Riding bucking broncos isn’t just something you see in an old John Wayne Western. Ranch hands and rodeo riders still ride bucking horses for sport and rodeo competitions. And sometimes, a horseback rider gets bucked unexpectedly when a pleasure horse gets spooked or for some unknown reason. Injuries can occur from such an event. The subject of this study is a particular type of trauma from a bucking horse called the saddle-horn injury of the pelvis.
The saddle-horn injury occurs when a rider gets bucked up in the air, then comes back down and collides with the still bucking horse. Crashing into the saddle horn of the saddle can fracture the pelvis, separate the pelvic bones, and cause direct injury to the soft tissues of the perineum (groin area in contact with the saddle).
This isn’t a typical injury seen in emergency departments across the United States. But it happens enough in places like Montana, Wyoming, Nevada, Utah, and Texas that orthopedic surgeons need to know how to respond. In this article, a fellowship-trained orthopedic trauma surgeon from the Fort Worth, Texas area reports on 20 cases (all men) of saddle-horn injury. Diagnosis, treatment, and prognosis with outcomes after one-year’s time (up to five years post-injury) are presented.
The authors report that in researching this topic for their own article, they found that pelvic ring injuries as described in this study are more common than they thought. Men are affected more often than women. That may be because men are more likely to be involved in high-risk behaviors such as riding untamed horses or riding aggressively. It may be that more men than women ride with a Western saddle that has a saddle horn (rather than English style — a low saddle without a horn).
All but one man in the study had surgery to repair the damage. A few patients had other injuries such as rib fractures and bladder rupture, but the majority had diastasis (separation) of the pubis symphysis (where the pubic bones come together). X-rays and CT scans were used to confirm the diagnosis. Clamps, plates, and screws were used to bring the two bones back together and hold them in place.
The question is: what happens to these guys? Can they recover? Do they hop back on a horse and ride again? Experts always say the best thing to do after getting bucked off a horse is to get right back on again. Is that possible after an injury and surgery of this kind?
The answer is: yes! Eighty per cent of the men (18 out of 20) were back to work and back in the saddle within a year of the injury. Some were working and riding at the level they were before the injury. But 14 of the 20 said that their ability to ride was limited compared to before the injury.
The major problem after it was all said and done was with erectile dysfunction (ED). ED is the inability to develop or maintain an erection of the penis. ED can lead to an inability to ejacul*te during sexual activity. The patients did not have this problem before the injury, so it was concluded that it occurred as a result of the musculoskeletal damage from the injury. Upon further questioning, it turns out that one-third of the affected group also had urinary dysfunction with incontinence (dribbling urine) and urinary urgency (sudden need to urinate).
Although erectile dysfunction is a serious impairment, saddle-horn injuries don’t usually result in a poor outcome such as internal hemorrhaging, death, or permanent physical disability. The surgery seems to be successful in holding the bones together nicely. X-rays show good alignment of the pubic bones and pelvic ring formed by the pubic bones. Second surgeries are rarely needed. Mild groin and/or perineal pain with activity is a common report.
So what can be done to help those who are dissatisfied with their sexual function after treatment? That may depend on what is the underlying cause. Was there nerve or blood vessel damage done at the time of the injury that could be causing this problem? Are there psychologic causes? Age is definitely a factor. The older men in this study were more likely to have erectile dysfunction than the younger men. Younger men may have more motivation to recover full sexual function than do older men.
Viagra, the drug used most often for erectile dysfunction did not seem to help with this group of men. But many did not follow-up with the urologist to seek additional help, so the answer to what works and what doesn’t help with this problem remains a mystery. For now, based on the results of this small study, the authors can offer the information that saddle-horn injuries have a good prognosis. Return to work and riding horses is possible and even likely. Male patients should be forewarned about the potential for sexual dysfunction.
