Joint dislocations due to equestrian activity: what can a sports physician anticipate?

Objective Overview

Horse riding can lead to joint dislocations, primarily in the upper body, and this study uses national emergency department data to understand the types, causes, and demographics of these injuries to help sports physicians anticipate and prevent them.

Study Purpose and Data Source

• The study aimed to describe joint dislocations caused specifically by equestrian activities.
• The research utilized the National Electronic Injury Surveillance System (NEISS) database, covering the years 2000 to 2023.
• NEISS provides a statistically representative sample of injuries seen in emergency departments across the U.S., allowing for national estimates of injury patterns.
• By analyzing this data, the study sought to identify common mechanisms of injury to inform prevention strategies for horse-related joint dislocations.

Mechanisms of Injury Categorized

• The injury events were categorized into seven groups based on the mechanism:
• Falling from the horse
• Being bucked, thrown, or kicked off the horse
• Equipment (tack) malfunction
• Being stepped on by the horse
• Being struck by or against an object
• Being kicked by the horse
• Other unspecified mechanisms
• This categorization helps clarify how these dislocations occur and which situations pose the greatest risk.

Results: Types and Frequency of Joint Dislocations

• A total of 625 joint dislocation cases associated with horse riding were identified.
• Distribution of dislocations by joint:
• Shoulder: 289 cases (46.2%) – the most common site
• Elbow: 95 cases (15.2%)
• Finger: 85 cases (13.6%)
• Acromioclavicular joint: 48 cases (7.7%)
• Patellofemoral joint (knee area): 39 cases (4.8%)
• Hip: 22 cases (3.5%)
• Pubic symphysis: 16 cases (2.6%)
• Ankle: 7 cases (1.1%)
• This distribution shows a predominance in upper extremity injuries related to horse riding accidents.

Demographics and Injury Details

• Average age of patients: 41 years
• Gender distribution was nearly equal: 49.7% male and 50.3% female
• Age differences by injury type:
• Elbow dislocations involved younger individuals (average age 32 years)
• Pubic symphysis dislocations involved older individuals (average age 52 years)
• Gender differences in specific dislocations:
• Females had the highest rate of patellofemoral dislocations (70.2%)
• Males had the highest rate of pubic symphysis dislocations (92.9%)

Injury Mechanisms and Epidemiological Insights

• Most joint dislocations occurred due to falls from the horse (54.1%).
• The second most common cause was being bucked, thrown, or kicked off the horse (27.7%).
• Other mechanisms included equipment failure (7.3%), being stepped on by the horse (2.1%), struck by or against an object (1.9%), and being kicked by the horse (0.6%).
• These data emphasize the risks associated with falls and sudden ejection from the horse during riding.

Conclusions and Clinical Implications

• Though joint dislocations linked to equestrian activity are relatively uncommon compared to other injuries, they predominantly affect the upper extremities, particularly the shoulder.
• The male-to-female ratio for dislocations was roughly equal, which differs from the overall female predominance usually seen in equestrian sports and related injuries.
• Understanding these patterns can help sports physicians predict the likelihood and type of joint dislocation depending on the injury mechanism.
• This knowledge supports targeted prevention strategies and informs the management of equestrian patients presenting with injuries.