The popularity of cycling has increased by leaps and bounds over recent years. Bicycling has always been a favorite form of recreation for children, but, recently, more adults have migrated to cycling for its benefits as an aerobic exercise and as an inexpensive mode of transportation. The popularity of professional on-road cycling has spread from Europe to the United States and has been boosted by the accomplishments of American, Lance Armstrong. Both professional and recreational off-road mountain biking are gaining popularity, as well. Organized cycling events now range from short BMX (Bicycle Motocross Racing) sprints and acrobatic demonstrations to on-road races that stretch hundreds of miles and off-road races that take place over difficult terrain.
Unfortunately, along with the increase in cycling popularity, there has been an increase in cycling related trauma. Today, more bicycles are sold annually than automobiles, and more than 17 million adults are estimated to ride at least twice weekly. Cyclists now account for 2% of all traffic deaths, and cyclist-related accidents make up as much as 4% of all emergency room visits.
Traumatic cycling injuries to the upper extremity are more frequent than injuries to the lower extremity. Simple abrasions and lacerations are the most common injuries, followed by sprains and contusions, with fractures being the least common. Head and facial injuries occur frequently, but are often less severe because helmet use has increased. On the other hand, injuries to the abdomen and thorax are relatively rare, but are usually severe. When cycling related fatalities are reported, an automobile-versus-cyclist accident is usually the cause.
Abrasions and lacerations
Spoke injuries to the feet and toes are usually seen in children. These injuries often cause significant damage to the soft tissues, which can sometimes result in amputation. Spoke injuries are easily prevented by using spoke shields and wearing appropriate shoes.
Sprains and contusions
For cyclists, fractures (broken bones) are most common in the hand, wrist, forearm, or shoulder. They occur when the rider attempts to break his or her fall with an outstreched arm. After a fall, marked and immediate pain and swelling usually indicates a fracture of the distal radius, scaphoid, hamate, (wrist bones) (Fig. 1) or clavicle (collarbone). Separations or dislocations of the acromioclavicular joint (joint between the clavicle and shoulder blade) are also common when the rider lands directly on the shoulder (Fig. 2). Treatment depends on the bone involved, the amount of displacement (how much the bone has moved from its normal anatomic position) and whether the fracture is open (fractured bone breaks through skin) or closed.
Head and facial injuries
C. Curt Starling, MD