Fri., 10/19/07 Pelvis, Paper #28, 11:34 am OTA-2007
•Characteristics, Results, and Outcomes of Surgically Treated Pelvic Ring Injuries Caused while Being Bucked from a Horse: The “Saddlehorn” Injury
Cory A. Collinge, MD1 (*); George LeBus, MD2 (*);
1Harris Methodist Fort Worth Hospital/John Peter Smith Orthopedic Residency Program,
Fort Worth, Texas, USA;
2Orthopedic Specialty Associates, Atascadero, California, USA
Purpose/Hypothesis: The purpose of this study is to evaluate the characteristics, clinical results, and outcomes of patients treated surgically for “saddlehorn” injuries of the pelvis incurred while being bucked from a horse.
Methods: From 1999 though 2005, 132 pelvic ring injuries were treated surgically at our trauma center by a single pelvic surgeon. Inclusion criteria for this study were patients operatively treated for pelvic ring injury caused by blunt-force trauma to the perineum while being bucked from a horse (“saddlehorn” injury) and who were available for follow-up at >18 months. Medical records and radiographs were reviewed for patient and injury factors, treatment methods, complications, and results. All patients were evaluated using visual analog scale (VAS) pain scores; a questionnaire addressing occupational, recreational, and sexual function; Iowa pelvic score; SF-36; and MFA.
Results: 20 patients met inclusion criteria and all participated in this study. Follow-up averaged 32 months (range, 18-56). All were men and the mean age was 48 years (17 of 20 were between 42 and 58 years). 19 experienced isolated trauma to the pelvic region (1 pneumothorax), and 1 urethral tear and 1 bladder rupture were identified. There were 18 OTA B1.1 and 2 B1.2 injuries, with a mean pubic diastasis of 43 mm (range, 23-79 mm). No patients experienced shock (defined as SBP of ≤90 mmHg) or required angiographic embolization. All underwent symphyseal plating using a 6-hole 3.5-mm symphysis plate and 3.5-mm screws.
17 of 20 (85%) patients reported erectile dysfunction and 10 (50%) reported a partial loss of sensation around the penis and/or scrotum. Eight patients (40%) reported minor incontinence (dribbling). 10 of 20 (50%) had returned to previous levels of heavy recreation and 17 (85%) had returned to riding horses. 18 had returned to their previous employment, although 8/18 (44%) required modification of their work duties. VAS pain scores (0-10) were reported as follows: mean “Pain-Average” was 2.1 (range, 1-6) and “Pain-At worst” was 4.1 (range, 0-8). Pain was reported in the area of the sacroiliac joint in 10 patients (50%), the pubic symphysis in 4 cases (20%), and the “groin” in 3 (15%). The mean Iowa pelvic score was 84 (range, 56-99). SF-36 SMFA scores are reported.
Conclusions and Significance: Patients requiring surgical treatment for “saddlehorn” injury of the pelvic ring are typically middle-aged men who suffer isolated trauma to the pelvic region and “open book” OTA 61-B injuries. They may expect reasonably predictable return of recreational and occupational function; however, relatively mild pelvic discomfort and sexual dysfunction can be expected. The injuries and treatment seen in this strict cohort of patients, or their results/outcomes, have not been previously described.
If noted, the author indicates something of value received. The codes are identified as a-research or institutional support; b-miscellaneous funding; c-royalties; d-stock options; e-consultant or employee; n-no conflicts disclosed, and *disclosure not available at time of printing.
• The FDA has not cleared this drug and/or medical device for the use described in this presentation (i.e., the drug or medical device is being discussed for an “off label” use). ◆FDA information not available at time of printing.