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Surgery May Be Best Treatment for Leg Fracture Caused by Horseback Riding Accident
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Posted on: 07/26/2007
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A cuboid nutcracker fracture is a break of the shinbone caused by the forefront being forced away from the center, usually because of a force that pushes it away. Left untreated, these fractures could cause disability and severe pain.
The researchers in this study went over the records of children who were admitted to a particular hospital because of fractures of the tibia (shinbone). They found four girls ranging in age from 11 to 15 years who had broken their leg in a horseback riding accident. As they fell, the horse did as well, trapping the girls beneath, causing the fracture.
Two patients underwent surgery and then wore non-weightbearing casts for six weeks followed by walking casts for another six weeks. Both girls recovered well and on follow-up (two years for one girl, three years for the other), there were no complications. The girls were walking normally and both had resumed their previous level activity, including participating in sports. The other two girls did not have surgery because they or their parents refused. Both girls wore non-weightbearing casts for six weeks. One girl then wore a walking cast for six week. Follow-up after three years found that the girl had no pain in the foot but did have stiffness and some arthritis was found in the joint. Although she had returned to her previous level of activity, she could only participate in non-strenuous sports. The fourth girl had a walking cast applied after six weeks of non-weightbearing the cast was only removed after three months. At five-year follow-up, the girl was not able to return to sports and still had pain and stiffness in her foot. This affected her daily activities and she could not participate in any sports activities.
The authors concluded that although these fractures are rare, if they are found, physicians should also look for other injuries in the mid-foot. A computed tomography scan (CT scan) is the best way to detect this. If there are no other injuries mid-foot, surgery may not be needed, but other studies did not have good results (fair to bad) from non-surgical treatment. The authors also point out that physicians should encourage the use of safety equipment, such as strengthened riding boots, to reduce horseback riding injuries.
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References:
Dimitri Ceroni, MD, et al. Cuboid Nutcracker Fracture Due to Horseback Riding in Children. In Journal of Pediatric Orthopaedics. July/August 2007. Vol. 27. No. 5. Pp.557-562.
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