Diastasis of the Pubic Symphysis Without Fall While Horseback Riding: A Case Report.

Diastasis of the pubic symphysis can occur from pelvic ring injuries even without a high-energy trauma like a fall. This case report highlights a rare instance where horseback riding, without any fall or direct injury, caused a significant pelvic injury requiring surgical intervention and rehabilitation.

Background and Purpose

• The study focuses on a rare case of pelvic ring injury in a healthy 43-year-old man without any history of a high-energy traumatic event.
• Typically, such injuries occur due to significant trauma, so this case challenges the common understanding of injury mechanisms.

Patient Presentation and Clinical Findings

• The patient experienced localized pain in the pubic symphysis area and had difficulty walking immediately following horseback riding.
• Notably, the patient did not report any falls or direct injuries during the horseback riding session.
• Physical examination showed hemodynamic stability except for mild tachycardia and no neurological deficits, indicating no nerve involvement.

Diagnostic Imaging

• Initial radiological imaging revealed an anterior-posterior compression (APC) type II injury of the pelvic ring.
• The diastasis (separation) of the pubic symphysis measured 3.6 cm, indicating a significant injury.
• Temporary pelvic stabilization was implemented using a pelvic binder to reduce movement and pain.
• A computed tomography (CT) scan was performed to assess the injury more precisely and help plan treatment.

Treatment

• Surgical intervention involved closed reduction (realigning the bones without open surgery) and stabilization.
• External fixation was applied supraacetabularly using two 6 mm pins to stabilize the pelvic ring externally.
• Postoperative imaging showed the diastasis was successfully reduced to 1.5 cm, indicating better alignment.
• The patient was kept in bed for four weeks to allow initial healing.
• After this period, the patient was permitted gradual mobilization with partial weight-bearing using crutches to support recovery while minimizing stress on the injury.
• The external fixation device was removed 10 weeks after surgery.

Outcome and Follow-up

• Four months after the injury, the patient returned to his pre-injury activities without any pain or discomfort.
• The outcome suggests that conservative management combined with timely surgical intervention can result in full functional recovery even in unusual low-energy traumatic pelvic injuries.

Significance and Clinical Implications

• This case highlights that pelvic ring injuries can occur in low-energy scenarios without any falls or direct trauma, which is extremely rare.
• Clinical awareness is crucial: sudden onset of pubic pain and difficulty walking after activities like horseback riding should prompt investigation for possible pelvic injury.
• Misdiagnosis or delayed diagnosis may occur because such injuries are unexpected in low-energy contexts.
• Prompt imaging and stabilization are essential for good prognosis and recovery.