Polodoc: Big Crack & No Air

Dr.med. Andreas Krüger is a Swiss board orthopaedic and trauma surgeon in Zurich, who specialises in knee and shoulder surgery. Andi is a second generation of tournament doctors for equine sports, known as Polodoc since 2013

Big Crack & No Air

Combined Chest Injuries

The chance of falling off your horse has two main categories – it is high for beginners learning to play polo and equally, for professionals who push the limits to take the extra risk to win. Despite injuries being rare, they are potentially very dangerous and can end with a player in the operating theatre. Although injuries of the chest wall, clavicle and scapula are much more frequent in motor vehicle, motorbike or cycling accidents, polo and other equestrian activities are also often associated with injuries of the chest.

Injury Mechanism

Three specific mechanisms can be identified: 1. Riding off or falling off the horse due to leaning out the middle and landing on the arm in adduction to the chest wall 2. Sudden stop or stumbling of the horse 3. Overrun by horse/opponent

Especially when riders lean over in order to hit a ball with the mallet, they are putting themselves in an unstable position and may fall from the horse. Also, when riding off and getting in close contact with the opponent falls are possible or injury to the elbow or hitting arm. Not only can the impact from the fall itself cause serious injuries, but also when the rider gets overrun by his/her own horse or another rider. The arrows indicate multiple and severely displaced rib fractures and laceration of the left lung

‘Typical’ combination injury, pictured all in the same patient Injury Pattern

The most common injuries resulting from a fall are simple singular rib fractures, which per se do not require any special treatment other than bandaging, pain killers and rest. On the other hand, rib fractures can occur in multiple locations, resulting in chest wall instability and difficulty in breathing.

Moreover, injuries of the underlying lung can result in laceration of the lung as well as pneumothorax or even life threatening tension pneumothorax – requiring immediate decompression with a chest tube. Also, fractures of the scapula and clavicle are often seen in combination with serial rib fractures. But also bleeding from internal organs such as the liver of spleen have to be considered, which may cause internal bleeding and need immediate attention by a medical specialist.

PD Dr. med. Gregor Kocher, Chief physician, Department of General Thoracic Surgery, University Hospital Bern

Blunt trauma to the chest can result in a large variety of injuries, ranging from simple rib fractures to life threatening injuries of the internal organs such as lung, liver, spleen or the large vessels (aorta).

It is therefore crucial that an experienced medical specialist does a first assessment of such patients in order to rule out any life threatening condition.

Depending on the extent of injuries, once the patient has overcome the initial critical phase, further healing of rib fractures +/- fractures of the clavicle is often unproblematic and a full recovery is expected within three months after trauma. sporting activities should be avoided for six weeks after the procedure. Contact sports such as polo or similar activities should not be pursued before three months after surgical fixation and only once good healing of the bone has been documented on X-Rays and/or CT.

Prevention & Safety

To change the number of falls is a mission impossible, but what we can do is to change the impact when landing. Physical fitness is always an aid when it comes to a protective muscle shield. Also, flexibility and falling techniques from martial arts can make a difference. But as the elasticity of bone is limited airbag vests, such as Helite, may help to protect the thorax and reduce the impact. These vests can even bring some stabilisation to the cervical spine in case of activation. Otherwise no relevant restriction in free range of motion is objected by a player like Fabio Meier Products such as Helite help to reduce the impact from a fall and improve rolling manoeuvres

On Site Management

Since some of the abovementioned injuries may be life threatening, a well-trained specialist along with the necessary tools should be on site at all times. Besides a portable ultrasound to recognize internal bleeding, also the equipment for chest tube insertion should be readily available.

Treatment

Nondisplaced rib fractures and simple nondisplaced fractures of the clavicle usually do not warrant surgery to fix these injuries. In the case of pneumothorax, a chest tube should be inserted in order to allow to re-expansion of the lung. In the case of multiple and dislocated rib fractures as well as in dislocated or complicated fractures of the clavicle, surgical fixation of the rib and clavicle should be done by a specialist to facilitate breathing and start a speedy recovery.

Healing Process

Simple rib fractures may cause pain up to six weeks after trauma. With more severe injuries of the chest wall and/or clavicle which required surgery, weight bearing and “Free movement, no restriction, full swing proof” Fabio Meier said whilst wearing a Helite airbag vest at PoloPark Zurich

For more information on Polodoc contact Andreas Krüger at drmedkrueger@gmail.com or www.polodoc.ch