Background: A saddle-horn injury of the pelvis occurs when a horse rider is thrown into the air and then falls back, with the perineum coming into contact with the saddle or saddle horn. The purpose of this study was to evaluate the characteristics and clinical outcomes, including sexual dysfunction, of this injury.

Methods: We conducted a retrospective review of a consecutive series of male patients who had a saddle-horn injury of the pelvis after being bucked from a horse. Clinical and radiographic results were assessed more than eighteen months after the injury. Functional outcome measures were evaluated at the time of the latest follow-up with use of visual analog pain scales, a questionnaire addressing occupational and recreational function, the International Index of Erectile Function instrument, the Iowa pelvic score, and the Short Form-36.

Results: Twenty patients were assessed at an average of thirty-three months after the injury. Seventeen patients had returned to riding horses, and ten felt that they had returned to their previous level of recreation, which had been "heavy" in nine cases and "moderate" in one. Eighteen patients had returned to their previous employment. Eighteen patients were found to have sexual dysfunction at the time of the latest follow-up. The mean Iowa pelvic score was 84 points (range, 56 to 99 points). The Short Form-36 outcomes scores were diminished in two subsections, role physical and role emotional, compared with population norms.

Conclusions: Mild pain can be expected after saddle-horn injury despite successful surgical treatment, and the injury does not preclude a return to previous employment or riding horses. A high proportion of men experience erectile dysfunction, which is unlikely to respond well to pharmacologic therapy.

Level of Evidence: Prognostic Level IV. See Instructions to Authors for a complete description of levels of evidence.