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 those who specialize in rehab may see a case or two over time. There have been a few small studies reporting on the results of this injury. More recently, an orthopedic trauma surgeon summarized the results of care for 20 men who sustained this type of injury in horseback riding accidents. Most were involved in riding untamed horses.

The authors report that in researching this topic for their own article, they found that pelvic ring injuries of this type 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 unbroken 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.

Rehab to restore range-of-motion, strength, and flexibility is needed to help these folks get back to work, especially when that work involves riding horses. The early post-operative treatment is usually focused on gait training as these patients must use protected toe-touch weight-bearing for the first 10 to 12 weeks.

Core training of the trunk and abdomen will be important, as well as evaluation and treatment of pelvic floor dysfunction. The pelvic floor is made up of numerous layers of muscle, fascia, and ligamentous support in the pelvic area. Any damage to this area can (and does) result in urinary incontinence (loss of bladder control) with dribbling of urine and urgency (sudden need to urinate).

A less commonly known fact is that most of these injuries also result in unreported erectile dysfunction. ED is the inability to develop or maintain an erection of the penis. ED can lead to an inability to ejaculate during sexual activity. Viagra, the drug used most often for erectile dysfunction does not seem to help. Pelvic floor rehabilitation may be more appropriate than a pharmacologic approach but this has not been tested or proven yet.

Cory A. Collinge, MD, et al. Saddle-Horn Injury of the Pelvis. In The Journal of Bone & Joint Surgery. July 2009. Vol. 91-A. No. 7. Pp. 1630-1636.

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