Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing: A report of two cases.
Abstract: We reported two cases of jockeys who sustained fracture/dislocation of the mid-thoracic spine due to traumatic falls during horse racing. We examined the injury mechanism based upon the patients' diagnostic images and video footage of races, in which the accidents occurred. Admission imaging of patient 1 (a 42 years old male) revealed T5 burst fracture with bony retropulsion of 7 mm causing complete paralysis below T5/6. There existed 22° focal kyphosis at T5/6, anterolisthesis of T5 relative to T6, T5/6 disc herniation, cord edema and epidural hemorrhage from T4 through T6, and cord injury from C3 through C6. Admission imaging of patient 2 (a 23 years old male) revealed T4/5 fracture/dislocation causing incomplete paralysis below spinal level. There existed compression fractures at T5, T6, and T7; 4 mm anterior subluxation of T4 on T5; diffuse cord swelling from T3 through T5; comminuted fracture of the C1 right lateral mass; right frontal traumatic subarachnoid hemorrhage; and extensive diffuse axonal injury. The injuries were caused by high energy flexion-compression of the mid-thoracic spine with a flexed posture upon impact. Our results suggest that substantially greater cord compression occurred transiently during trauma as compared to that documented from admission imaging. Video footage of the accidents indicated that the spine buckled and failed due to abrupt pocketing and deceleration of the head, neck and shoulders upon impact with the ground combined with continued forward and downward momentum of the torso and lower extremities. While a similar mechanism is well known to cause fracture/dislocation of the cervical spine, it is less common and less understood for mid-thoracic spine injuries. Our study provides insight into the etiology of fracture/dislocation patterns of the mid-thoracic spine due to falls during horse racing.
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Publication Date: 2021-07-06 PubMed ID: 34272119PubMed Central: PMC8606606DOI: 10.1016/j.cjtee.2021.07.003Google Scholar: Lookup
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Summary
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The research article examined two cases of jockeys who suffered fractures/dislocations of the mid-thoracic spine following falls during horse racing, and aims to understand the cause and mechanism of these injuries.
Overview of Research
- The researchers used the patients’ diagnostic images and videos of the races where the accidents occurred to study the mechanism of injury. They profiled two patients, a 42-year-old male (patient 1) and a 23-year-old male (patient 2), both jockeys who had sustained serious spine injuries from falls during horse racing.
Patient Cases
- Patient 1: Imaging revealed a fracture at T5 level of the spine, which had caused a bony fragment to be pushed backwards and resulted in complete paralysis below T5/6. The injury also caused a curvature in the spine, slipped disc, cord edema, and internal bleeding from T4 through T6.
- Patient 2: Imaging showed fractures/dislocation at T4/5 level leading to incomplete paralysis. There were compression fractures at T5, T6, and T7; the fourth thoracic vertebra had slid forward on the fifth one. There was swelling in the spinal cord from T3 through T5, along with other injuries such as a complex fracture of one side of C1 vertebra, internal bleeding in the right frontal area of brain, and diffuse axonal injury which involves damage to nerve cells.
Findings and Analysis
- The researchers concluded that these types of injuries were the result of a high force bending and compressing the mid-thoracic spine, as a result of the jockey’s body flexing upon impact with the ground.
- Interestingly, the team found a greater degree of spinal cord compression upon analyzing the video footage of the accidents. Essentially, this suggests that the spine endured a higher degree of trauma during the actual incident than what could be recorded from the imaging performed post-admission.
- The video footage also revealed that the spine incurred damage due to the bending and rapid deceleration of the head, neck, and shoulders with the impact on the ground, as well as the forward and downward momentum of the torso and lower extremities.
- While this mechanism of injury is well known for causing damage to the cervical spine, its impact on the mid-thoracic spine is less common and not as thoroughly understood.
Conclusion
- The research article provides important insights into the mechanisms and reasons behind mid-thoracic spine fractures/dislocations occurring as a result of falls during horse racing.
- These findings can contribute to the development of safety measures, preventative strategies and provide a better understanding for post-accident therapy.
Cite This Article
APA
Ivancic PC.
(2021).
Mechanisms of mid-thoracic spine fracture/dislocation due to falls during horse racing: A report of two cases.
Chin J Traumatol, 24(6), 397-400.
https://doi.org/10.1016/j.cjtee.2021.07.003 Publication
Researcher Affiliations
- North Haven, Connecticut, 06473, USA. Electronic address: pcivancic@gmail.com.
MeSH Terms
- Accidental Falls
- Animals
- Horses
- Humans
- Joint Dislocations
- Male
- Spinal Cord Injuries / diagnostic imaging
- Spinal Cord Injuries / etiology
- Spinal Fractures / diagnostic imaging
- Spinal Fractures / etiology
- Spinal Injuries
- Thoracic Vertebrae / diagnostic imaging
- Thoracic Vertebrae / injuries
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