Injury Patterns and Associated Demographic Characteristics in Children with a Fracture from Equines: A US National Based Study

Abstract

Background: Fractures often occur due to equestrian activities with injury patterns varying by age. The purpose of this study was to investigate in detail fracture patterns and associated demographics in children due to equine activities.

Materials: The US National Electronic Injury Surveillance System was queried for all injuries with the consumer product code 1239 (horseback riding) from 2000 to 2023. Those <16 years old with fractures were extracted. Statistical analyses were performed with SUDAAN 11.0.01™ software to obtain national estimates.

Results: There were an estimated 101,677 patients with a fracture. Girls comprised 72.5% and the patient was discharged from the hospital in 81.5% of cases. Fractures involved the upper extremity in 80,973 (80.0%), the pelvis/lower extremity in 11,794 (11.7%), the spine in 3060 (3.0%), the skull/face in 4321 (4.4%), and the rib/sternum in 940 (0.9%). The humerus, elbow, radius/ulna, and wrist accounted for 62.4% of all the fractures. The youngest age group (0- to 5-year-olds) had more boys and was more likely to be admitted to the hospital. The child was injured due to a fall from the horse in 75.7%, bucked/thrown off/kicked off in 17.0%, with the remaining 7.3% from other mechanisms.

Conclusions: This extensive description of fractures in children due to equestrian injuries can be used to determine the effectiveness of future prevention strategies, such as protective equipment and educational programs. It also gives pediatric trauma and orthopedic surgeons an overall view of the types of fractures which occur in children due to equestrian activities.

Keywords: NEISS; child; demographics; equestrian; fracture; horse; injury.

Figure 1

Histogram of all patients. The greatest number occurred in the 12-year-old group.

Figure 2

Fracture locations. (a) Detailed locations. (b) Location aggregated by upper extremity, lower extremity, spine, head/neck, and rib/sternum.

Figure 2

Fracture locations. (a) Detailed locations. (b) Location aggregated by upper extremity, lower extremity, spine, head/neck, and rib/sternum.

Figure 3

Appendicular compared to axial fracture locations in children with injuries due to equines. (a) By mechanism of injury (p = 0.021). (b) By hospital size (p = 0.021).

Figure 4

Differences between boys and girls with fractures due to equine activities. (a) By race (p = 0.003). (b) By incident locale (p = 0.003). (c) By mechanism of injury (p = 0.035).

Figure 5

Distribution of associated internal organ injuries in children with fractures. The numbers of each pie slice are the number of patients having each particular internal organ injury. TBI = traumatic brain injury, pneumo/hemo = pneumothoroax/hemothorax.

Figure 6

Differences by age groups. (a) Differences by sex; note there were more boys among those < 6 years old (p < 10⁻⁴). (b) By disposition from the ED (p = 0.029). Those <6 years old were more commonly admitted to the hospital. (c) By mechanism of injury (p = 0.031). Those in the 11 to 15-year-old group had the highest percentage of being bucked/thrown/kicked off the horse. (d) By major fracture location (p < 10⁻⁴). Lower extremity fractures were more than twice as frequent in the oldest age group compared to the youngest (15.1% vs. 6.5%). (e) By hospital size (p = 0.0003).

Figure 6

Differences by age groups. (a) Differences by sex; note there were more boys among those < 6 years old (p < 10⁻⁴). (b) By disposition from the ED (p = 0.029). Those <6 years old were more commonly admitted to the hospital. (c) By mechanism of injury (p = 0.031). Those in the 11 to 15-year-old group had the highest percentage of being bucked/thrown/kicked off the horse. (d) By major fracture location (p < 10⁻⁴). Lower extremity fractures were more than twice as frequent in the oldest age group compared to the youngest (15.1% vs. 6.5%). (e) By hospital size (p = 0.0003).

Figure 7

Changes by year, month, and weekday in pediatric equestrian-related fractures. (a) Join point analysis demonstrating the average annual percentage decrease of 3.64% in children with fractures due to equine activities from 2000 through 2022 (p < 10⁻⁶). The black squares are the estimated number per year and the line is the best fit joinpoint regression. (b) By month of year. The estimated number of ED visits per month is at the top of the bar. (c) By weekday. The estimated number of ED visits per weekday is at the top of the bar.

Figure 7

Changes by year, month, and weekday in pediatric equestrian-related fractures. (a) Join point analysis demonstrating the average annual percentage decrease of 3.64% in children with fractures due to equine activities from 2000 through 2022 (p < 10⁻⁶). The black squares are the estimated number per year and the line is the best fit joinpoint regression. (b) By month of year. The estimated number of ED visits per month is at the top of the bar. (c) By weekday. The estimated number of ED visits per weekday is at the top of the bar.