Handlebar Injuries Are Bad…Really Bad

November 2, 2021

Written by Clay Smith

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Handlebars can cause significant intra-abdominal injuries as well as other soft tissue injuries. Take handlebar injuries, especially those to the abdomen, very seriously.

Why does this matter?
We know bicycle handlebars uniquely concentrate the force of impact to a small area and are associated with severe intra-abdominal injuries. If you see a round handlebar mark on the abdomen, CT is negative, but the child is still very tender on exam, call pediatric surgery and admit. Some children have bowel injury that may not be apparent even on CT. But do handlebars cause other injuries as well?

Handlebar mustache = stylish! | Handlebar vs child = badness.

Design: This was a retrospective review of a single center trauma registry that identified 385 bicycle injuries in children, 107 (27.8%) of which involved handlebars.

Results: As expected, this study also found that both solid organ (34.6% vs 4.3%) and hollow viscus (9.3% vs 0.7%) injuries were far more common with a handlebar vs non-handlebar mechanism. The authors also found a large number of soft tissue injuries, such as thigh, abdominal wall, or genital lacerations requiring repair in the handlebar cohort vs not (23.4% vs 2.2%, respectively). Extremity (4.7% vs 41.4%) and skull/spine/CNS (1.9% vs 43.2%) injuries were far less common in the handlebar vs non-handlebar group, respectively.

Implications: Handlebar injuries can be bad. Know that serious intra-abdominal injury is likely when you see a handlebar bruise on the abdomen. What this study adds is that handlebars also cause other serious soft tissue injuries commonly.

Limitations: This was a retrospective registry study, which may have had incomplete inclusion of all injuries related to bicycles. Also, presence of handlebar mechanism was based on the history and exam findings documented, which also could have missed many patients.

Source
Pediatric Handlebar Injuries: More Than Meets the Abdomen. Pediatr Emerg Care. 2021 Sep 1;37(9):e517-e523. doi: 10.1097/PEC.0000000000001690.