Patterns of Mandibular Fractures Related to Interaction with Horses

Document Type: Original Article

Authors

Department of Craniomaxillofacial Surgery, Medical School Hannover, Hannover, Germany

Abstract

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.

Keywords


1. Schröter C, Schulte-Sutum A, Zeckey C, Winkelmann M, Krettek C, Mommsen P, et al. Accidents in equestrian sports: Analysis of injury mechanisms and patterns. Unfallchirurg 2017;120:129-38.

2. Watt GM, Finch CF. Preventing equestrian injuries. Locking the stable door. Sports Med 1996;22:187‑97.

3. Lloyd RG. Riding and other equestrian injuries: Considerable severity. Br J Sports Med 1987;21:22-4.

4. Ball JE, Ball CG, Mulloy RH, Datta I, Kirkpatrick AW. Ten years of major equestrian injury: Are we addressing functional outcomes? J Trauma Manag Outcomes 2009;3:2.

5. Chitnavis JP, Gibbons CL, Hirigoyen M, Lloyd Parry J, Simpson AH. Accidents with horses: What has changed in 20 years? Injury 1996;27:103-5.

6. Avery JG, Harper P, Ackroyd S. Do we pay too dearly for our sport and leisure activities? An investigation into fatalities as a result of sporting and leisure activities in England and Wales, 1982-1988. Public health. 1990;104:417-23.

7. Thomas KE, Annest JL, Gilchrist J, Bixby-Hammett DM. Non-fatal horse related injuries treated in emergency departments in the United States, 2001-2003. Br J Sports Med 2006;40:619-26.

8. Davidson SB, Blostein PA, Schrotenboer A, Sloffer CA, VandenBerg SL. Ten years of equine-related injuries: Severity and implications for emergency physicians. J Emerg Med 2015;49:605-12.

9. Havlik HS. Equestrian sport-related injuries: A review of current literature. Curr Sports Med Rep 2010;9:299-302.

10. Mayberry JC, Pearson TE, Wiger KJ, Diggs BS, Mullins RJ. Equestrian injury prevention efforts need more attention to novice riders. J Trauma 2007;62:735-9.

11. Altgärde J, Redéen S, Hilding N, Drott P. Horse-related trauma in children and adults during a two year period. Scand J Trauma Resusc Emerg Med 2014;22:40.

12. Whitlock MR. Injuries to riders in the cross country phase of eventing: The importance of protective equipment. Br J Sports Med 1999;33:212- 4.

13. Sorli JM. Equestrian injuries: A five year review of hospital admissions in British Columbia, Canada. Inj Prev 2000;6:59-61.

14. Guyton K, Houchen-Wise E, Peck E, Mayberry J. Equestrian injury is costly, disabling, and frequently preventable: The imperative for improved safety awareness. Am Surg 2013;79:76-83.

15. Exadaktylos AK, Eggli S, Inden P, Zimmermann H. Hoof kick injuries in unmounted equestrians. Improving accident analysis and prevention by introducing an accident and emergency based relational database. Emerg Med J 2002;19:573-5.

16. Carmichael SP, Davenport DL, Kearney PA, Bernard AC. On and off the horse: Mechanisms and patterns of injury in mounted and unmounted equestrians. Injury 2014;45:1479-83.

17. Ueeck BA, Dierks EJ, Homer LD, Potter B. Patterns of maxillofacial injuries related to interaction with horses. J Oral Maxillofac Surg 2004;62:693-6.

18. Bond GR, Christoph RA, Rodgers BM. Pediatric equestrian injuries: Assessing the impact of helmet use. Pediatrics 1995;95:487-9.

19. Weber CD, Nguyen AR, Lefering R, Hofman M, Hildebrand F, Pape HC, et al. Blunt injuries related to equestrian sports: Results from an international prospective trauma database analysis. Int Orthop 2017;41:2105-12.

20. Antoun JS, Steenberg LJ, Lee KH. Maxillofacial fractures sustained by unmounted equestrians. Br J Oral Maxillofac Surg 2011;49:213-6.

21. Lee KH, Steenberg LJ. Equine-related facial fractures. Int J Oral Maxillofac Surg 2008;37:999-1002.

22. Griffen M, Boulanger BR, Kearney PA, Tsuei B, Ochoa J. Injury during contact with horses: Recent experience with 75 patients at a level I trauma center. South Med J 2002;95:441-5.

23. Ball CG, Ball JE, Kirkpatrick AW, Mulloy RH. Equestrian injuries: Incidence, injury patterns, and risk factors for 10 years of major traumatic injuries. Am J Surg 2007;193:636-40.

24. Islam S, Gupta B, Taylor CJ, Chow J, Hoffman GR. Equine-associated maxillofacial injuries: Retrospective 5-year analysis. Br J Oral Maxillofac Surg 2014;52:124-7.

25. Meredith L, Antoun JS. Horse-related facial injuries: The perceptions and experiences of riding school. Inj Prev 2011;17:55-7.

26. Nelson DE, Rivara FP, Condie C. Helmets and horseback riders. Am J Prev Med 1994;10:15-9.

27. Buckley SM, Chalmers DJ, Langley JD. Injuries due to falls from horses. Aust J Public Health 1993;17:269-71.

28. Tanaka N, Hayashi S, Amagasa T, Kohama G. Maxillofacial fractures sustained during sports. J Oral Maxillofac Surg 1996;54:715-9.

29. Mourouzis C, Koumoura F. Sports-related maxillofacial fractures: A retrospective study of 125 patients. Int J Oral Maxillofac Surg 2005;34:635-8. 30. Boffano P, Roccia F, Zavattero E, Dediol E, Uglesic V, Kovacic Z, et al. European Maxillofacial Trauma (EURMAT) project: A multicentre and prospective study. J Craniomaxillofac Surg 2015;43:62-70.