) required surgery. Upon discharge, 86.6% of the patients had an mRS grade of 0-2, 3.6% had a grade of 3, 1.8% had a grade of 4, and 1.8% had a grade of 5. Seven patients (6%) died (mRS grade 6).

CONCLUSIONS

Most neurologic injuries involve isolated trauma to the head. Fifteen percent of the riders' falls were caused after the horse was impacted by a motor vehicle. Forty percent of the patients require admission and 21% undergo surgery. Ten percent of the patients had a poor mRS grade of 4- to 6 when discharged.

Hospital Admissions Associated With Head and Neck Injuries From Olympic-style Sports and Activities Between 2010 and 2022

The objective of this study was to evaluate which Olympic-style sports and activities are most likely to result in hospitalizations relating to head and neck injuries. This was a cross-sectional study using the National Electronic Injury Surveillance System (NEISS) database. Subjects with head and neck injuries from selected Olympic-style sports and activities between 2010 and 2022 were included. Independent variables were demographics and injury characteristics (injury location and sport). The primary outcome variable was hospitalization (yes/no). Survey-weighted descriptive, bivariate, and logistic regression statistics were computed to measure the association between demographic/injury variables and hospitalization. There were 175,995 subjects (national estimate, 5,922,584) meeting inclusion criteria. After adjusting for demographic and injury characteristics, head injuries (odds ratio [OR] = 2.17; 95% CI, 1.83-2.56; P<0.001) demonstrated higher odds of hospitalization compared with facial injuries. Injuries from cycling (OR = 2.52; 95% CI, 2.16-2.95; P<0.001), mountain biking (OR = 2.56; 95% CI, 1.80-3.65; P<0.001), and horseback riding (OR = 4.01; 95% CI, 2.76-5.83; P<0.001) demonstrated higher odds of hospitalization relative to baseball injuries. In conclusion, head and neck injuries associated with high velocity Olympic-style sports and activities such as cycling, mountain biking, and horseback riding had the highest odds of hospitalization.

Camel-Related Facial Injuries: A Seven-Year Retrospective Study

Facial injuries caused by camels can be associated with adverse long-term effects on patients' quality of life. We aimed to investigate camel-related facial injuries in Al-Ain City, UAE, focusing on their incidence, types, mechanisms, anatomical distribution, and outcomes, to enhance preventive measures. We retrospectively collected data from all patients who were admitted to our hospital with camel-related facial injuries from January 2014 through January 2021. Thirty-six patients were included; all were males, with a mean (range) age of 31 (14-66) years, 29 (80.5%) were camel caregivers. The most common mechanisms of injury were falling while riding a camel and camel kicks. The head was the most commonly injured region in 52.7%. Twenty-three (63.8%) patients had facial bone fractures. The middle third of the face accounted for 71.4% of the bony fractures. The most performed surgical procedures in our patients were soft tissue laceration repair and open reduction with internal fixation of fractures (ORIF). Camel-related facial injuries affect young adult male camel caregivers working on camel farms. Orbital and maxillary bone fractures are the most predominant fractures requiring operative management. Legislation for compulsory helmet usage may reduce the incidence of these injuries and their serious consequences.

Horse-related injury patterns: a single center report

BACKGROUND

For ages, humankind and horses have been closely related to occupational and recreational activities. The dangers of engaging with horses have been previously reported. Among sporting activities, horse riding is well-known for its risks. Despite multiple recommendations to wear protective gear, horse-related activities still comprise the risk of severe injuries. This study aimed to examine: (1) if specific mechanisms are correlated to particular injury patterns and (2) if injury types are related to patient demographics.

METHODS

From one level I trauma center, between July 2019 and July 2022 (3 years) all emergency reports and discharge letters were retrospectively reviewed by full-text search regarding horse-related injuries. Patient demographics, body mass index, trauma mechanism, injury types, and initiated treatment were extracted from medical records and analyzed.

RESULTS

During the study period, 95 patients with 99 horse-related injuries were included. The overwhelming majority of the patients was female (93.7%). Age averaged 35.3 years (range 6 to 71). BMI was 23.6 kg/m². Inpatient treatment was required in 60.6%. Length of hospital stay averaged 10 days. Surgical treatment was performed in 55 patients (55.6%). Open reduction and internal fixation was the most common procedure (74.5%). Trauma mechanism was fall from a horse followed by being hit by a horse (60.6% and 23.2%, respectively). Injured upper extremities counted up for 52.5% followed by spinal and pelvic injuries (23.2%). Spinal and pelvic injuries were related to fall from a horse (p < 0.001). Injuries to the lower extremities were predominantly caused by a kick of the horse when the rider was unmounted (p = 0.001) and negatively related to a fall from a horse (p = 0.002). Ten patients got their fingers tangled while holding the reins and suffered from injuries to the upper extremity (p < 0.001). Three of them required an amputation (30%).

CONCLUSION

Despite the fact that patients are young and healthy, horse related injuries must not be underestimated. In our study, almost two-thirds of the patients required inpatient treatment and 50% underwent surgery. We could show that patient age was related to injury severity according to the Abbreviated Injury Scale (AIS). Spinal and pelvic injuries were significantly related to a fall from a horse with a significantly greater trauma impact according to the AIS. Therefore, these severe entities need to be ruled out in such events. Accidents caused by holding the reins, may result in serious injuries to the hand with 30% requiring an amputation. Doctors need to be aware of possible horse-related injury patterns to reduce morbidity.

Horseback Riding-Related Injuries in Portugal and Prevention Strategies

CONTEXT

Horse riding (HR) has gain popularity in Portugal, thereby increasing the number of related injuries. This study identifies frequently occurring injuries in Portuguese riders, the conditions under which they occur, and preventive measures.

DESIGN

A retrospective cohort study.

METHODS

We included 216 Portuguese riders practicing HR at the time of the study with ≥1 year of experience. Data were obtained from a questionnaire that characterized first and second rider injuries; we opted for a systematic method to assess the riders' injuries, in a temporal order. Questions regarding demographic data, sports-related background, systematic training workload, number and characteristics of the first 2 injuries, and the need for treatment were included in the questionnaire.

RESULTS

Most first and second injuries were musculoskeletal, occurred from falling off the horse during training, and primarily affected the lower limb. Rehabilitation was required in almost 50% of all cases. The occurrence of injury was significantly associated with the number of days of training per week, years of experience, height and weight of the rider, and practice of another sport. Riding different horses was also significantly associated with the number of injuries.

CONCLUSIONS

The most frequently occurring injuries during HR are musculoskeletal and in the extremities. Injury prevention is essential in HR, as most riders have at least one injury while practicing. Rehabilitation should involve a physiatrist and core strengthening exercises.

Epidemiological Study of Equestrian Trauma in Geneva

BACKGROUND

Horse-related activities are increasingly popular among young people but are frequently associated with severe injuries requiring hospital treatment. There are few data on the incidence of equestrian injuries, especially in child populations, or on means of prevention. Thus, this study's purpose was to highlight the epidemiological data on specific injuries due to equestrianism and serve as the groundwork for future studies on the prevention of equestrian accidents.

METHODS

A retrospective study collected data on all children younger than 16 years old who attended our regional emergency department after involvement in an equestrian accident. The study covered the periods from 1990 to 2003 and 2011 to 2018. Twenty-two years of data on trauma circumstances, injury patterns (mechanism, anatomic site, and severity), treatment protocols, and hospital lengths of stay were analyzed.

RESULTS

This study confirmed that more young females participating in equestrian sports attended our emergency department than males. The leading cause of equestrian injury was falling from a horse (80.2%). Orthopaedic injuries represented around 60% of all reported lesions, far ahead of head injuries (30%). More than half of the injured children required hospitalization for inpatient medical care, and almost 50% of these underwent a surgical procedure, especially for upper extremity fractures (72% of all fractures). One patient died due to severe cerebral injury.

CONCLUSIONS

Horse riding injuries occur more frequently and are more serious than in many other sporting activities. There is an urgent need to reassess preventive measures to reduce the incidence and severity of equestrian injuries.

LEVEL OF EVIDENCE

Level IV.

Occupational vs. non-occupational equestrians: Differences in demographics and injury patterns

INTRODUCTION

Nineteen million people participate in horseback riding activities in the US, and the horse industry employs more than 460,000 full-time workers. Emergency department data suggest young female amateurs and male professionals are most at risk of death from horse-related injuries. However, there has been no investigation into factors that may increase severe injury and mortality risk in these populations. This study investigates demographics and injury pattern differences between occupational and non-occupational horse-related injuries in the US.

METHODS

The 2017 American College of Surgeons National Trauma Databank (ACS NTDB) was analyzed for horse-related injury using ICD 10 codes. Demographics, injury data, protective device use, and hospital procedures were analyzed. Occupational versus non-occupational injuries based on incident location (farm, sports, recreational, residential) were compared using ANOVA or Pearson's Chi-squared test.

RESULTS

Of 3911 incidents, the most common injury mechanism was falling from the horse, but occupational and non-occupational farm injuries showed higher incidence of being struck by a horse. One-third required surgery. Upper extremity injuries were most common. Occupational injuries more often affected upper extremities of working age, minority males with commercial insurance. Non-occupational injuries most often affected heads of women at the extremes of age. Helmet use was higher in occupational, non-occupational sports, and non-occupational recreation injuries, and severe head injury incidence was decreased in these groups. Complications and discharge dispositions were not different across groups.

CONCLUSIONS

In the largest trauma center study to date, we have shown equine-related trauma to be common and affect a predictable demographic that may permit injury prevention initiatives. Helmets may reduce severe head injury, but the efficacy of protective clothing remains to be validated.

Severe injury to the brachial neurovascular bundle and muscles due to a horse bite: a case report

Introduction

Only a small portion of horse injuries are related to horse bites. In the majority of these occurrences, injuries are minor and self-treated. However, in some cases, the injury may be destructive and limb- and life-threatening. In these instances, the patient requires complex surgery and compound perioperative care.

Case report

We present the case of a 35-year-old Albanian male farm-worker in whom a horse bite caused an extensive lacero-contusive and avulsive wound to the arm. The wound resulted in injury to the brachial artery, brachial and basilic vein, and biceps and brachialis muscles. Nerve structures and underlying humerus remained intact. The initial management of the severe hemorrhagic shock caused by the bleeding at the site of injury included reconstruction of the brachial artery by interposing saphenous graft and that of the brachial vein by termino-terminal anastomosis. Basilic vein was ligated. The wound was extensively debrided, and after a drain was placed in the wound, biceps and brachialis muscles were reconstructed. The patient received several units of red blood cells and fresh frozen plasma before and after surgery, as well as antibiotic, antitetanic, and antirabies prophylaxes. He had several consecutive necrectomies in the following days. However, due to postoperative sepsis and hemorrhagic shock at time of admission, the patient developed acute renal failure, therefore requiring several hemodialysis sessions. After his general and local condition was stabilized, the patient also underwent several reconstructive surgeries.

Conclusion

Horse bites of large extent require a multidisciplinary approach. The composition of the team of physicians needed for treatment varies depending on the degree of the injury and eventual complications. In the case of our patient, emergency department physicians, vascular and plastic surgeons, intensive care specialists, nephrologists, and infective care specialists were involved. In different instances, the inclusion of other specialists may be necessary to save and functionalize the limbs of the patient, or save his/her life.

A new approach to recording nasal fracture in skeletonized individuals

OBJECTIVE

This work describes a new method for recording nasal fracture in skeletonized individuals, suitable for use in biocultural studies of violence and fracture in past societies.

METHODS

The method consists in recording the 'side of fracture', 'side of deviation', 'type of fracture', 'other facial fractures', and stage of 'bone remodeling'.

RESULTS

A lateral impact force to the facial area is typical of interpersonal violence. This may result in a unilateral nasal fracture and/or a laterally deviated nose. Given the predominance of right-handedness in human populations, side of fracture and, especially, side of deviation, may be useful indices of interpersonal violence. As regards fracture type, although a distal fracture of the nasal bones is the most common type, their comminution may be associated with higher impact forces. The presence of other facial fractures may also be an indicator of high-energy impacts.

CONCLUSIONS

Different patterns of nasal trauma may be consistent with different etiologies.

SIGNIFICANCE

The method is focused at improving our ability to distinguish the direction and type of impact that caused the injury and, in particular, whether, at a population or sub-group level, such injuries are likely to be predominantly due to violence or to other causes.

LIMITATIONS

Well healed fractures of the nasal bones or injury to the septum may be difficult to identify. Also, it is not possible to confirm if nasal and other facial fractures are temporally concurrent.

SUGGESTIONS FOR FURTHER RESEARCH

To test this method using skeletal collections with known trauma history or 3D prints of modern nasal injuries of known etiologies.

Could a Compliant Foam Anvil Characterize the Biofidelic Impact Response of Equestrian Helmets?

The performance of equestrian helmets to protect against brain injuries caused by fall impacts against compliant surfaces such as turf has not been studied widely. We characterize the kinematic response of simulated fall impacts to turf through field tests on horse racetracks and laboratory experiments. The kinematic response characteristics and ground stiffness at different going ratings (GRs) (standard measurement of racetrack condition) were obtained from 1 m and 2 m drop tests of an instrumented hemispherical impactor onto a turf racetrack. The "Hard" rating resulted in higher peak linear accelerations and stiffness, and shorter impact durations than the "Soft" and "Heavy" ratings. Insignificant differences were found among the other GRs, but a strong overall relationship was evident between the "going rating" and the kinematic response. This relationship was used to propose a series of three synthetic foam anvils as turf surrogates in equestrian falls corresponding to ranges of GRs of (i) heavy-soft (H-S), (ii) good-firm (G-F), and (iii) firm-hard (F-H). Laboratory experiments consisted of a helmeted headform being dropped onto natural turf and the turf surrogate anvils using a monorail drop rig. These experiments revealed that the magnitudes and durations of the linear and rotational accelerations for helmeted impacts to turf/turf surrogates were similar to those in concussive sports falls and collisions. Since the compliance of an impacted surface influences the dynamic response of a jockey's head during a fall impact against the ground, it is important that this is considered during both accident reconstructions and helmet certification tests.

An Evidence Basis for Future Equestrian Helmet Lateral Crush Certification Tests

The aim of this study is to determine what loads are likely to be applied to the head in the event of a horse falling onto it and to determine by how much a typical equestrian helmet reduces these loads. An instrumented headform was designed and built to measure applied dynamic loads from a falling horse. Two differently weighted equine cadavers were then dropped repeatedly from a height of 1 m (theoretical impact velocity of 4.43 m/s) onto both the un-helmeted and helmeted instrumented headforms to collect primary force–time history data. The highest mean peak loads applied to the headform by the lighter horse were measured at the bony sacral impact location (15.57 kN ± 1.11 SD). The lowest mean peak loads were measured at the relatively fleshier right hind quarter (7.91 kN ± 1.84 SD). For the heavier horse, highest mean peak loads applied to the headform were measured at the same bony sacral impact location (16.02 kN ± 0.83 SD), whilst lowest mean peak loads were measured at the more compliant left hind quarter (10.47 kN ± 1.08 SD). When compared with the un-helmeted mean values, a reduction of 29.7% was recorded for the sacral impact location and a reduction of 43.3% for the lumbosacral junction location for helmeted tests. Notably, all measured loads were within or exceeded the range of published data for the fracture of the adult lateral skull bone. Current helmet certification tests are not biofidelic and inadequately represent the loading conditions of real-world “lateral crush” accidents sustained in equestrian sports. This work presents the first ever evidence basis upon which any future changes to a certification standards test method might be established, thereby ensuring that such a test would be both useful, biofidelic, and could ensure the desired safety outcome.

Do equestrian helmets prevent concussion? A retrospective analysis of head injuries and helmet damage from real-world equestrian accidents

OBJECTIVES

To collect and analyse helmets from real-world equestrian accidents. To record reported head injuries associated with those accidents. To compare damage to helmets certified to different standards and the injuries associated with them.

METHODS

Two hundred sixteen equestrian helmets were collected in total. One hundred seventy-six helmets from amateur jockeys were collected via accident helmet return schemes in the UK and USA, while 40 helmets from professional jockeys were collected by The Irish Turf Club. All helmet damage was measured, and associated head injury was recorded.

RESULTS

Eighty-eight percent (189) of equestrian fall accidents returned an injury report of which 70% (139) reported a head injury. Fifty-four percent (75) of head injury cases had associated helmet damage while 46% had no helmet damage. Reported head injuries consisted of 91% (126) concussion, 4% (6) skull fractures, 1 (0.7%) subdural hematoma, 1 (0.7%) cerebral edema and 5 (3.6%) diffuse axonal injury (DAI). It is also shown that helmets certified to the most severe standard are overrepresented in this undamaged group (p <0.001).

CONCLUSIONS

It is clear that despite jockeys wearing a helmet, large proportions of concussion injuries still occur in the event of a jockey sustaining a fall. However, the data suggest it is likely that helmets reduce the severity of head injury as the occurrence of skull fracture is low. The proportion of undamaged helmets with an associated head injury suggests that many helmets may be too stiff relative to the surface they are impacting to reduce the risk of traumatic brain injury (TBI). It may be possible to improve helmet designs and certification tests to reduce the risk of head injury in low-severity impacts.

The influence of impact surface on head kinematics and brain tissue response during impacts with equestrian helmets

Current equestrian standards employ a drop test to a rigid steel anvil. However, falls in equestrian sports often result in impacts with soft ground. The purpose of this study was to compare head kinematics and brain tissue response associated with surfaces impacted during equestrian accidents and corresponding helmet certification tests. A helmeted Hybrid III headform was dropped freely onto three different anvils (steel, turf and sand) at three impact locations. Peak linear acceleration, rotational acceleration and impact duration of the headform were measured. Resulting accelerations served as input into a three-dimensional finite element head model, which calculated Maximum principal strain (MPS) and von Mises stress (VMS) in the cerebrum. The results indicated that impacts to a steel anvil produced peak head kinematics and brain tissue responses that were two to three times greater than impacts against both turf and sand. Steel impacts were less than half the duration of turf and sand impacts. The observed response magnitudes obtained in this study suggest that equestrian helmet design should be improved, not only for impacts to rigid surfaces but also to compliant surfaces as response magnitudes for impacts to soft surfaces were still within the reported range for concussion in the literature.

Equestrian-related injuries, predictors of fatalities, and the impact on the public health system in Sweden

OBJECTIVES

Horse riding is a popular activity but has also been found to lead to many injuries and even fatalities. No reduction in the numbers of those being admitted to hospital for equestrian-related injuries have been seen in Sweden in recent years. The aim of this work was to examine injuries, fatalities, and predictors of fatalities in equestrian-related activities and to investigate the cost of these injuries to the public health system.

STUDY DESIGN

The study is a retrospective analysis of hospital data.

METHODS

National Swedish hospital and mortality registers were retrospectively examined, inclusive of the years 1997-2014. Logistic regression was used to examine the predictors of fatal injuries, and cost of hospital treatment was considered.

RESULTS

Over the study period, there were an observed 29,850 injured cases and 51 fatalities. Women comprized almost 90% of those injured and 70% of fatalities. The average age was 26.8 years (range 0-91, standard deviation [SD] = 16.1) for injured and 43 years (range 7-78 years, SD = 20.5) for fatal cases. Men dominated both injured and fatal samples in the older age ranges (Fatal: >50 years; Injured: >70 years), although overall numbers were small. Injuries to the head contributed more than any other body region for both injured and fatal cases, and fractures were the most frequently seen injury type. A chi-squared analysis confirmed that injury type and injured body region were not independent of age. Logistic regression examining the association between fatality and age, gender, home region, and year of injury, indicating trends over time, found that there was an increase of 5.1% in the odds of fatality for every year increase in age of the patient and men had 2.2 times higher odds to be in the fatal sample than women. The conservative estimated cost of injury was 1800 Euro per injury event, equating to over 3 million Euro per year.

CONCLUSION

Equestrian-related injury events present a major public health concern. Observed decreases in fatalities suggest improved health care, yet head injury and fatality rates are still high, indicating a need for further intervention. The type of injury changes with the age group, and a better understanding of injury patterns with age is needed to identify protective measures for the different user groups.

Assessing the risk for major injuries in equestrian sports

Background/aim

Horse riding is a popular sport, which bears the risk of serious injuries. This study aims to assess whether individual factors influence the risk to sustain major injuries.

Methods

Retrospective data were collected from all equine-related accidents at a German Level I Trauma Centre between 2004 and 2014. Logistic regression was used to identify the risk factors for major injures.

Results

770 patients were included (87.9% females). Falling off the horse (67.7%) and being kicked by the horse (16.5%) were the two main injury mechanisms. Men and individuals of higher age showed higher odds for all tested parameters of serious injury. Patients falling off a horse had higher odds for being treated as inpatients, whereas patients who were kicked had higher odds for a surgical therapy (OR 1.7) and intensive care unit/intermediate care unit (ICU/IMC) treatment (OR 1.2). The head was the body region most often injured (32.6%) and operated (32.9%). Patients with head injuries had the highest odds for being hospitalised (OR 6.13). Head or trunk injuries lead to the highest odds for an ICU/IMC treatment (head: OR 4.37; trunk: OR 2.47). Upper and lower limb injuries showed the highest odds for a surgical therapy (upper limb: OR 2.61; lower limb: OR 1.7).

Conclusion

Risk prevention programmes should include older individuals and males as target groups. Thus a rethinking of the overall risk assessment is necessary. Not only horseback riding itself, but also handling a horse bears a relevant risk for major injuries. Serious head injures remain frequent, serious and an important issue to be handled in equestrians sports.

Horse-related incidents and factors for predicting injuries to the head

Objectives

Head injuries are the leading cause of death in horse-related injury events and, even since the introduction of helmets, represent a sizeable proportion of all horse-related injuries. Falls from horseback and kicks to the head are the most frequent type of incident causing head injuries, but it is unknown whether these incidents are predictors of head injury. This study aimed to investigate head injuries and the association between incident type and head injury.

Method

Retrospective review of 7815 horse-related injury events was conducted. Data were gathered from hospitals, local healthcare centres and public dental services in Skaraborg, Sweden. Binary logistic regression was used to analyse the association between the incident type and occurrence of head injury while controlling for risk factors.

Results

Approximately 20% of riders sustained a head injury, mostly soft tissue injuries (56.3%) and concussions (33.4%). A fall from or with the horse was the primary cause of head injury (63.9%). Those who fell from a carriage or other height or who were injured through contact with the horse had no difference in the likelihood of head injury when compared with those that fell from or with the horse. However, those who sustained an injury without any horse contact had lower odd of head injury (OR: 0.640, p<0.00005, 95% CI 0.497 to 0.734). Additionally, the older the rider, the lower the odds of head injury (OR=0.989, p<0.00005, 95% CI 0.985 to 0.993).

Conclusion

Improved protection for those suffering falls from horseback as well as those who are kicked in the head should be investigated.

Markers of Bone Health, Bone-Specific Physical Activities, Nutritional Intake, and Quality of Life of Professional Jockeys in Hong Kong

Weight-making practices, regularly engaged in by horse racing jockeys, have been suggested to impair both physiological and mental health. This study aimed to assess bone health markers, nutritional intake, bone-specific physical activity (PA) habits, and quality of life of professional jockeys in Hong Kong (n = 14), with gender-, age-, and body mass index-matched controls (n = 14). Anthropometric measurements, serum hormonal biomarkers, bone mineral density, bone-specific PA habits, nutritional intake, and quality of life were assessed in all participants. The jockey group displayed significantly lower bone mineral density at both calcanei than the control group (left: 0.50 ± 0.06 vs. 0.63 ± 0.07 g/cm²; right: 0.51 ± 0.07 vs. 0.64 ± 0.10 g/cm², both ps < .01). Thirteen of the 14 jockeys (93%) showed either osteopenia or osteoporosis in at least one of their calcanei. No significant difference in bone mineral density was detected for either forearm between the groups. The current bone-specific PA questionnaire score was lower in the jockey group than the control group (5.61 ± 1.82 vs. 8.27 ± 2.91, p < .05). Daily energy intake was lower in the jockeys than the controls (1,360 ± 515 vs. 1,985 ± 1,046 kcal/day, p < .01). No significant group difference was found for micronutrient intake assessed by the bone-specific food frequency questionnaire, blood hormonal markers, and quality of life scores. Our results revealed suboptimal bone conditions at calcanei and insufficient energy intake and bone-loading PAs among professional jockeys in Hong Kong compared with healthy age-, gender-, and body mass index-matched controls. Further research is warranted to examine the effect of improved bone-loading PAs and nutritional habits on the musculoskeletal health of professional jockeys.

Hospital-treated injuries from horse riding in Victoria, Australia: time to refocus on injury prevention?

BACKGROUND

The most recent report on hospital-treated horse-riding injuries in Victoria was published 20 years ago. Since then, injury countermeasures and new technology have aimed to make horse riding safer for participants. This study provides an update of horse-riding injuries that required hospital treatment in Victoria and examines changes in injury patterns compared with the earlier study.

METHODS

Horse-riding injuries that required hospital treatment (hospital admission (HA) or emergency department (ED) presentations) were extracted from routinely collected data from public and private hospitals in Victoria from 2002-2003 to 2015-2016. Injury incidence rates per 100 000 Victorian population per financial year and age-stratified and sex-stratified injury incidence rates are presented. Poisson regression was used to examine trends in injury rates over the study period.

RESULTS

ED presentation and HA rates were 31.1 and 6.6 per 100 000 person-years, increasing by 28.8% and 47.6% from 2002 to 2016, respectively. Female riders (47.3 ED and 10.1 HA per 100 000 person-years) and those aged between 10 and 14 years (87.8 ED and 15.7 HA per 100 000 person-years) had the highest incidence rates. Fractures (ED 29.4%; HA 56.5%) and head injuries (ED 15.4%; HA 18.9%) were the most common injuries. HA had a mean stay of 2.6±4.1 days, and the mean cost per HA was $A5096±8345.

CONCLUSION

Horse-riding injuries have remained similar in their pattern (eg, types of injuries) since last reported in Victoria. HA and ED incidence rates have increased over the last 14 years. Refocusing on injury prevention countermeasures is recommended along with a clear plan for implementation and evaluation of their effectiveness in reducing injury.

Sport-Related Traumatic Brain Injury with and without Helmets in Children

BACKGROUND

Soccer, bicycling, and horseback riding are sports most commonly associated with traumatic brain injury (TBI) in Germany. The latter 2 sports activities are commonly practiced with helmets, and data on helmet use and usefulness vary widely.

METHODS

On Ethics Committee approval, a retrospective analysis was performed for patients age 5-17 between January 2009 and August 2014 based on a diagnosis of TBI, using the electronic patient file for 2 university hospital locations. Descriptive data analysis and multivariate and univariate logistic regression were used to calculate odds ratios (ORs).

RESULTS

A total of 380 children were identified, including 162 females (42.6%) and 218 males (57.4%), with a mean age of 11.9 ± 3.8 years. Activities included bicycling (n = 64), horseback riding (n = 19), and soccer (n = 16). Helmet use was documented in 26 patients (14 cyclists, 12 riders), and nonuse was documented in 20 (all cyclists). Compared with not wearing a helmet, wearing a helmet was associated with a trend toward lower odds of loss of consciousness (OR, 0.7; 95% confidence interval [CI], 0.18-2.52). A cohort of 251 patients with non-sports-related TBI (NSTBI) served as a control group for further analyses. Compared with the NSTBI group, the odds of amnesia were 2.9 times greater (95% CI, 1.1-21.6) in the patients with a riding-related TBI and 4.8 times greater (95% CI, 0.3-239) in those with a cycling-related TBI, and the odds of epidural hematoma were 2.2 times greater (95% CI, 0.4-12.3) in those with a cycling-related TBI and 4.9 times greater (95% CI, 0.5-50.4) greater in those with a soccer-related TBI.

CONCLUSIONS

We gained important epidemiologic data on pediatric TBI in our region. Despite the descriptive nature of the data, a trend toward reduced odds of loss of consciousness was seen in the helmet wearers. Nevertheless, serious injury can occur despite helmet use.

Paediatric horse-related trauma

AIM

This retrospective cohort study reported on the epidemiology of horse-related injuries for patients presenting to the only tertiary paediatric trauma hospital in Queensland. The secondary outcome was to examine the use of helmets and adult supervision. Traumatic brain injury (TBI) was examined in relation to helmet use. Morbidity and mortality were also recorded.

METHODS

Included were all patients presenting with any horse-related trauma to the Royal Children's Hospital in Brisbane from January 2008 to August 2014. Data were retrospectively collected on patient demographics, hospital length of stay (LOS), mechanism of injury (MOI), safety precautions taken, diagnoses and surgical procedures performed.

RESULTS

Included in the analysis were 187 incidents involving 171 patients. Most patients were aged 12-14 years (36.9%) and female (84.5%). The most common MOI were falls while riding horses (97.1%). Mild TBI (24.6%) and upper limb fractures (20.9%) were common injuries sustained. Patients who wore helmets had significantly reduced hospital LOS and severity of TBI when compared with those who did not wear helmets (P < 0.001 and P = 0.028, respectively). Morbidity was reported in 7.5% of patients. There were three deaths in Queensland.

CONCLUSION

Helmet use is recommended for non-riders when handling horses, in addition to being a compulsory requirement whilst horse riding. Prompts in documentation may assist doctors to record the use of safety attire and adult supervision. This will allow future studies to further investigate these factors in relation to clinical outcomes.

Danger on the Farm: A Comparison of Agricultural and Animal-Related Injuries

Animal-related injuries are common in rural areas. Agricultural workers can suffer severe injuries involving farm machinery or falls. The spectrum of injuries related to rural activities is poorly defined and characterizing these injuries will improve injury prevention efforts. Records for injured patients admitted between 2010 and 2013 were retrospectively reviewed. Patients with a mechanism of injury involving a large animal or with the injury site listed as “farm” were included. Patients with agricultural injuries (n = 85) were older with more multisystem injuries than patients injured by animals (n = 132) but the Injury Severity Score was equivalent. There was no difference in intensive care unit length of stay, ventilator days, or mortality. There was no difference in frequency of solid organ injury, pelvic fractures, rib fractures, or hemo- or pneumothorax between groups. Animal injuries had more frequent traumatic brain injuries (22.4% vs 10.5%, P = 0.03), whereas agricultural injuries had more vertebral fractures (20.5% vs 9.2%). Of toxicology screens performed, 25 per cent (22/88) were positive. No significant differences were found between occupational versus recreational animal injuries. Agricultural and animal-related injuries have different characteristics but Injury Severity Score and mortality were similar. Severe injuries from both mechanisms are common in rural communities and injury prevention activities are needed in both settings.

Factors Influencing the Safety Behavior of German Equestrians: Attitudes towards Protective Equipment and Peer Behaviors

Simple Summary

The handling and riding of horses can be quite dangerous. Although the use of protective gear among equestrians is increasing, a high number of incidents occur and the voluntary use of safety equipment is described as inconsistent to low. Therefore, this study looks at the safety behavior of German equestrians and at factors influencing this behavior to decrease the high number of horse-related injuries. The results reveal that attitudes towards safety products as well as the protective behavior of other horse owners and riding pupils from the stable are key factors that might alter the safety behavior of equestrians.

Abstract

Human interactions with horses entail certain risks. Although the acceptance and use of protective gear is increasing, a high number of incidents and very low or inconsistent voluntary use of safety equipment are reported. While past studies have examined factors influencing the use of safety gear, they have explored neither their influence on the overall safety behavior, nor their relative influence in relation to each other. The aim of the present study is to fill this gap. We conducted an online survey with 2572 participants. By means of a subsequent multiple regression analysis, we explored 23 different variables in view of their influence on the protective behavior of equestrians. In total, we found 17 variables that exerted a significant influence. The results show that both having positive or negative attitudes towards safety products as well as the protective behavior of other horse owners or riding pupils from the stable have the strongest influence on the safety behavior of German equestrians. We consider such knowledge to be important for both scientists and practitioners, such as producers of protective gear or horse sport associations who might alter safety behavior in such a way that the number of horse-related injuries decreases in the long term.

Biomechanical modelling of impact-related fracture characteristics and injury patterns of the cervical spine associated with riding accidents

BACKGROUND

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.

METHODS

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.

FINDINGS

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.

INTERPRETATION

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.

Helmet Use Amongst Equestrians: Harnessing Social and Attitudinal Factors Revealed in Online Forums

Equestrian activities pose significant head injury risks to participants. Yet, helmet use is not mandatory in Australia outside of selected competitions. Awareness of technical countermeasures and the dangers of equestrian activities has not resulted in widespread adoption of simple precautionary behaviors like helmet use. Until the use of helmets whilst riding horses is legislated in Australia, there is an urgent need to improve voluntary use. To design effective injury prevention interventions, the factors affecting helmet use must first be understood. To add to current understandings of these factors, we examined the ways horse riders discussed helmet use by analyzing 103 posts on two helmet use related threads from two different Australian equestrian forums. We found evidence of social influence on helmet use behaviors as well as three attitudes that contributed towards stated helmet use that we termed: "I Can Control Risk", "It Does Not Feel Right" and "Accidents Happen". Whilst we confirm barriers identified in previous literature, we also identify their ability to support helmet use. This suggests challenging but potentially useful complexity in the relationship between risk perception, protective knowledge, attitudes, decision-making and behavior. Whilst this complexity is largely due to the involvement of interspecies relationships through which safety, risk and trust are distributed; our findings about harnessing the potential of barriers could be extended to other high risk activities.

Ten Years of Equine-related Injuries: Severity and Implications for Emergency Physicians

BACKGROUND

The size, speed, and unpredictable nature of horses present a significant risk for injury in all equine-related activities.

OBJECTIVE

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.

METHODS

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.

RESULTS

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.

CONCLUSION

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.

A comparison of the position of elite and non-elite riders during competitive show jumping

The purpose of this study was to compare the jumping positions of elite riders (within the top 150 of the British Showjumping rankings) with non-elites (unranked). Video footage of 10 elite and 10 non-elite riders jumping a one stride double combination (a vertical followed by a square oxer) within a 1.20 m competition was analysed. Four angles were measured: the angle between the trunk and the vertical (TRUNKvert), the hip angle (HIP), the angle of the thigh to the horizontal (THIGHhoriz) and the angle of the lower leg to the horizontal (LOWER LEGhoriz). Differences in the angles at five points throughout the double combination and the changes in angles between points were compared using Mann-Whitney U tests. The effect of fence (vertical versus oxer) within groups (elite and non-elite) was also compared. The level of significance was set at P<0.05. HIP angle was significantly smaller on approach to the vertical (P=0.019) and significantly greater when approaching the oxer (P=0.001) for elite riders compared to non-elites. During approach to the oxer compared to the vertical elites had a greater HIP angle (P=0.007), whereas non-elites had smaller HIP (P=0.005) and THIGHhoriz (P=0.005) angles. During suspension, non-elite riders had a greater HIP (P=0.01) over the vertical and smaller LOWER LEGhoriz angle over the oxer (P=0.028) than elite riders. There were significant differences in change in HIP, THIGHhoriz and LOWER LEGhoriz angles between elite and non-elite riders between approach to and suspension over the oxer (P=0.007). During suspension, only elite riders showed an effect of fence with a greater HIP angle (P=0.005) and smaller TRUNKvert angle (P=0.013) over the oxer. Key differences in angles and change in angles exist between elite and non-elite riders. This information is useful in characterising elite rider position and identifying areas of interest for future study.

Factors affecting injury severity of vehicle occupants following road traffic collisions

AIM

We aimed to define factors affecting injury severity of vehicle occupants following road traffic collisions (RTC).

PATIENTS AND METHODS

422 vehicle occupants (343 males, 81.3%) with RTC-related injuries were prospectively studied over 18 months. General linear model was used to test the effect of age, gender, alcohol and drug use, time of injury, mechanism of injury, size and speed of the vehicle, position in the vehicle, seatbelt usage, and air bag deployment on the Injury Severity Score (ISS) of the vehicle occupants.

RESULTS

The mean (range) age of patients was 28.2 (1-78) years and the mean (range) ISS was 7.9 (1-50). Front impact was the most common mechanism of injury (32.9%) followed by rollover (25.6%) and side impact (22.3%). 18.2% used seatbelts. The general linear model was highly significant and showed that mechanism of injury (p<0.0001), speed of the vehicle (p=0.02), and age of the vehicle occupant (p=0.03) significantly affected the Injury Severity Score.

CONCLUSIONS

The mechanism of the RTC, the vehicle speed, and age of the vehicle occupant are the most important factors affecting the severity of road traffic collision injuries. A detailed history of the mechanism of injury is important for alerting clinicians to severity of injury, the need for admission, and workup of the patients. Furthermore, strict speed limit enforcement is an injury prevention priority in our community.

A description of the severity of equestrian-related injuries (ERIs) using clinical parameters and patient-reported outcomes

INTRODUCTION

Despite a number of injury prevention campaigns and interventions, horse riding continues to be a dangerous activity, resulting in more accidents per hour than motorcycling, skiing and football. Injuries are often serious, with one in four patients requiring admission to hospital. This study aims to describe the severity of equestrian-related injuries (ERIs) using both clinical parameters and patient-reported outcomes.

PATIENTS AND METHODS

A retrospective study of all patients aged ≥18 years admitted to The Alfred Hospital between January 2003 and January 2008 with an ERI was performed. Specific clinical data were extracted from the medical record. In addition, a questionnaire was conducted identifying the details of the accident, the required recovery time and levels of ongoing pain and physical disability.

RESULTS

During the study period 172 patients met the inclusion criteria. There were three deaths (2%). Eighty-two patients (48%) suffered head injuries. Forty-one patients (24%) were admitted to the ICU and 31 patients (18%) required mechanical ventilation. On discharge, 41 patients (24%) required transfer to a sub-acute rehabilitation facility. One-hundred-and-twenty-four patients (72%) completed the questionnaire. Thirty-nine respondents (31%) were not wearing a helmet. Among patients injured for more than 6 months, 38 (35%) still experienced moderate or severe pain or disability. Ninety-five patients had returned to work at the time of review, among which 47(50%) required longer than 6 months to recover, and 40 (42%) returned at a reduced capacity.

CONCLUSIONS

The clinical and patient-reported outcomes of ERIs requiring hospital admission are poor. Persistent pain and disability are common, even up to 5 years post-injury. A large proportion of patients required longer than 6 months to return to work and many return at a reduced capacity.

Open Fracture of the Forearm Bones due to Horse Bite

Introduction:

Fractures have been described mainly following falling accidents in horse-related injuries. Horse bites are uncommon accidents. We present a case of open fracture of the forearm due to horse bite.

Case Report:

A 35-year-old male farm-worker presented to the emergency room with alleged history of horse bite to the right forearm about 2 hours prior to presentation while feeding the horse. There was deformity of the forearm with multiple puncture wounds, deep abrasions and small lacerations on the distal-third of the forearm. Copious irrigation with normal saline was done and he was administered anti-tetanus and postexposure rabies prophylaxis. Prophylactic antibiotic therapy was commenced. Radiographs revealed fracture of radius and ulna in the mid-shaft region. He underwent emergency wound debridement, and the ulna was stabilised with an intra-medullary square nail. Seventy-two hours later, he underwent re-debridement and conversion osteosynthesis. He had an uneventful recovery and at three-month follow-up, the fractures had healed radiographically in anatomic alignment. At two-year follow-up, he is doing well, is pain free and has a normal range of motion compared to the contralateral side.

Conclusion:

Horse bites behave as compound fractures however rabies prophylaxis will be needed and careful observation is needed. Early radical debridement, preliminary skeletal stabilisation, re-debridement and conversion osteosynthesis to plate, and antibiotic prophylaxis were the key to the successful management of our patient.

The effects of kinesio tape on isokinetic muscular function of horse racing jockeys

[Purpose] The purpose of this study was to conduct a scientific analysis of the effectiveness of Kinesio taping at preventing injury and improving horse racing jockey' performance, by studying the effects on isokinetic muscular function of Kinesio taping applied to the knee joint muscle. [Subjects] Eight horse racing jockeys were selected for this study. [Methods] Measurement of isokinetic muscular function of both flexor and extensor muscles was performed at the angular velocities of 60°/sec and 180°/sec using a Biodex system 3, before and after application of Kinesio taping to the rectus femoris, vastus medialis, vastus lateralis, and hamstring. [Result] At the angular velocities of 60°/sec and 180°/sec, significant differences were observed in both flexor and extensor peak torque, average power, and total work of the knee joint after application of Kinesio taping. [Conclusion] The application of Kinesio taping has a positive effect on the function of both knee flexors and extensors, and also kinetic ability. Therefore, its use would lead to a significant increase in the muscle function of horse racing jockeys.

Camel-related pancreatico-duodenal injuries: a report of three cases and review of literature

BACKGROUND

Human pancreatico-duodenal injuries caused by camels are extremely rare.

OBJECTIVE

We report three patients who sustained camel-related pancreatico-duodenal injuries and review the literature on this topic.

RESULTS

A 32-year camel caregiver was kicked by a camel which then stepped on his abdomen trying to kill him. The patient's abdomen was soft and lax. CT scan of the abdomen showed free retroperitoneal air. Laparotomy revealed a complete tear of the anterior wall of the second part of duodenum which was primarily repaired. A 40-year camel caregiver was directly kicked into his abdomen by a camel. He developed traumatic pancreatitis which was treated conservatively. A 31-year-old male fell down on his abdomen while riding a camel. Abdominal examination revealed tenderness and guarding. Abdominal CT Scan showed complete transection of the neck of the pancreas which was confirmed by laparotomy. The patient had distal pancreatectomy with preservation of the spleen. All patients were discharged home in good condition.

CONCLUSION

These cases demonstrate the misleading presentation of the camel-related pancreatico-duodenal injuries and their unique mechanism of injury.

Nonfatal sport-related craniofacial fractures: characteristics, mechanisms, and demographic data in the pediatric population

BACKGROUND

Few reports exist on sport-related craniofacial fracture injuries in the pediatric population. Most patients with craniofacial injuries are adults, and most studies on pediatric sport injuries do not focus specifically on craniofacial fractures. The authors' goal was to provide a retrospective, descriptive review of the common mechanisms of sport-related craniofacial injuries in the pediatric population, identifying the characteristics of these injuries and providing a description of the demographics of this population.

METHODS

The study population included children between the ages of 0 and 18 years who were seen in the emergency department at Children's Hospital of Pittsburgh of the University of Pittsburgh Medical Center between 2000 and 2005. Of the 1508 patients identified, 167 had injuries caused by sport-related trauma (10.6 percent).

RESULTS

After evaluation in the emergency department, 45.5 percent were hospitalized, and 15.0 percent of these were admitted to the intensive care unit. The peak incidence of sport-related injuries occurred between the ages of 13 and 15 years (40.7 percent). Nasal (35.9 percent), orbital (33.5 percent), and skull fractures (30.5 percent) were most common, whereas fractures of the maxilla (12.6 percent), mandible (7.2 percent), zygomaticomaxillary complex (4.2 percent), and naso-orbitoethmoid complex (1.2 percent) were observed less frequently. Baseball and softball were most frequently associated with the craniofacial injuries (44.3 percent), whereas basketball (7.2 percent) and football (3.0 percent) were associated with fewer injuries. The most common mechanisms of injury were throwing, catching, or hitting a ball (34.1 percent) and collision with other players (24.5 percent).

CONCLUSION

These data may allow targeted or sport-specific craniofacial fracture injury prevention strategies.

Camel-related injuries: prospective study of 212 patients

BACKGROUND

Camel-related injuries have been less well studied than other animal-related injuries. We aimed to study prospectively the incidence, mechanism, distribution of injury, and outcome of patients admitted to hospital with camel-related injuries in Al-Ain, United Arab Emirates.

METHODS

All patients who were admitted to Al-Ain Hospital with a camel-related injury were prospectively studied during the period of October 2001 to January 2010. Patient's demography, time of injury, mechanism of injury, and distribution and severity of injury were studied.

RESULTS

A total of 212 patients, all male, with a median age of 28 years (5-89 years) were studied. The estimated incidence of hospitalized camel-related injured patients in Al-Ain City was 6.88 per 100,000 population per year. Camel kicks were most common (36.8 %) followed by a fall from a camel (26.4 %) and camel bites (25.0 %). Camel kicks and falling from a camel were more common during the hot month of August, and camel bites were more common during the rutting season (November to February). Patients with a kick-related injury had a significantly higher rate of maxillofacial fractures compared with other mechanisms. Spinal injuries occurred significantly more often in vehicle occupants who collided with camels compared with other mechanisms (3/7 compared with 7/205, p = 0.0022, Fisher's exact test). Twelve patients (5.7 %) were admitted to the intensive care unit. The mean hospital stay was 8.6 days (1-103 days). Two patients died (overall mortality 1 %).

CONCLUSIONS

Understanding the biomechanisms and patterns of injury and correlating them with the behavior of the camel is important for identification and prevention of camel-related injuries.

Prevention of child camel jockey injuries: a success story from the United Arab Emirates

OBJECTIVE

To study the effects of a law banning children from taking part in camel racing on child camel jockey injuries in Al-Ain City, United Arab Emirates.

DESIGN

Prospective study.

SETTING

University Teaching Hospital.

PATIENTS

All patients who were admitted to Al-Ain Hospital and were injured while riding camels were prospectively studied between January 1, 2002, and December 31, 2009.

ASSESSMENT OF RISK FACTORS

Two periods, before the law and after its introduction, were compared.

MAIN OUTCOME MEASURES

Pediatric injuries, their anatomical distribution, and severity of injury.

RESULTS

Fifty-four patients were studied, and all were males. There were 13 children and 41 adults. All children were camel jockeys except 1 child who was riding a camel for fun. None of the adult camel riders was a camel jockey. The median (range) age of patients admitted before the law was 12.5 (5-45) years, which was significantly less compared with 27.2 (20-40) years after its introduction (P = 0.001, Mann-Whitney test). All 13 children sustained their injuries before the law was implemented, whereas 12 of 41 adults sustained their injuries before the legislation was in place (P < 0.0001, Fisher exact test). The total length of hospital stay of patients was significantly reduced after the law enforcement (P < 0.01, Mann-Whitney test).

CONCLUSIONS

Our findings emphasize the important role of law enforcement in injury prevention, illustrated by the replacement of children by robot substitutes. This is possibly one of the few examples where child injury has been completely prevented by legislation.

Camel bite injuries in United Arab Emirates: a 6 year prospective study

PURPOSE

To prospectively study the incidence, mechanism, distribution of injury, and outcome of patients admitted to Al-Ain Hospital with camel bite injuries in Al-Ain, United Arab Emirates.

METHODOLOGY

All patients admitted to Al-Ain Hospital with a camel bite were prospectively studied during the period of October 2001-October 2007. Patient's demography, mechanism of injury including behaviour of the camel, distribution and severity of injury, and outcome were studied.

RESULTS

33 patients were studied having a median (range) age of 27 (10-58), all were males. 97% were from the Indian subcontinent. A majority of injuries (73%) occurred during the camel rutting season (November-March). Twenty-five patients were camel caregivers whilst five were camel jockeys. All camel jockeys were children. Seven patients were raised up by the camel's mouth and thrown to the ground whilst 26 patients were only bitten. Most injuries were in the upper limb (64%) and head and face (15%). 48% of upper limb injuries had associated fractures. Two patients who were bitten at the neck were admitted to the ICU. One of these died due to massive left-brain infarction and the other had complete quadriplegia due to spinal cord injury. The median hospital stay was 6 days. There was only one death (3%).

CONCLUSION

The behaviour of the camel is occasionally unpredictable, especially during the rutting season. The mechanism of camel bite injuries, which are usually severe, are complex including penetrating and crushing injuries by the camel jaw and blunt injuries when patients are picked up and thrown away. Care should be taken when handling camels, particularly in the rut.

Home and other nontraffic injuries among children and youth in a high-income Middle Eastern country: a trauma registry study

A trauma registry in the United Arab Emirates was used to ascertain nontraffic injuries of 0- to 19-year-olds. The registry's value for prevention was assessed. A total of 292 children and youth with nontraffic injuries were admitted for >24 hours at surgical wards of the main trauma hospital in Al Ain region during 36 months in 2003-2006. Injuries were analyzed by external cause, location, body part, and severity. Nontraffic represented 60% (n = 292) of child and youth injuries. Incidence/100 000 person-years was 91 for males, 43 for females. Unintentional included falls 65% (n = 191), burns 17% (n = 49), animal-related (mainly camel) 3% (n = 10), and others 10% (n = 29). Intentional accounted for 4% (n = 13). Falls affected all ages, burns mainly 1- to 4-year-olds. Of the injuries, 70% occurred at home. Most frequent and severe injuries measured by the Injury Severity Score and Abbreviated Injury Scale involved extremities. Prevention of home falls for all ages and burns of 1- to 4-year-olds are priorities. Registries should cover pediatric wards and include data on fall locations and hazardous products.

Separating a horse from the social group for riding or training purposes: a descriptive study of human-horse interactions

The aim of this study was to investigate how difficult it was to halter and separate a horse (Equus caballus) from a group for riding or training purposes and to describe how human-horse interactions could affect this common procedure. A total of 20 different horse groups, with a minimum of five horses in each, were studied on 14 farms in Norway, from June to October 2007. On each farm, information about the facilities, the horse and the handler was recorded. In each group, the horse owner or keeper (handler) was asked to enter the group, approach his/her horse, halter it and lead it out through the gate, then keep the horse standing out of sight from other horses for two minutes. The entire procedure was video recorded and the behaviour of the target horse, handler and other horses was subsequently scored. Only one of the 100 horses moved away from the handler when approached. Ninety-six percent of the target horses followed their handler without showing any resistance. In 75% of the tests, the other horses did not interact with the target horse and/or handler. At the gate, 26% of the handlers did not turn the target horse around before closing the gate, thereby placing themselves in a vulnerable position, with their body in very close proximity to the horse's hind legs. In conclusion, separating a horse from its group can be considered relatively safe and unproblematic, provided good management practices and trained handlers.

Protective and risk factors in amateur equestrians and description of injury patterns: A retrospective data analysis and a case - control survey

BACKGROUND

In Switzerland there are about 150,000 equestrians. Horse related injuries, including head and spinal injuries, are frequently treated at our level I trauma centre.

OBJECTIVES

To analyse injury patterns, protective factors, and risk factors related to horse riding, and to define groups of safer riders and those at greater risk

METHODS

We present a retrospective and a case-control survey at conducted a tertiary trauma centre in Bern, Switzerland.Injured equestrians from July 2000 - June 2006 were retrospectively classified by injury pattern and neurological symptoms. Injured equestrians from July-December 2008 were prospectively collected using a questionnaire with 17 variables. The same questionnaire was applied in non-injured controls. Multiple logistic regression was performed, and combined risk factors were calculated using inference trees.

RESULTS

RETROSPECTIVE SURVEY: A total of 528 injuries occured in 365 patients. The injury pattern revealed as follows: extremities (32%: upper 17%, lower 15%), head (24%), spine (14%), thorax (9%), face (9%), pelvis (7%) and abdomen (2%). Two injuries were fatal. One case resulted in quadriplegia, one in paraplegia. CASE-CONTROL SURVEY: 61 patients and 102 controls (patients: 72% female, 28% male; controls: 63% female, 37% male) were included. Falls were most frequent (65%), followed by horse kicks (19%) and horse bites (2%). Variables statistically significant for the controls were: Older age (p = 0.015), male gender (p = 0.04) and holding a diploma in horse riding (p = 0.004). Inference trees revealed typical groups less and more likely to suffer injury.

CONCLUSIONS

Experience with riding and having passed a diploma in horse riding seem to be protective factors. Educational levels and injury risk should be graded within an educational level-injury risk index.