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

Int Orthop. 2017 Oct;41(10):2105-2112. doi: 10.1007/s00264-017-3592-1. Epub 2017 Aug 11.


Introduction: 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.

Methods: 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).

Results: 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 ± 13 years), 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.

Conclusions: 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.

Keywords: Carriage; Equestrian sports; Fall from horse; Horse kick; Mortality; Severe injuries.

Publication types

  • Multicenter Study

MeSH terms

  • Adult
  • Aged
  • Animals
  • Athletic Injuries / epidemiology*
  • Athletic Injuries / mortality
  • Austria / epidemiology
  • Belgium / epidemiology
  • Databases, Factual
  • Female
  • Finland / epidemiology
  • Germany / epidemiology
  • Horses
  • Humans
  • Injury Severity Score
  • Luxembourg / epidemiology
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Prospective Studies
  • Slovenia / epidemiology
  • Sports
  • Switzerland / epidemiology
  • Wounds, Nonpenetrating / epidemiology*
  • Wounds, Nonpenetrating / mortality
  • Young Adult