Bike Injuries
Collision-related trauma

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
Although they are usually minor, abrasions and lacerations require proper care. Most can be taken care of at home with cleaning and bandage changes. However, severe cases of road rash, which involve large surface areas or contamination by dirt or debris, or deep lacerations should be properly evaluated and cleaned. Debridement (removal of foreign material) is usually carried out in the emergency room, but can occasionally require the use of the operating room. These injuries often improve with a short period of antibiotics to guard against infection.

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
Sprains and contusions usually heal with the application of rest, ice, compression, and elevation (RICE). Over the counter anti-inflammatory medications, such as aspirin or ibuprofen, can also help control swelling and pain. Sprains that do not improve with these simple measures may be a more serious ligament injury and should be evaluated more thoroughly.

Fractures
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
Head and facial injuries are most common in children, who often react more slowly than adults when protecting themselves during a fall. Helmet use has significantly reduced serious head injuries, however, it does little to protect the face. For this reason, safety experts recommend that BMX, which imitates motorcycle racing, and off-road riders wear a mouthguard to protect the teeth. After a fall, any symptoms of confusion, dizziness, diplopia (double vision), loss of consciousness, excessive sleepiness or severe headache should be promptly evaluated. These symptoms could represent a cerebral (brain) concussion, contusion (bruising) or hematoma (bleeding)-conditions that require immediate attention. A cyclist with persistent neck pain should be evaluated to rule out cervical vertebral (neck) fractures.

Avoiding injuries
To avoid injuries, cyclists and motorists should be aware of each other's presence and follow traffic regulations. Cyclists should follow the same traffic rules motorists do and should always dress appropriately with a helmet and bright reflective clothing. Motorists, in turn, should always be on the lookout for cyclists and should yield them the right of way when possible. Cyclists should be aware of road damage and debris, which can cause a fall and lead to injury. Interestingly, 47% of cyclists involved in accidents in urban settings, cited themselves as being at fault; therefore, an "ounce of prevention" truly is worth a "pound of cure."

C. Curt Starling, MD
Valdosta, Georgia