Horse Kick Research Articles

Case report: Conservative management of a blunt trauma to a horseshoe kidney

With trauma representing the leading cause of death in children, and renal injuries representing a large proportion of that trauma, understanding the appropriate management of renal injuries is vital to preventing pediatric morbidity and mortality. Cases involving aberrant anatomy are even more crucial to understand as there is less data on appropriate management. Here, a case is presented of a 7-year-old male presenting after a horse kick to the abdomen resulting in traumatic disruption of a previously unknown horseshoe kidney and the subsequent conservative management. The patient presented with abdominal pain, leukocytosis, and elevated liver function enzymes. An abdominal and pelvic Computed Tomography (CT) demonstrated a horseshoe kidney with a grade IV laceration to the isthmus and left lower pole of the kidney resulting in fracture/disruption of previously fused horseshoe kidneys. Additionally, there was a large retroperitoneal hematoma and hemoperitoneum. The patient was successfully managed with observation, and hemodynamic monitoring and has had resolution of hematoma and preserved kidney function through 8 months of follow-up. In conclusion, this is an example of how a patient with complicated renal anatomy can be managed conservatively to model for potential future cases.

Head and dental injuries among farriers and hoof care practitioners: A nationwide survey in Switzerland.

There is a paucity of evidence on injuries sustained by farriers and hoof care practitioners, two professions exposed to unique occupational hazards. The aim of this study was to collect and examine data on occupational head/face and dental injuries among farriers and hoof care practitioners in a nationwide survey in Switzerland. Data on occupational head/face and dental injuries were gathered in a questionnaire-based, voluntary survey, which was mailed to all farriers and hoof care practitioners in Switzerland. The statistical analysis comprised multiple regressions with a nested design (α=0.05). The survey included 278 respondents (response rate of 78.1%). Head/face injuries were more frequently reported by farriers than hoof care practitioners (60.6% and 20.7%, respectively). Among full-time workers, farriers had a higher chance of an occupational head/face injury compared with hoof care practitioners (p= .007). The rate of dental injuries, mainly related to a horse kick, was 11.1% and 1.9% among farriers and hoof care practitioners, respectively. Negligence in wearing mandatory eye protection was reported by 37.5% of respondents. Farriery and hoof care management entail a significant risk of occupational head/face and dental injuries. Preventive safety measures-eye protection in particular-and knowledge in dental first aid should be promoted among farriers and hoof care practitioners to decrease the frequency and severity of work-related injuries.

Pelvic and acetabular trauma in amateur equestrian enthusiasts – A retrospective review

IntroductionHorse riding related accidents can present with devastating pelvic and acetabular fractures. This study examines the nature, management and treatment outcomes of severe pelvic and acetabular trauma in amateur horse riders presenting to a national tertiary referral centre. We also aim to define certain at-risk groups. MethodsThis was a retrospective descriptive cohort of all patients who were referred to the National Centre for Pelvic and Acetabular trauma resulting from horse riding accidents. All patients who were referred to the National Centre for Pelvic and Acetabular Trauma between January 2018 and July 2020 were included. Professional horse riders were excluded. Clinical and treatment outcome measures were stratified to four different mechanisms of injury: fall from horse (FFH), horse crush (HC), Horse Kick (HK) and Saddle Injury (SI). ResultsThere were 31 equestrian related injuries referred to our centre between January 2018 and July 2020. One patient was a professional jockey and was thus excluded from the study. Eighteen were female and the mean age at referral was 37 years old. The majority of these were pelvic ring injuries (73%). Fifty per cent of patients required surgical intervention and the majority of these were male. ConclusionHorse riding is a potentially dangerous recreational pursuit with significant risk of devastating injury. Pelvic and acetabular fractures secondary to horse riding are frequently associated with other injuries and the need operative intervention is common in this group. Young women and older men are higher risk groups.

Retrospective analysis of 15 years of horse-related maxillofacial fracture data at a major German trauma center

PurposeThe purpose of this study was to estimate the effect of the mechanism of trauma (fall versus kick), rider demographics, equestrian experience, protective equipment, and whether or not a horse was shod on the anatomic site of a horse-related maxillofacial fracture, operating time, postoperative complication rate, and length of hospital stay.MethodsWe retrospectively reviewed the medical records of patients treated for horse-related maxillofacial fractures at a single institution in Germany between January 2000 and March 2015. We used linear and logistic regression to test the above-mentioned variables for statistical correlations.ResultsDuring the study period, we treated 138 horse-related facial fractures in 71 patients. The mean patient age was 34.5 years, and 80.3% of the injuries occurred in women. Most of the maxillofacial fractures were the result of a horse kick (71.8%) when unmounted and the majority occurred in more experienced riders (70.4%). There was a significant association of wearing of protective equipment with a shorter hospital stay and lower risk of postoperative complications.ConclusionMore education is needed in the equestrian community regarding the use of protective equipment when unmounted. Safety helmets should be redesigned to include a faceguard and be worn at all times.

Experimental determination of the impact energy of horse kicks

Kicking is a natural behaviour of horses, but it can become problematic if stall components are hit and do not withstand the impact load. Injuries may occur due to material failure or hoof entrapment. In Germany, while the Animal Protection Law is intended to prevent such incidents, neither the law nor the corresponding interpretation aid indicates how this requirement should be fulfilled. This paper gives an overview of the methods of determining horse kick energy and presents results of own kick energy measurements. The outcome of a re-evaluation of literature data is presented and two attempts to roughly estimate the expected kick load are introduced. The developed measuring device consists of a steel-made framework, mechanical energy sensors, and an impact panel. Its verification was carried out by loading with impacts of defined energy applied by a pendulum impact machine. The measurement of kick energy was taken at a stud farm in the context of heat detection by observing the response of a mare to the presence of a stallion, whereby the kicks of the stallion were measured. With regard to the kick-resistance and entrapment-safety calculation, a representative value of 71 J was calculated and using a safety factor of 1.5 this gives a design value of 106 J. The presented results and the theoretical background of kick energy measurements described should in the future form the basis for the dimensioning of kick-resistant and entrapment-secure stall planks. • Theory background of horse kick energy determination. • Horse kick measurement applying specially designed dynamic energy sensors. • Kick energy determined to 106 J (design value) for stall plank dimensioning. • Result validation performed by application of various estimation approaches. • Kick-resistant and entrapment-safety stall plank dimensioning now possible.

Gastric ulcerations after a traumatic horse kick

Abstract Blunt abdominal trauma in pediatric patients can lead to a wide range of consequences and disease processes. To date, there have only been a few documented cases of gastric ulcers from blunt abdominal trauma. Even less frequent, are reports describing ‘kissing gastric ulcers' from blunt abdominal injuries in the pediatric patient population. In our case report, we highlight a case of a 13-year-old female presenting to an emergency room after sustaining a kick to the abdomen by a horse. Initial cross sectional imaging was significant for mild left upper quadrant mesenteric edema and the patient was discharged in stable condition. However, upon repeat presentation to the emergency room with hematemesis, an upper endoscopy was performed revealing two large opposing areas of ulceration on the greater and lesser curvature of the stomach. This case report provides an insight in to a rare condition that can be difficult to diagnose. Clinicians must be cognizant of these potential injuries when evaluating patients presenting with blunt abdominal trauma.

2190 A Unique Case Demonstrating the Endoscopic Management of a Duodenal Stump Fistula

INTRODUCTION: Medical procedures continue to evolve towards being more minimally invasive leading to significant advances in the endoscopic management of transmural defects of the gastrointestinal (GI) tract. These are typically divided into three primary types; anastomotic leaks, perforations and fistulas. Once the site of injury has been identified, basic management involves surgical debridement and drainage with subsequent closure, diversion or both. We present a case of a complicated fistula and a novel approach to closing it. CASE DESCRIPTION/METHODS: A 35 year old female presented to the emergency room following blunt abdominal trauma from a horse kick. She sustained significant injuries to the small bowel requiring emergent surgical intervention and ultimately a duodenectomy with gastrojejunostomy. She was left with a 6cm blind limb of native post pyloric duodenum that was drained percutaneously with a 32Fr Malecot catheter. Gastroenterology was consulted to assist with endoscopic drain removal and management of the residual fistula tract. The Malecot was replaced with a 24Fr percutaneous gastrostomy tube with subsequent downsizing procedures every 2-3 weeks. The end result was a 3-4mm duodenal-cutaneous fistula with persistent output. After fulguration of the surrounding area with Argon plasma coagulation a single running suture of 5 stitches was placed using the OverStitchTM device and the external opening was allowed to close by secondary intention. At a 2 week clinic follow up she had returned to her usual activities and a barium upper GI series at 4 weeks post closure confirmed no stump leak. DISCUSSION: There is a paucity of data to guide the gastroenterologist on duodenal stump defects. In the setting of a planned surgical fistula such as in our patient, the most appropriate treatment option was successive downsizing of the tract with definitive closure via endoscopic suturing. The unique location of the fistula in a blind pouch precluded the use of a self-expanding metal stent, the defect was too large to close with a through-the-scope clip, and there was a theoretical concern of retention in the stump if a larger over-the-scope clip was employed. The high volume of bilious output through the fistula precluded the use of tissue adhesives as a monotherapy. Despite the desired outcome being achieved in our case we suspect this method of closure would be less successful in fistulas complicated by chronic inflammation, infection, or malignancy.

Horse Kick to the Abdomen Causing a Triad of Injury: A Case Report

A 35-year-old male, a horse trainer, was brought to the emergency room after being kicked in the abdomen, which resulted in an abdominal wall hematoma and a blow-out rupture of the proximal jejunum, with a mesenteric tear and posterior lumbar disc herniation. The initial evaluation did not raise significant concerns; however, the patient's abdominal pain progressively worsened after the administration of oral contrast in preparation for the computed tomography (CT) scan. The patient did well after abdominal exploration and operative repair of the small bowel injury. Our objective is to shed light on this mechanism of injury that can be underestimated during a patient's initial evaluation.

Retrospective analysis of equestrian-related injuries presenting to a level 1 trauma center.

Report the incidence, pattern, and severity of equestrian-related injuries presenting to a rural level 1 trauma center and detail the total radiation dose, imaging, and hospital charges related to those injuries. An IRB-approved retrospective review of patients presenting to our facility following equine-related trauma was conducted. Demographics, mechanism of injury, types and number of imaging exams, approximate radiation dose administered, imaging findings, Injury Severity Score (ISS), rate/length of hospitalization, and approximate cost of care were recorded. A total of 222 patients (161 F:61 M; mean age 38.5years (range 4-79)) presented to our emergency department following horse-related injury. Mechanisms of injury included the following: fall (n = 186), kick (n = 18), stepped on (n = 9), and other (n = 9). Body part injured included extremity (26.1%), torso (26.6%), spine (25.7%), and head/neck (18.5%). Longer hospital admission, higher expenditure, increased CT/MR imaging, higher ISS, and radiation dose were noted in older patients and those injured by a fall or kick. Head injuries were more frequent following a horse kick (p = 0.006). Spinal and torso injuries were more common in patients older than 54years (p = < 0.001) and those with falls (p < 0.04). Extremity injuries were more common in older patients (p < 0.001). Patient age greater than 54years and mechanism of injury are strong predictors of the ISS, injury localization, healthcare expenditure, and mean hospital stay. With the exception of obvious minor wounds, full trauma work-ups (CT chest/abdomen/pelvis and cervical spine) are encouraged for equestrian-related injuries in older patients and those injured by a fall.

The Risk of a Shod and Unshod Horse Kick to Create Orbital Fractures in Equine Cadaveric Skulls.

The aim of this study was to compare the potential of an unshod and shod hoof to cause an orbital fracture in the event of a kick. Thirty-four equine cadaveric orbitae were exposed to a steel or horn impactor in a dropping test set-up. An impactor velocity of 7 m/s was used for both materials. Testing was repeated on the same orbit at a velocity of 10 m/s with the horn impactor if no damage occurred. A high-speed camera was used to analyse the impact process. Physical parameters (peak force and impact duration) were calculated based on quantitative video-tracking. Computed tomographic (CT) scans were generated and fracture configurations described. At 7 m/s, the fracture probability was lower for horn (23.5%) than for steel impactors (70.6%, p = 0.015). On CT-images, damage of the frontal, temporal, zygomatic and lacrimal bones was detected. Furthermore, the orbital socket (17.2%), the supraorbital foramen (34.5%) and the temporomandibular joint (58.6%) were involved. The frequency of affected orbital bones was not significantly different between fractures generated by steel and horn impactors, but the fracture severity was subjectively greater when fractures were generated by steel impactors. The orbital fracture probability was significantly higher when a kick of a shod versus unshod horse was simulated. This indicates that keeping horses unshod would decrease the injury risk of neighbouring horses when considering group housing systems.

Liver trauma in equestrian accidents. A case report

Background: Equestrian sports may carry a risk of liver injury. Horse kick injuries usually occur when rides are dismounted, most frequently when grooming without wearing protective equipment. Equine-associated liver injuries are not well studied due to the relative infrequency of these patients. Some of these patients needs surgery to repair liver injuries but most of them can be management with close observation. Methods: We present a case of hepatic trauma due to equine injury. Results: 21-year-old-female, abdominal pain after being kicked by a horse in the right side of the abdomen. On admission: tachycardia (120 bpm) and hipotension (90/40), diffused abdominal tenderness, haemoglobin level of 12 g/dl with elevation of liver transaminases. CT: laceration grade IV of the right liver (AAST scale). Laparotomy was performed. 2 litres of hemoperitoneum were evacuated and a resection of segment VI was carried. No more abdominal injuries were found. After surgery, haemoglobin levels were 9,2 g/dl after receiving 2 transfusions of concentrated red blood cells. The patient was discharged after 6 days, without complications. Conclusion: Liver injuries in equestrian accidents should be suspected and carefully managed. When haemodynamic instability appears, surgical intervention is mandatory for bleeding control. If there is no instability, conservative management could be taken. Radiological intervention such as embolization is an increasingly viable alternative in the non-operative management in stable patients.

Abdominal injuries caused by a horse kick - rescue procedure

Abdominal injuries caused by a horse kick - rescue procedure

Patterns of mandibular fractures related to interaction with horses

Background: The risks of facial injuries with horse-related activities are much higher than in other sports. There are just a few studies about horse-related maxillofacial injuries, and there are even less data in particular about mandibular fractures. However, the aim of this study was to determine the patterns for mandibular fractures caused by horse contact or horseback riding. Materials and Methods: Data from patient records were collected over 15 years from January 2000 to March 2015. All patients who suffer a mandibular fracture caused by horse contact or horseback riding were included in this study. The analysis contained demographical data, trauma mechanism, type of mandible fracture, and type of protective clothing. Results: Overall, 23 patients within 37 fractures were included in the study. Of those, 87% were females and 13% males. More than the half (52.2%) were aged between 16 and 30 years. The most common trauma mechanism was a horse kick (78.3%). The most common site of fractures was the parasymphysis (32.4%) and the condylar region (32.4%), followed by the angle (21.7%). In addition, 52.2% of the patients had a single and 47.8% a combined fracture of the mandible. Nearly all patients (95.7%) underwent surgery. Open reduction and internal fixation was the treatment of choice. Only 17.4% of the patients wore a helmet. Conclusion: Mandibular fractures are not the leading trauma in horse relating accidents; however, they are often associated with functional loss. The most frequent cause is a kick from the horse while unmounted. Hence, there is a need for protective equipment usage at all times around horses especially wearing a helmet with a face guard.

Blunt injuries related to equestrian sports: results from an international prospective trauma database analysis.

The objective of this study was to investigate the nature, management, and outcome of major injuries related to equestrian sports and to define the at-risk groups for serious and life-threatening injuries. We analyzed demographic, pre-hospital, clinical, and outcome data from an international population-based prospective trauma database (TraumaRegister DGU®). Patients with major injuries (Injury Severity Score [ISS] ≥9 points) related to equestrian sports activities were included (January 1, 1993, to December 31, 2012). Clinical and outcome parameters were stratified for four different types of injury mechanisms: fall from horse (FFH), horse-kick (HK), horse crush (HC), and carriage-related accidents (CRA). Participating countries included Germany, Austria, Switzerland, Finland, Slovenia, Belgium, Luxembourg, and The Netherlands. Statistical analyses were performed with SPSS (Version 22, IBM Inc., Armonk, NY). The Database identified 122,000 documented patients, of whom 679 were equestrian incidents. Among these, the four major injury mechanisms were: FFH (n=427), HK (n=188), HC (n=34), and the CRA (n=30). Females were more likely to sustain FFH (75.5%, p<0.001), leading to head injuries (n=204, 47.8%) and spinal fractures (n=109, 25.5%). HK injuries often resulted in facial fractures (29.3%, p<0.001). Individuals sustaining HC injuries had a high risk for pelvic (32.4%, p<0.001) and abdominal injuries (35.2%, p<0.001). In contrast to the FFH cohort, the CRA cohort involved older males (57±13years), with chest (63.3% p=0.001), and extremity injuries, resulting in significant injury severity (ISS 20.7±10.6). In the CRA cohort, 16% were in haemorrhagic shock on scene, and also the highest in-hospital mortality (14.8%, p=0.006) was observed. Young female riders are at risk from falling, horse-kicks, and crush-injuries. Older males in carriage-related accidents sustained the highest injury severity and mortality rate, and must specifically be targeted by future prevention initiatives. Level of evidence Descriptive Epidemiologic Study, Level II.

The influence of aluminium, steel and polyurethane shoeing systems and of the unshod hoof on the injury risk of a horse kick. An ex vivo experimental study.

To evaluate the damage inflicted by an unshod hoof and by the various horseshoe materials (steel, aluminium and polyurethane) on the long bones of horses after a simulated kick. Sixty-four equine radii and tibiae were evaluated using a drop impact test setup. An impactor with a steel, aluminium, polyurethane, or hoof horn head was dropped onto prepared bones. An impactor velocity of 8 m/s was initially used with all four materials and then testing was repeated with a velocity of 12 m/s with the polyurethane and hoof horn heads. The impact process was analysed using a high-speed camera, and physical parameters, including peak contact force and impact duration, were calculated. At 8 m/s, the probability of a fracture was 75% for steel and 81% for aluminium, whereas polyurethane and hoof horn did not damage the bones. At 12 m/s, the probability of a fracture was 25% for polyurethane and 12.5% for hoof horn. The peak contact force and impact duration differed significantly between 'hard materials' (aluminium and steel) and 'soft materials' (polyurethane and hoof horn). The observed bone injuries were similar to those seen in analogous experimental studies carried out previously and comparable to clinical fracture cases suggesting that the simulated kick was realistic. The probability of fracture was significantly higher for steel and aluminium than for polyurethane and hoof horn, which suggests that the horseshoe material has a significant influence on the risk of injury for humans or horses kicked by a horse.

Malignant Middle Cerebral Artery Infarction Secondary to Traumatic Bilateral Internal Carotid Artery Dissection. A Case Report

Traumatic bilateral dissection of the carotid arteries is a rare condition with potentially life-threatening complications. The case of a 57-year-old male patient with acute onset left sided hemiparesis, twelve hours after a blunt head injury, caused by a horse kick, is reported. A cerebral CT scan revealed right middle cerebral artery (MCA) territory infarction. Based on Duplex ultrasound and Angio CT scan findings, a diagnosis of bilateral ICA dissection was established. Despite antithrombotic treatment, the patient presented with a progressive worsening of his neurological status. The control CT scan evidenced malignant right MCA territory infarction that required decompressive craniotomy. The patient was discharged with significant neurological deficits. Together with this case, the aetiologies, clinical manifestations, diagnostic and therapeutical options and outcome of carotid artery dissection are discussed.

Emergency Closure of a Traumatic Ventricular Septal Defect (VSD) after a Horse Kick Injury with an 18-mm Occlutech ASD Occluder

Objective: Thoracic injuries after accidents with horses include chest lung contusions, rib fractures, and rarely cardiac involvement including right heart perforation, avulsion of the tricuspid or mitral valve and aortic dissections. We report a unique case of a traumatic ventricular septal defect.

Reconstruction of orofacial injury due to a horse hoof kick: Report of a case

We report the case of an orofacial injury caused by a horse kick. Animal attacks most commonly involve domestic animals, such as dogs, cats, bulls, camels, and horses. When an orofacial injury caused by a kick from a horse occurs, it is often serious, and may even be fatal. Children are the most common victims of horse kick injuries, generally being attacked by a horse they know. The patient was successfully treated via three stages of reconstruction: surgical, orthodontic, and prosthetic.

Horse kick injury mimicking a handle bar injury or a hidden speared injury.

A 16-year-old male was transported to our emergency department after he was kicked in the abdomen by a horse. He was diagnosed with injury of the liver and abdominal rectus muscle, and was cured by observational treatment. An Ichushi search was undertaken to identify articles published from 1983 to 2013 using the key words "horse" and "trauma". We found 13 cases that described horse-related injuries and summarized these cases, including our case. There were 10 males, three females and one patient of an undescribed sex. The patients ranged in age from 16 to 58 years old, with an average age of 33 years. The injured sites were predominantly the face (mandible) and upper abdomen, indicating that a projecting part of the body may be more likely to be injured. Cardiac rupture, aortic head injury, or lethality induced by a horse kick have not been reported in Japan, but such injuries have been reported in other countries. Ten of 15 cases (67%) required surgical treatment for severe injuries. Horse kick injuries tend to be severe, because the transfer of energy from the end of the hoof, with a small cross-sectional area, to a small field, leads to internal organic injuries that are more severe than predicted, similar to a handlebar injury. Accordingly, we advocate the close observation of patients with horse kick injuries, which may be regarded as being similar to blunt stab wounds or hidden speared injuries.

Ladislaus von Bortkiewicz—Statistician, Economist and a European Intellectual

SummaryLadislaus von Bortkiewicz (1868–1931) was a European statistician. His scientific work covered theoretical economics, stochastics, mathematical statistics and radiology; today, we would call him a cross‐disciplinary scientist. With his clear views on mathematical principles with their applications in these fields, he stood in conflict with the mainstream economic schools in Germany at the dawn of the 20th century. He had many prominent students (Gumbel, Leontief and Freudenberg among them), and he carved out the path of modern statistical thinking. He was a true European intellectual with a career path from St. Petersburg via Göttingen to Straßburg and finally the Berliner Universität, now Humboldt‐Universität zu Berlin. He is known for the precise calibration of insurance claims applying the—at that time hardly known—Poisson distribution to Prussian horse kick and child suicide data. He proposed a simple solution to the Marxian transformation problem and wrote numerous articles and books on the mathematical treatment of statistical (including radiological physical) data. In this article, we sketch his life and work and point out the prominent role that he has in today's statistical thinking.