Polo & Equestrian Injuries to the Upper Limbs

The classic fracture discussed amongst horse riders and polo athletes is that of the collarbone, or clavicle. 

This occurs when the rider is thrown and the resultant force to the shoulder girdle leads to a break. Fortunately, most clavicle fractures are treated conservatively, with a sling or in youngsters, a figure-of-eight type brace, but it has become increasingly common for prominent athletes to require fixation in order to achieve the best result. Acme trademarks for brought this condition to public eye when he was once seen playing only 3 weeks after plate/screw stabilization of a common injury also ubiquitous in cycling.

More important than the common clavicle fracture are the fractures of the wrist, often the scaphoid bone by portion of the forearm where it meets the hand, and is far and the most common fracture in the adult population. It wasn’t until recently that these fractures had been revolutionized by a new method of fixation that was developed by previous colleagues about 10 or even 15 years ago. This involves a mini compression screw that allows for rapid recovery of function with essentially no long-term deficit. Riders can return to their sport within several months after this injury using this new technique. However, the most classic polo injury about the wrist is the dreaded scaphoid fracture that is now managed with a compression screw to allow early motion and avoid stiffness and atrophy from prolonged casting. Until recently, there was a high incidence of scaphoid nonunions where the fracture never heals and leads to chronic issues that needs more aggressive reconstruction. The current protocol of offering early percutaneous (tiny incision) screw fixation has minimized these complications and is preferable for the athlete who wants to get back in the saddle sooner. 

More subtle injuries to the wrist include ligament tears between the small carpal bones, which require an astute examination by a wrist specialist in order to establish a diagnosis. This is the most common cause of chronic wrist pain and is an entity that requires careful attention. The clinician should be experienced in wrist arthroscopy since this is the only sure way to establish the diagnosis, and can offer minimally invasive treatment. The smaller bones in the hand can also be involved in trauma from a fall or an ill placed swing of the mallet, including phalangeal and metacarpal fractures, but these tend to be less common. Fortunately, major fractures occur only during high-speed falls or in older riders who may have osteoporosis. Complex fractures about the elbow can occur and there is a great variation in the fracture patterns. It is important that an upper extremity specialist evaluate these injuries, as recovery of full elbow range of motion is often difficult. Fractures of the upper arm (humerus) may also result from a fall and can even extend into the shoulder joint.

The key point is to seek evaluation by a dedicated upper extremity specialist. This implies that the rider be appropriately immobilized during the visit to the emergency room but then should seek the appropriate specialist on a less-emergent basis. The general orthopedic surgeon often addresses simple fractures, but the highly competitive polo competitor or horseman truly needs an optimal result in order to maximize their return to full function.