Diastasis of the Pubic Symphysis Without Fall While Horseback Riding: A Case Report

The purpose of this study was to demonstrate a rare case of pelvic ring injury in a healthy man without a history of high energy damage. A 43-year-old man presented to the emergency with local pain in pubic symphysis and difficulty walking after horseback riding. The patient did not report any fall or injury during this recreational activity, and apart from tachycardia, he was hemodynamically stable with normal blood pressure. Additionally, no deficit of neurological function was observed. The radiological imaging demonstrated an injury of the pelvic ring APC II with a diastasis of pubic symphysis of 3.6 cm. After a temporary stabilization with a pelvic binder, a computed tomography scan was also executed. A closed reduction and stabilization of the pelvic ring with supraacetabular external fixation with two 6 mm pins was performed. Postoperatively, the diastasis of the pubic symphysis was reduced to 1.5 cm. The patient remained in bed for four weeks, and afterward, gradual mobilization with partial weight bearing was allowed with crutches. The external fixation was removed 10 weeks postoperatively, and he fully returned to his pre-injury activities without any discomfort four months after the injury. Pelvic ring injuries in young patients without high-energy injuries are extremely rare and might be misdiagnosed. As presented in this case, the sudden onset of pain in pubic symphysis, combined with difficulty walking after a similar low-energy task, should not be overlooked for pelvic injury.