A combination of bimalleolar fracture and fracture on talar body and neck: A rare case report

RATIONALE

Talar fracture accompanied with malleolar fracture is rare, and its management is complex. Ankle soft tissue is much thinner than other parts of the human body, and the shape of the ankle makes wounds difficult to close immediately after surgery, which may result in poor skin condition if the wound tension is too high. However, joint congruity and osteonecrosis are the main concerns of talar fracture.

PATIENT CONCERNS

A 57-year-old man presented at the emergency department following a motorcycle accident.

DIAGNOSES

Physical examination revealed swelling and tenderness of the left ankle and midfoot. The patient had comminuted talar fracture and was indicated for dual-screw fixation or even plate with screw fixation.

INTERVENTIONS

We performed single screw fixation after assessing the soft tissue condition and employed a technique of using continuous longitudinal force to bring together fracture fragments (ankle ligamentotaxis) during surgery. Open reduction with a mini-hook plate and tension band wire was used for bimalleolar fracture repair using the combined anteromedial and anterolateral approach with extension of the incision. Kirschner wire for temporary fixation was performed using ligamentotaxis, and a 2.4 headless screw was inserted from the posteromedial to the anterolateral direction.

OUTCOMES

The patient was discharged with a standard short leg splint and was instructed not to bear weight on the affected ankle for 2 months. The patient walked well without discomfort, and the Hawkins sign was clearly visible. Single screw fixation preserves the integrity of the talus bone as minimal space is used for this operative technique. Single screw fixation preserves more bony stock when most of the internal fixator is located within the bone. Additionally, surgery time is shorter than multiple implantations even when performing the same procedure; as a result, there was less ankle soft tissue swelling.

LESSONS

This case provides evidence of using the single screw fixation technique for addressing both malleolar and talar fractures, and that talar fracture management can be less aggressive with limited weight bearing and initial limited range of motion given the presence of malleolar fracture. The alignment and stability of bony fragments also benefit from ankle ligamentotaxis.

Epidemiology, etiology, and types of severe adult brachial plexus injuries requiring surgical repair: systematic review and meta-analysis

The literature describing epidemiology, etiology, and types of serious brachial plexus injuries (BPIs) is sparse. The aim of this review was to investigate the epidemiological and etiopathogenetical data of serious BPIs undergoing surgical reconstruction. A systematic search was conducted from January 1985 to December 2017. All studies that reported data about prevalence of specific types and causes of BPIs in adults treated surgically were included and cumulatively analyzed. Ten studies including 3032 patients were identified. The pooled prevalence of closed BPIs was 93% (95% CI: 87-97%), lacerations accounted for 3% (95% CI: 1-6%), and gunshot wounds (GSWs) for 3% (95% CI: 0-7%). The prevalence of male patients was 93% (95% CI: 90-96%) and female cases 7% (95% CI: 4-10%). The most common cause of closed BPI was motorcycle accidents with 67% (95% CI: 49-82%) prevalence followed by car crashes with 14% (95% CI: 8-20%). Other causes were rare. Ninety percent (95% CI: 78-98%) of patients suffered from a supraclavicular or combined supra-/infraclavicular trauma, while 10% (95% CI: 2-22%) from isolated infraclavicular injury. The prevalence of complete lesions was 53% (95% CI: 47-58%) followed by upper plexus lesion with 39% (95% CI: 31-48%) and lower plexus injury with 6% (95% CI: 1-12%). This meta-analysis demonstrates that the typical patient suffering from severe BPI is a male after motorcycle accident with closed supraclavicular injury causing complete or slightly less commonly upper plexus palsy. Lacerations and GSWs of brachial plexus are rare.

Quantitative assessment of environmental exposure of delivery men in Wuhan

The take out industry is rapidly developing in China, but the environmental exposure of delivery men is neglected. "Ele.Me," an online food ordering platform, is one of the two largest catering online-to-offline platforms in China. From January 2018 to April 2018, data from 16,528 take out shops in Wuhan were crawled by using Python. The data included store name, average delivery time, delivery price, region, and store type. With the use of Baidu map's API batch reverse address resolution, the map locations of the take out shops were identified. Network service area was utilized to obtain the activity space of delivery men along the Wuhan traffic road network. Combined with the data on sulfur dioxide (SO₂), nitrogen dioxide (NO₂), carbon monoxide (CO), ozone (O₃), PM2.5, PM10, and noise provided by the Wuhan Environmental Protection Bureau, the spatial interpolation, regional analysis, superposition analysis, and other geographic information system spatial analysis methods were used to study the air and noise pollution within the activity space of delivery men in various take out shops. Results revealed the unbalanced environment faced by Wuhan delivery men. The exposure to NO₂, CO, and PM2.5 was mainly concentrated in the central city, whereas the exposure to SO₂, O₃, and PM10 was mainly noted far from the city. Noise pollution was mainly observed in the districts of Hannan, Caidian, and Dongxihu; and the most serious pollution was recorded in Shamao Street. The weighted comprehensive pollution index model was used to calculate the contribution weight of each evaluation factor to obtain the results of environmental exposure to air pollution. The influence of noise was further considered to obtain the consequences of comprehensive environmental exposure to pollution. The highly polluted regions were those in the central part of the city. Pollution was mainly concentrated in the third loop, whereas Zhucheng Street in the Xinzhou District provided the best environment. The results of this study can serve as a reference for the physical health risk assessment of delivery men.

Development and Validation of the Overall Foot Pain Questionnaire in Motorcycle Riders

Objectives: Our primary aim was to develop a transcultural adaptation of a cycling questionnaire using the Borg CR-10 scale as a tool to describe the discomfort among motorcyclists during the riding process in two trial sessions. Design: A transcultural adaptation and descriptive cross-sectional study. Settings: Jarama motorcycling circuit (Madrid, Spain). Participants: The participants were riders recorded across in a final motorcycling race. Interventions: The study design is based in two tools, the adapted Motorcyclist Questionnaire (MQ-21) with 21 items and Borg CR10 Scale^® was used to determine discomfort level during motorcycling performance. The translation procedure, reliability, and reproducibility were performed. Results: All items showed an almost perfect intraclass correlation coefficient (ICC) (ICC = 0.909–1.00), except for item 9 (ICC = 0.881). Almost perfect internal consistency was shown for the total score (Cronbach α = 0.899). No systematic differences existed among test and retest in all items (p > 0.05) according to Bland–Altman plots. Respondents experienced slight discomfort on their body parts during the test-retest 1 h riding process. Foot discomfort was scored as 1.20, being the eighth of the 12 studied body parts. Conclusions: Internal consistency and test-retest reliability of the MQ-21 questionnaire were excellent and this questionnaire may be recommended to be used in motorcycling sports and clinical settings to evaluate the discomfort.

Boda Bodas and Road Traffic Injuries in Uganda: An Overview of Traffic Safety Trends from 2009 to 2017

INTRODUCTION

Road traffic injuries (RTIs) are an important contributor to the morbidity and mortality of developing countries. In Uganda, motorcycle taxis, known as boda bodas, are responsible for a growing proportion of RTIs. This study seeks to evaluate and comment on traffic safety trends from the past decade.

METHODS

Traffic reports from the Ugandan police force (2009 to 2017) were analyzed for RTI characteristics. Furthermore, one month of casualty ward data in 2015 and 2018 was collected from the Mulago National Referral Hospital and reviewed for casualty demographics and trauma type.

RESULTS

RTI motorcycle contribution rose steadily from 2009 to 2017 (24.5% to 33.9%). While the total number of crashes dropped from 22,461 to 13,244 between 2010 and 2017, the proportion of fatal RTIs increased from 14.7% to 22.2%. In the casualty ward, RTIs accounted for a greater proportion of patients and traumas in 2018 compared to 2015 (10%/41% and 36%/64%, respectively).

CONCLUSIONS

Although RTIs have seen a gross reduction in Uganda, they have become more deadly, with greater motorcycle involvement. Hospital data demonstrate a rising need for trauma and neurosurgical care to manage greater RTI patient burden. Combining RTI prevention and care pathway improvements may mitigate current RTI trends.

Enhancement of unsafe behaviors in simulated moped-riding performance under the influence of low dose of alcohol

The effects of low levels of blood alcohol concentration (BAC) on motorcyclist performance are still not fully comprehended. The great majority of the studies are, in fact, focused on car driving. So far, it is known that even BAC levels below the legal limit negatively affect riding motor skills correlated with crash rate. In the present study, we used a moped riding simulator to investigate the effects of low alcohol dosages (under the limits established in Italy, and in most European countries) on the defensive riding ability of light drinkers, particularly focusing on the degree of danger characterizing their riding performance. We recruited 24 participants through a double-blind, random distribution, balanced, cross-over design. We administered moderate amounts of alcohol to participants during two sessions of moped riding simulation. The results showed that even though BAC levels were always below (mean value: 0.03 g/dL) the limit allowed by Italian traffic law (0.05 g/dL), alcohol induced a reduction in safe riding behaviors, as indicated by the greater amount of hazardous scenes faced with dangerous riding behaviors when participants were under the influence of alcohol than when they were sober. Moreover, low BAC levels had a greater detrimental influence when a certain amount of learning had already been achieved by the participants (i.e., in the last experimental session). The results suggest that the effect of a low dose of alcohol interacts with participants' self-confidence.

Effects of Motorcycle Noise on Annoyance-A Cross-Sectional Study in the Alps

Motorcycle noise is an increasing noise problem, especially in Alpine valleys with winding roads and low environmental noise. The annoyance response to motorcycle engine noise is extraordinarily high in comparison to other traffic noise and cannot be explained by standard noise assessment curves. Therefore, the Tyrolean state government decided to initiate a multi-purpose study. Exposures were calculated based on sound-measurements taken across the entire district of Reutte in the western part of the State of Tyrol and a telephone survey (n = 545) was conducted with regional participants. The influence of demographic characteristics; sensitivity to noise; attitudes towards motorcycles and background noise on the annoyance was examined using bivariate analyses. In addition; exposure-response curves and their 95% confidence intervals with cut-off points of 60% and 72% for “highly annoyed” were created. The exposure annoyance response curves for motorcycle noise show a shift of more than 30 dB in annoyance reaction compared to other road traffic noise. The annoyance response to motorcycle noise in this Alpine region is concentrated on summer Sundays and Saturdays and is independent of the background exposure caused by other road traffic

The electric scooter: A surging new mode of transportation that comes with risk to riders

Objective: The proliferation of electric scooter sharing companies has inundated many municipalities with electric scooters. The primary objective of this study is to characterize the epidemiology of injuries from this new mode of transportation in order to inform injury prevention efforts.Methods: A multicenter, retrospective study was conducted at two level 1 trauma centers in an urban setting. Patients seen in the emergency department from September 4, 2018 to November 4, 2018 were included if injury coding and chart review identified a scooter-related injury. Demographics, injury patterns, and other injury related factors were obtained via chart review.Results: Ninety-two patients were identified over the study period in 2018 with electric scooter-related injuries. Of the patients utilizing an electric scooter; none used protective gear and 33% used alcohol prior to presentation. More than 60% of patients required medical intervention including laceration repair (26%), fracture reduction (17%), operative fixation of a fracture (7%), or arterial embolization for an associated arterial injury (1%). Approximately 10% of patients required inpatient admission and one required an admission to the intensive care unit.Conclusion: We found a substantial increase in the number of scooter-related injuries during the first two months of electric scooter legalization. There was a lack of safety equipment utilization and concomitant alcohol utilization was common. These may offer areas of focus for injury prevention efforts. Additionally, standardization of injury coding for electric scooter related injury is critical to future studies and will help better understand the impact of this new mode of transportation.

Physiological and biomechanical comparison between electrically assisted bicycles and motorbikes during simulated mail delivery

Electrically assisted bicycles (EABs) and motorbikes were compared in terms of energy expenditure, internal and external forces, and technique when delivering mail with different loads at different distances from the mailbox. Twenty-two postal workers performed two simulated postal tasks (foot placement [close vs. far] and delivery, and simulated mail delivery circuit) while carrying 0 and 32 kg. Independent of mail load, delivering mail with EABs was classified as moderate intensity and resulted in 33% higher energy expenditure when compared to motorbikes. Ground reaction forces were larger (7-25%) for EAB when compared to motorbike. Larger ground reaction forces were observed when both EABs and motorbikes were positioned further from the mailbox (5-23%). Using EABs during mail delivery has potential to result in numerous health benefits that are associated with moderate intensity physical activity, but can lead to larger external forces when compared to motorbikes. Practitioner summary: In order to compare electrically assisted bicycles (EAB) and motorbikes, postal workers performed simulated deliveries in the laboratory whilst measurements of energy expenditure, body loads and movement patters were undertaken. Body loads and energy expenditure were larger using EAB, which result in health benefits associated with moderate intensity exercise. Abbreviations: EAB: electrically assisted bicycles; CI: confidence interval; UHEC: University Human Ethics Committee; MB: motorbike;SH: seat height; SF: seat to floor distance; VO2: oxygen uptake; VCO2: exhaled carbon dioxide; RER: respiratory exchangeratio; TTL signal: Transistor-Transistor Logic; MET: metabolic equivalent; 3D: three-dimensional; IIR: infinite impulse response; Hz:Hertz; N: Newtons; ROM: range of motion; SD: standard deviation; p: significance level; d: Cohen effect sizes.

Descriptive analysis of the effect of back protector on the prevention of vertebral and thoracolumbar injuries in serious motorcycle accident

CONTEXT AND OBJECTIVE

Among the different products and protective gear used by riders of two-wheeled motorized vehicles, back protectors that are designed to prevent damage to the spinal column are widely used today compared other protections. However, few studies measure their effectiveness. Can their effectiveness be measured? How do they help decrease or change the nature of thoracolumbar traumas that occur? To address these questions and remedy the lack of objective data regarding these products, an epidemiological, clinical, and biomechanical analysis of motorcycle riders who were admitted to a French trauma center after an accident was performed. So, this study investigates the effectiveness of back protectors, including their ability to prevent specific mechanisms of thoracic and lumbar spinal injuries related to TWMV accidents.

METHOD

A questionnaire was administered to victims of accidents involving two-wheeled motorized vehicles who were admitted to the trauma room at the Marseille trauma center over the course of 2016. Collect data are related to the victim, the accident scenario, and a detailed description of the observed injuries using AIS (Abbreviated Injury Scale) coding and Magerl classification. Univariate analyses and Fisher tests were performed for victims who were or were not wearing back protectors.

RESULTS

This study collected data from 124 victims. Almost half of the victims were wearing a back protector at the time of the accident (53 victims, thus 43% of riders). Collectively, twenty-nine victims who were wearing back protectors had 57 thoracolumbar injuries, and twenty eight victims who were not wearing back protectors had 75 thoracolumbar lesions. The results from this study show that there is no significant difference in the nature and mechanism of thoracolumbar injuries as a function of back protection. The majority of the thoracolumbar injuries were not severe. They were primarily bone injuries, essentially compression fractures, regardless of whether a back protector was worn.

CONCLUSION

This study shows that the use of back protection does not decrease the number, type, or mechanism of thoracolumbar injuries associated with accidents involving two-wheeled motorized vehicles. However, it suggests that lumbar vertebral injuries are deflected towards the thoracic vertebrae when back protectors are worn. Finally, it suggests that the design of back protectors should be reconsidered to better protect riders from what are referred to as compression fractures (craniocaudal force), which remain the primary form of fracture regardless of the rider's characteristics, based on the data analyzed.

The Influence of Static Factors on Seating Comfort of Motorcycles: An Initial Investigation

OBJECTIVE

The aim of the current study is to examine the influence of static factors on overall seating comfort in motorcycles and validate the use of static lab-based setups for evaluating seating comfort in motorcycles.

BACKGROUND

Seating comfort in automobiles has two factors, static and dynamic. Research on seating comfort of passenger cars has shown that when the magnitude of vibration reaching the seat is low, comfort is largely determined by static factors. Studies have also validated the use of static lab-based setups for research on seating comfort in passenger cars. Static lab-based setups are easy to develop, provide a controlled environment, and efficient for experimental research. The riding posture, mass distribution, and dynamics of a motorcycle differ from a passenger car and warrant further investigation to extend the results from the research on passenger cars.

METHOD

The study compares subjective rating of seating comfort and objective measurement of seat interface pressure in two test conditions: a static lab-based setup and actual driving on a flat test track where the magnitude of vibration reaching the seat is low. The vibration at the seat is measured for the driving trial. A group of 18 male volunteers from TVS Motor Company participated in the study, and two motorcycles from the economy/executive segment of India are used in the study. The subjective ratings are analyzed statistically using analysis of variance (ANOVA) and Pearson's correlation. The vibration data are analyzed as per ISO 2631-1 to calculate the frequency-weighted acceleration, a_w.

RESULTS

The results show that there is no significant difference between the two test conditions either in the objective measurements or in the subjective rating of comfort. There is also a statistically significant correlation between the subjective ratings of seating comfort in static lab-based setup and actual riding (r = .77, p < .01, n = 36). The mean a_w at the seat while driving in the test track used in this study is 0.2 m/s².

CONCLUSION

Static factors have a significant influence on seating comfort in motorcycles. When the vibration reaching the seat is low (a_w ≤ 0.2 m/s²), seating comfort is largely determined by the static factors. The use of static lab-based setups for evaluating static factors of seating comfort in motorcycles is validated.

APPLICATION

The results of this study enable further research to understand the human criterion for seating comfort in motorcycles using static lab-based setups which are easier to develop and provide controlled environment that is essential for any research.

The spectrum of injuries from motorcycle induced road traffic accidents from level one trauma center: A prospective observational study

OBJECTIVE

To observe the role of motorcycles in causing Road Traffic Accidents and assess the demographics of the drivers, the injury patterns and their outcomes.

METHODS

This prospective observational study was conducted at the Surgical Unit 1, Lahore General Hospital, Lahore for a period of 6 months from November 2017 to May 2018. All patients presenting in ER with RTA secondary to motorcycle trauma were included in the study. Data of patients including demographic and medical data, helmet use, spectrum of injuries, specific injury diagnosis, and final disposition of patients was analyzed. The distribution and associations of both victim- and crash-related variables such as crash mechanism, types of involved vehicles, types of injuries, and demographic characteristics were investigated. Data were analyzed by SPSS v23.

RESULTS

A total of 835 patients were included in this study with 685 (82%) being male (mean age 28.38 ± 13.89 years) and775 (92.7%) were motorcycle users. The majority of road traffic crashes, traffic accident's mechanism were motorcycle-vehicle accident 579 (69.3%), followed by collision with slow moving carts and bicycles 104 (12.5%). Inner city main roads were the site for 563 (67.4%) accidents. Only 168 (2.2%) patients were wearing helmets at the time of trauma.

CONCLUSIONS

Motorcycle traffic morbidities and mortalities remain to be a major public health issue in Lahore as well as all over Pakistan. There is an urgent need for an efficacious interventional programs to decline the burden of motorcycle related morbidity and mortalities.

Thoracic Spine Fracture in the Panscan Era

STUDY OBJECTIVE

In the current era of frequent chest computed tomography (CT) for adult blunt trauma evaluation, many minor injuries are diagnosed, potentially rendering traditional teachings obsolete. We seek to update teachings in regard to thoracic spine fracture by determining how often such fractures are observed on CT only (ie, not visualized on preceding trauma chest radiograph), the admission rate, mortality, and hospital length of stay of thoracic spine fracture patients, and how often thoracic spine fractures are clinically significant.

METHODS

This was a preplanned analysis of prospectively collected data from the NEXUS Chest CT study conducted from 2011 to 2014 at 9 Level I trauma centers. The inclusion criteria were older than 14 years, blunt trauma occurring within 6 hours of emergency department (ED) presentation, and chest imaging (radiography, CT, or both) during ED evaluation.

RESULTS

Of 11,477 enrolled subjects, 217 (1.9%) had a thoracic spine fracture; 181 of the 198 thoracic spine fracture patients (91.4%) who had both chest radiograph and CT had their thoracic spine fracture observed on CT only. Half of patients (49.8%) had more than 1 level of thoracic spine fracture, with a mean of 2.1 levels (SD 1.6 levels) of thoracic spine involved. Most patients (62%) had associated thoracic injuries. Compared with patients without thoracic spine fracture, those with it had higher admission rates (88.5% versus 47.2%; difference 41.3%; 95% confidence interval 36.3% to 45%), higher mortality (6.3% versus 4.0%; difference 2.3%; 95% confidence interval 0 to 6.7%), and longer length of stay (median 9 versus 6 days; difference 3 days; P<.001). However, thoracic spine fracture patients without other thoracic injury had mortality similar to that of patients without thoracic spine fracture (4.6% versus 4%; difference 0.6%; 95% confidence interval -2.5% to 8.6%). Less than half of thoracic spine fractures (47.4%) were clinically significant: 40.8% of patients received thoracolumbosacral orthosis bracing, 10.9% had surgery, and 3.8% had an associated neurologic deficit.

CONCLUSION

Thoracic spine fracture is uncommon. Most thoracic spine fractures are associated with other thoracic injuries, and mortality is more closely related to these other injuries than to the thoracic spine fracture itself. More than half of thoracic spine fractures are clinically insignificant; surgical intervention is uncommon and neurologic injury is rare.

Active safety systems for powered two-wheelers: A systematic review

Objective: Active safety systems, of which antilock braking is a prominent example, are going to play an important role to improve powered two-wheeler (PTW) safety. This paper presents a systematic review of the scientific literature on active safety for PTWs. The aim was to list all systems under development, identify knowledge gaps and recognize promising research areas that require further efforts.Methods: A broad search using "safety" as the main keyword was performed on Scopus, Web of Science and Google Scholar, followed by manual screening to identify eligible papers that underwent a full-text review. Finally, the selected papers were grouped by general technology type and analyzed via structured form to identify the following: specific active safety system, study type, outcome type, population/sample where applicable, and overall findings.Results: Of the 8,000 papers identified with the initial search, 85 were selected for full-text review and 62 were finally included in the study, of which 34 were journal papers. The general technology types identified included antilock braking system, autonomous emergency braking, collision avoidance, intersection support, intelligent transportation systems, curve warning, human machine interface systems, stability control, traction control, and vision assistance. Approximately one third of the studies considered the design and early stage testing of safety systems (n. 22); almost one fourth (n.15) included evaluations of system effectiveness.Conclusions: Our systematic review shows that a multiplicity of active safety systems for PTWs were examined in the scientific literature, but the levels of development are diverse. A few systems are currently available in the series production, whereas other systems are still at the level of early-stage prototypes. Safety benefit assessments were conducted for single systems, however, organized comparisons between systems that may inform the prioritization of future research are lacking. Another area of future analysis is on the combined effects of different safety systems, that may be capitalized for better performance and to maximize the safety impact of new technologies.

Deaths in traffic accidents associated with THC abuse

From the National Registry of autopsies and toxicology examinations, we selected the deceased for 2015, 2016, 2017 and January 2018 active road accident participants, i.e. pedestrians, cyclists and motor vehicle drivers. From these, we further selected those who were tested for THC presence. Of the 836 deceased active road accident participants, only 251 (i.e. 30%) were tested for cannabinoids, most often passenger car drivers, 46 percent. Of the 251 people tested, THC was demonstrated in 12 (4.8%), most commonly motorcycle drivers (7.8%) and passenger car drivers (3.4%). Of the 12 positive people, 7 were found to have a possible effect of THC ingestion on the road accident, but only one participant was found to have overdosed on THC, and 2 were reported by the dissecting physician to have had no effect on the accident. In the Czech Republic, when driving under the influence of addictive substances, there is no uniform procedure for qualification, whether it is an offence or an offence, and thus in the award of punishment. While somewhere there is an effort to divide this wrongdoing into offences and crimes, elsewhere it practically always only constitutes an offense. This situation seeks to resolve the instruction of the Attorney-at-chief 1 SL 732/2018 of 29 December 4.2019, which, however, arose without any discussion with the professional public, which is heavily criticized especially for the absurly high limits, which in particular in morphine and cocaine are practically unachievable. At the time of this writing, the impact of this guideline on practice is not clear.

Are riders of electric two-wheelers safer than bicyclists in collisions with motor vehicles?

Electric two-wheelers (E2Ws) have become newly popular transportation tools with the associated growing traffic safety concerns. E2W riders and bicyclists behave similarly as vulnerable road users (VRUs), while exhibited dissimilarities in riding postures and interactions with the two-wheelers. Existing epidemiology reveals prominent differences in injury risks between E2W riders and other vulnerable road users in collisions with motor vehicles. The objective of this study is to investigate the factors influencing kinematics and head injury risks of two-wheeler rides in two-wheeler-vehicle collisions and compare between E2W-vehicle and bicycle-vehicle collisions. Via multi-body modeling of two two-wheeler types, two vehicle types, and three rider statures in MADYMO, twelve collision scenarios were developed. A simulation matrix considering a range of impact velocities and relative positions was performed for each scenario. A subsequent parametric analysis was conducted with focus on the kinematics and head injury risks of two-wheeler riders. Results show that the head injury risk increased with vehicle moving velocity, while the two-wheeler velocity and relative location between rider and vehicle prior to the collision exhibited highly non-linear influence on the kinematical response. The rider with larger stature had higher possibilities to miss head impact on the vehicle. In collisions with the sedan, E2W riders would sustain lower head injury risks with lower contacting velocity on the windshield than bicyclists. While in collisions with the SUV, E2W riders would sustain increasing head injury risks due to the higher structural stiffness at contact, and the risk level was about the same as bicyclists. The findings revealed the loading mechanisms behind the different head injury risks between E2W riders and bicyclists.

Emergency braking at intersections: A motion-base motorcycle simulator study

Powered two-wheeler riders are frequently involved in crashes at intersections because an approaching car driver fails to give right of way. This simulator study aimed to investigate how riders perform an emergency braking maneuver in response to an oncoming car and, second, whether longitudinal motion cues provided by a motion platform influence riders' braking performance. Twelve riders approached a four-way intersection at the same time as an oncoming car. We manipulated the car's direction of travel, speed profile, and its indicator light. The results showed that the more dangerous the situation (safe, near-miss, impending-crash), the more likely riders were to initiate braking. Although riders braked in the majority of trials when the car crossed their path, they were often unsuccessful in avoiding a collision with the car. No statistically significant differences were found in riders' initiation of braking and braking style between the motion and no-motion simulator configurations.

Obesity and age as factors in leg amputations in fatal motorcycle crashes

The autopsy files at Forensic Science South Australia were searched over an 11-year period from January 2008 to December 2018 for all cases of motorcycle fatalities in which there had been lower-limb amputations. Six cases were identified, consisting of five male riders and one female pillion passenger. The age range was 48–67 years (average 59 years), which was significantly older than the control group (40.6 years; p < 0.01). All the decedents were overweight, with a body mass index (BMI) of 28.7–43.5 kg/m2 (average 34.9 kg/m2), which again was significantly greater than the control group (28.8 kg/m2; p < 0.05). Five of the incidents involved a collision between a motorcycle and a motor vehicle; the remaining case involved a collision with a tree. Five of the amputations were on the right side in the motorcycle-vehicle impacts, and they varied in severity from loss of a foot to a hind-quarter amputation. There was a single left lower-leg amputation which occurred during the collision with a tree, which was beside the road on the motorcyclist’s left. This study has shown that motorcyclists at greatest risk of lower-limb/pelvis amputations are older than the average rider with higher BMIs. This may be significant information given the increase in both BMI and age in many populations.

Regulating Innovation: Utility vs. Leisure in Swedish Moped History, 1952-1961

This article investigates the attempts to regulate innovation in Sweden's road traffic system, specifically small, two-wheeled motorized vehicles or mopeds. Regulators wanted to establish a definition of the moped as a utility vehicle. Moped users and producers challenged their intentions, envisioning the moped as a vehicle for leisure. Our close reading of artefacts allows us to trace the evolution of moped technology and to conceptualize innovation in the moped niche. Situating moped innovation within the context of regulatory attempts and social change, we show how the imposition of technical requirements failed to regulate specific usage of a consumer technology. More broadly, the case study shows how users together with the producers find ways to innovate and shape technologies for their own purposes.

The epidemiology and prehospital care of motorcycle crashes in a sub-Saharan African urban center

OBJECTIVE

Road traffic crashes (RTCs) are common among motorcyclists in Kigali, Rwanda. The Service d'Aide Medicale Urgente (SAMU), a prehospital ambulance service, responds to many of these crashes. We aimed to describe motorcycle-related RTCs managed by SAMU.

METHODS

SAMU clinical data including demographic information, injury characteristics, and management details were analyzed descriptively for all motorcycle crashes occurring between December 2012 and July 2016.

RESULTS

Every patient included in this study was injured. These patients all called the ambulance for their injuries after a motorcycle crash. There were 2,912 motorcycle-related RTCs over the study period, representing 26% of all patients managed by SAMU. The incidence of motorcycle crashes in Kigali was 258 crashes per 100,000 people over the 3.5-year study period. The average age was 30 years and 80% were males. The most common injuries were to the lower extremities (n = 958, 33%), head (n = 878, 30%), or upper extremities (n = 453, 16%). Injuries often resulted in fractures of extremities (n = 740, 25%) and external hemorrhage anywhere in the body (unspecified region; n = 660, 23%), yet few were severe based on the Kampala Trauma Score (n = 23, 2%) and Glasgow Coma Scale (n = 42, 1.5%). The most common interventions were provision of diclofenac (n = 1,526, 52.5%), peripheral intravenous (IV) access (n = 1,217, 42%), and administration of IV fluids (n = 1,048, 36%).

CONCLUSION

Motorcycle-related RTCs represent a large burden of disease for patients treated by SAMU in Kigali, Rwanda. Young men are most at risk of injury, which imposes a financial strain on society. Though injuries occurred frequently, critical trauma cases from motorcycle crashes were uncommon. This may be a result of several initiatives in Rwanda to improve road safety.

Injury from electric scooters in Copenhagen: a retrospective cohort study

OBJECTIVE

To analyse injuries related to manual and electric scooter use from January 2016 up to and including July 2019.

SETTING

Electric scooter rental services were launched in Denmark in January 2019. The services were provided by private companies. Although rules for handling and riding scooters have been established, no reports either before or after introduction of electric scooters anticipated the full extent of use, and injuries to riders and pedestrians.

PARTICIPANTS

All patient records mentioning manual or electric scooters. Records were reviewed, and data were stratified according to two groups: manual and electric scooters.

INTERVENTIONS

A predefined survey was completed in all cases where 'scooter' was present. This contained variables such as type of scooter, type of participant, mechanism of injury, acuity, intoxication, referral to treatment facility.

OUTCOME MEASURES

Among incidents involving scooters, summary statistics on continuous and categorical variables of interest were reported.

RESULTS

468 scooter-related injuries were recorded. We found that manual scooter riders were more likely to be children under the age of 15; fall alone-involving no other party; sustain contusions, sprains and lacerations; and bruise either their fingers or toes. Riders of electric scooters were likely to be 18-25 years, sustain facial bruising and lacerations requiring sutures, and be under the influence of alcohol or drugs. Non-riders of electric scooters were mostly elderly people who tripped over scooters, consequently sustaining moderate to severe injuries.

CONCLUSION

There were two different types of population sustaining injuries from manual and electric scooters, respectively. The proportion of non-riders injured by electric scooters were surprisingly large (17%), and while electric scooters are here to stay, several apparently preventable injuries occur as a result of reckless driving and discarded electric scooters. Current rules for usage might not prevent unnecessary accidents and secure traffic safety and the lives of older individuals.

Personality traits and risky behavior among motorcyclists: An exploratory study

BACKGROUND

Personality traits have been associated with a series of dysfunctional behaviors, ranging from violence to drug abuse and other risky behaviors. However, few studies have investigated motorcycle riders' personality traits, and no research using the psychobiological model of personality was found. Thus, we investigated the association between temperament and character traits and the occurrence of Motorcycle Accidents (MAs).

METHODS

This cross-sectional study was conducted with a randomly selected of 153 Brazilian motorcycle riders (116 male and 37 female) with a mean age of 31.8randomly selected from the driver's license register, between 2015 and 2018. A sociodemographic questionnaire and the Temperament and Character Inventory (TCI) were used.

RESULTS

Of the 153 participants, 146 (95.4%) reported having been involved in previous accidents, with the main causes as follows: "other drivers' careless behavior" (34.9%); "personal disrespect of traffic rules" (18.5%) and "personal careless behavior" (20.6%). Motorcyclists exhibited higher scores for the temperament factors of novelty seeking and persistence and lower scores for harm avoidance and reward dependence in comparison to the Brazilian population). Considering the reason for motorcycle use, the group of riders that used their motorcycles for work exhibited more temperament factors associated with risk behaviors than those who did not. It was observed that 68.9% of them had low Harm Avoidance (HA) factor scores, whereas 72.1% had high Novelty Seeking (NS) factor scores.

DISCUSSION

The present study highlighted the influences of different personality traits on behaviors, decision-making and risk attitudes that can be potentially harmful to an individual and others. The results provided evidence that a lack of knowledge and experience in riding a motorcycle or any other vehicle, combined with personality traits, contribute to the adoption of risky behaviors that may act as triggers for most causes of Motorcycle Accidents.

Do Type of Helmet and Alcohol Use Increase Facial Trauma Severity?

PURPOSE

Facial trauma caused by motorcycle accidents has become a major issue because of its high prevalence and morbidity, causing death and esthetic and functional sequelae in many individuals. This work evaluated helmet and alcohol use and severity of facial fractures in motorcyclists treated at public hospitals in Pernambuco, Brazil.

PATIENTS AND METHODS

This prospective study was conducted from December 2016 to December 2018 and submitted to statistical and descriptive analysis. Variables such as gender, age, helmet use and type, previous accidents, and duration of hospitalization were collected. The Facial Injury Severity Scale was used to classify the facial fractures. The Alcohol Use Disorders Identification Test was used to verify alcohol dependence.

RESULTS

The sample was composed of 455 patients. Most were male patients (90.8%) and were aged 18 to 29 years (54.5%). Of the patients, 36.5% reported no helmet use and 31.6% reported wearing an open helmet. Alcohol use was reported in 38.7% of the group. In 79.8% of the sample, alcohol use was classified as low risk. There was a greater likelihood of having severe facial trauma if patients were aged between 30 and 39 years and had harmful or at-risk alcohol use. These patients also tended to remain hospitalized for more than 10 days. No statistically significant relationship was found with the type of helmet.

CONCLUSIONS

The individuals most affected by facial trauma were young male patients (aged 18 to 29 years). Patients aged 30 to 39 years with high-risk use and dependence on alcohol were more likely to have more complex facial trauma. The type of helmet used was not effective in reducing the severity of facial fractures.

Compliance of commercial motorcyclists with road safety measures in a Nigerian metropolitan city

Objectives: Motorcycle crashes are the second most common cause of road traffic injuries in Nigeria, which can be prevented through compliance with road safety measures. Compliance is defined as a state of being in accordance with established guidelines or legislations. There is a dearth of information on compliance with these measures by motorcyclists in Ibadan. Commercial motorcyclists often ignore safety measures, making them prone to accidents with other road users. This study therefore assessed the knowledge and reported compliance of commercial motorcyclists in Ibadan North Local Government Area with road safety measures as well as the factors influencing compliance.Data and methods: A cross-sectional study was carried out among motorcyclists in all 5 motorcycle parks in the city of Ibadan. Participants were selected through a simple random sampling technique after a proportional allocation to the size of the motorcyclists in the parks was concluded. A total of 439 motorcyclists were interviewed. A pretested, semistructured, interviewer-administered questionnaire was used to collect information on sociodemographic characteristics, knowledge, reported compliance, and attitudes toward road safety measures (Nigeria Highway Code). A total of 34 items on traffic rules and regulations were used to assess compliance. Chi-square test and logistic regression were used for analysis at a 5% level of significance.Result: Respondents were aged 34.4 ± 7.8 years. All respondents were male and 15.2% had a tertiary education in a university or institution of higher learning. About 20.0% had no proper formal or informal training as motorcyclists. Ninety-four respondents (21.6%) self-reported ever being involved in a motorcycle crash, of which 32 (34.0%) occurred 6 months preceding the study. About half of respondents (51.9%) had good knowledge of road safety measures. About 50.6% of the respondents were compliant with road safety measures. Only 54.4% of respondents who had ever been involved in a motorcycle crash were wearing a crash helmet at the time of the crash. However, 71.8% of respondents had a crash helmet with them during the study. About 73.6% owned the motorcycles they rode. About two thirds (60.4%) of motorcycle owners were significantly more compliant compared to 23.3% of those who were not owners. Respondents who were motorcycle owners were almost 4 times more likely to be compliant with road safety measures than those who were not owners (odds ratio [OR] = 4.0; confidence interval [CI], 2.0-7).Conclusion: Commercial motorcycle ownership and training contributed to knowledge and compliance with road safety measures and consequently low reporting of motorcycle crash. There is therefore the need to encourage ownership, conduct training, and create stringent laws to guide road safety.

Adult moped-related injuries treated in U.S. emergency departments

Objective: Few studies have investigated U.S. emergency department (ED) moped-related injuries. Our objective was to determine the characteristics of moped crashes among adult riders and to identify associations between key variables.Methods: Data were obtained from the National Electronic Injury Surveillance System (NEISS) for 2002-2014. Descriptive and comparative analyses of the identified cases were performed.Results: Based on a probability sample of 2,453 cases, an estimated 108,229 U.S. adult moped-related ED visits occurred during the study period. Injuries increased 2.7-fold over time. Summer months and weekdays were the most common crash times. Three-fourths of injured riders were male, two-thirds were ages 23-59 years, and 77% were Caucasian. Among cases documented, one-half were helmeted, and almost two-thirds of crashes occurred at ≤20 mph. The predominant mechanism was a non-collision crash (60%). Skin-related and musculoskeletal diagnoses were most common. Almost one-fifth of patients were admitted or transferred. Regression analyses showed that males were less likely than females to be in crashes with multiple riders, and more likely to have used alcohol/drugs and to be in a crash with another motor vehicle (MVC). Older riders (≥40 years) were more likely than those younger to have used alcohol/drugs and to suffer torso injuries, and less likely to be in an MVC. As compared to other crash mechanisms, MVCs were more likely to involve injuries to the head/neck/face and torso. The likelihood of being admitted/transferred was higher for males, with increasing age, and for collision-related crashes. The higher likelihood of being admitted/transferred was also characterized by alcohol/drug use, by lower limb and torso injuries, and almost 8 times more likely for riders with serious head injuries.Conclusions: Moped injuries increased in all adult age groups during the study period. However, there were significant differences in contributing factors, crash mechanism, and outcomes by sex, race, and age. These findings suggest the need for targeted injury prevention interventions.

A clustering approach to developing car-to-two-wheeler test scenarios for the assessment of Automated Emergency Braking in China using in-depth Chinese crash data

Two-wheeled vehicles (motorized and non-motorized, referred to as TWs) are an important part of the transport system in China. They also represent an important challenge for road safety, with many TW user fatalities and injuries every year. Recently, active safety systems for cars, such as Automated Emergency Braking (AEB), promise to reduce road traffic fatalities and injuries. For these systems to work effectively, it is necessary to understand and define the complex traffic scenarios to be addressed. The aim of this study is to contribute to the development of test procedures for AEB specifically, drawing on the China In-Depth Accident Study (CIDAS) data from July 2011 to February 2016 to describe typical scenarios for crashes between cars and TWs by means of cluster analysis. In total, 672 car-to-TW crashes were extracted. The data was clustered according to five main crash characteristics: time of crash, view obstruction, pre-crash driving behavior of the car driver and the TW driver, and relative moving direction. The analysis resulted in six car-to-TW crash scenarios typical of China. In three scenarios the car and the TW travel perpendicularly to each other before the crash, in two they travel in the same direction, and in one they travel in opposite directions. Further, each scenario can be described with three characteristics (the road speed limit, the TW's first contact point on the car, and the car's first contact point on the TW) that can be included in an AEB test suite. Some scenarios were similar to those in the Euro New Car Assessment Program (Euro NCAP). For example, in one, a TW moving straight ahead was hit by a car moving perpendicularly, and in the other the car hit a TW traveling in the same direction. Both occurred in daytime, without a visual obstruction. However, in contrast to the Euro NCAP, typical scenarios in China included night-time scenarios, scenarios where the car or the TW was turning, and those in which the TW was hidden from the car by an obstruction. The results contribute to a proposed novel AEB test suite with realistic scenarios specific to China.

Long-Term Outcome of Mini-Open Surgical Decompression for Chronic Exertional Compartment Syndrome of the Forearm in Professional Motorcycling Riders

OBJECTIVE

To evaluate results of mini-open fasciotomy (MOF) in high-level motorcycling or motocross riders with chronic exertional compartment syndrome (CECS) at long-term follow-up (minimum 5 years).

DESIGN

Case series.

LEVEL OF EVIDENCE

IV.

SETTING

University Hospital/Private Practice.

PATIENTS

Fifty-four professional motorcycling riders treated with MOF for a CECS of the forearm from January 2006 to June 2011. Inclusion criteria comprised: high-level motorcycling or motocross riders, clinical symptoms of CECS for at least 6 months, diagnosis confirmed using preoperative compartment hydrostatic pressure measurement and/or magnetic resonance imaging of the forearm, minimum follow-up of 5 years.

INTERVENTIONS

A MOF to obtain decompression of all compartments was performed in all patients.

MAIN OUTCOME MEASURES

Visual analog scale; a subjective scale to measure strength; QuickDash functional scores. Time to resume full riding capacities as short-term evaluation.

RESULTS

A total of 54 patients who underwent 77 MOF procedures overall (23 bilateral) were included. The mean age was 23.6 ± 5.2 years. Mean Visual Analog Scale decreased from a preoperative value of 68.2 to a 3-month postoperative value of 26 (P < 0.001). Mean QuickDash scale was 84 at preoperative registration, falling to 20, 3 months after surgery (P < 0.001) and down to 12 at 1-year follow-up (P = 0.017). The average time to return to full riding capacities was 3.5 ± 1 week.

CONCLUSIONS

Mini-open fasciotomy resulted safe and effective for the treatment of chronic exertional compartment syndrome in high-level motorcycling or motocross riders. The good outcome at follow-up resulted stable at 5 years and the incidence of complications remained low. Our data demonstrate that the resolution of symptoms is reliable and durable. Pain recovery was immediate after surgery, instead functional scores showed a more gradual recovery throughout the 12 months after surgery.

CLINICAL RELEVANCE

Mini-open fasciotomy is a reliable treatment for CECS of the forearm in professional motorcycling riders. This treatment should also be considered in young riders due to the absence of tardive relapse reported in this study.

A Novel Technique: Ultrasound-Guided Serratus Anterior Plane Block for the Treatment of Posttraumatic Intercostal Neuralgia

Serratus anterior plane block has been used for pain management during the acute period of conditions affecting the thorax, such as postthoracotomy recovery, rib fracture, and breast surgery recovery. Here, we report the use of serratus anterior plane block in posttraumatic chronic pain treatment. We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.

Forensic and Clinical Issues in a Case of Motorcycle Blunt Trauma and Bilateral Carotid Artery Dissection

Internal carotid artery dissection (ICAD) after motorcycle accidents is unusual but life threatening if not promptly diagnosed and treated. We report the case of a motorcyclist involved in a frontal collision with a car, suffering injuries due to direct blunt trauma and indirect trauma by sudden deceleration force. Bilateral ICAD was diagnosed by computed tomography angiogram 5 days after the accident. Here in, starting from a medicolegal case, we emphasized some clinical criteria to make a prompt diagnosis to prevent permanent neurological deficit in this pathology whose best management is still under the debate. An unusual case of ICAD is described with regard to both forensic and promptly diagnostic therapeutic management.

The prevalence and determinants of helmet use amongst commercial motorcyclists in Ido-Osi local government area

Commercial motorcycle (CM) accidents constitute a major public concern in Nigeria. There is 8:10 chance that injuries resulting from these accidents are severe and debilitating including head and spinal injuries. This study is aimed at producing useful data on the prevalence, frequency, and determinants of helmet use among commercial motorcyclist in Ido-Osi Local Government Area, Ekiti State, Nigeria. The study was a descriptive/cross-sectional study. A total of 360 respondents were selected by multi-stage sampling technique and interviewed using assisted self-administered, semi-structured questionnaire. Data were analyzed using SPSS version 21. Determinants of helmet use examined included age, educational level, marital status and religion. There was a 100% response rate. More than half of the respondents were within the age range of 20-29 years 164(53.6%) with the mean age of the study participants 29.9. The prevalence of helmet usage among commercial motorcyclist was 23.5%. The commonest reason for not using a crash helmet in this study was non-availability. The commonest reason for the non-availability of the welding helmet was the cost of the helmet. Less than half of the respondents were able to show or present helmet although some of the helmet presented were sub-standard (39.7%). The study also revealed irregular use of helmets among the respondents that used a helmet while riding a motorcycle as only 2.7% of them used it for all the five riding sessions assessed in this study. There was a statistically significant relationship between age, educational level, marital status and the use of helmets among respondents with p values of 0.005, 0.027, and 0.009, respectively. The prevalence of the use of helmets among the motorcyclist in this study is low despite the high level of awareness of legislation among the respondents on the use of helmets during riding. There is a need for the government to make provision for a safety helmet for this group of people at a subsidized rate if it cannot be given free of charge because of the economic situation of the country. There is a need to carry out behavioral change communication for this group of people.

Perceived factors associated with boda-boda (motorcycle) accidents in Kampala, Uganda

Objective: According to the United Nations, nearly 1.25 million people are killed and up to 50 million people are injured on the world's roads every year. Uganda loses about 10 people daily to road accidents, costing about US$1.2 billion annually, which represents about 5% of the gross domestic product (GDP). The objective of this study was to identify causal factors that can be associated with boda-boda accidents in Uganda.Method: A cross sectional study assessed 200 boda-boda riders in the urban areas of Kampala, Uganda. Interviews using semistructured questionnaires were administered to all participants. Data were entered in Excel and imported to STATA for analysis. Multivariate and bivariate analyses were conducted to determine factors that influenced accident risk perception. All variables that were significant at a bivariate level and thought to be theoretically important in influencing the outcome variable were included in a logistic regression model. All tests were performed at a significance of P < .05.Results: Competition for passengers with other public transport operators (83%), negligence of road safety rules (78%), and inadequate helmet usage (62%) were the main factors perceived to be associated with boda-boda accidents. Other factors identified by the respondents include age of the boda-boda rider (58%) and drug use (56%; P < .05). At multivariate analysis, competition for passengers (adjusted odds ratio [AOR] = 17; 95% confidence interval CI, 1.34-26.5) and being in between 18 and 25 years old (AOR = 19; 95% CI, 1.42-27.1) remained statistically significant.Conclusions: This study revealed behavioral factors by all public transport users as the main factors associated with boda-boda accidents in urban Kampala. This demonstrates the need for holistic interventions to address such boda-boda accidents in Uganda. Such interventions can be through digitization of transport system for clients to engage remotely with the transport operators, routine refresher trainings of all transport operators, and construction of lanes for boda-boda riders.

Underutilized strategies in traffic safety: Results of a nationally representative survey

Objective: Numerous strategies proven to be effective in reducing crash fatalities have been underutilized in the United States, including sobriety checkpoints; automated enforcement; lower blood alcohol concentration (BAC) limits; primary enforcement of safety belt and motorcycle helmet use laws; alcohol ignition interlock installations; drugged driving screening; lowered residential speed limits; and roundabout installations. If these strategies are implemented widely in every state, traffic fatalities could be reduced by at least 50%. A barrier to implementation is the perception by officials that the public is against them. The purpose of this study was to determine which of these underutilized measures would be favorable to the American public given that they are educated on the research of their effectiveness.Methods: A representative survey of 2,000 U.S. drivers was conducted in October 2018 with 30 questions about these underutilized strategies using the National Opinion Research Center's (NORC) AmeriSpeak® survey instrument. Our objective was to gauge the public's opinion of these strategies when they are aware of the research on their effectiveness.Results: Respondents were given a summary of the research on the effectiveness of these strategies and then asked whether they were in favor of them in their communities; 64.7% of the respondents were in favor of conducting sobriety checkpoints at least monthly; 68.2% were in favor of police using passive alcohol sensors at sobriety checkpoints; 60.3% of respondents were in favor of using speed and red light cameras for automated enforcement; 70.1% were in favor of a law that required all cars to have seat belt reminders that continuously chime until the seat belt is buckled, including for rear seat passengers; and 62.5% were in favor of raising the fine in their state for not using a seat belt from $25 to $100. Other results indicated public support for these strategies.Conclusions: The results indicate that when drivers in the United States are given facts about certain strategies to reduce crash fatalities, the majority are in favor of the underutilized strategies. This information could be useful to legislators and highway safety officials in their decisions to implement these strategies.

The 'Saw but Forgot' error: A role for short-term memory failures in understanding junction crashes?

Motorcyclists are involved in an exceptionally high number of crashes for the distance they travel, with one of the most common incidents being where another road user pulls out into the path of an oncoming motorcycle frequently resulting in a fatal collision. These instances have previously been interpreted as failures of visual attention, sometimes termed 'Look but Fail to See' (LBFTS) crashes, and interventions have focused on improving drivers' visual scanning and motorcycles' visibility. Here we show from a series of three experiments in a high-fidelity driving simulator, that when drivers' visual attention towards and memory for approaching vehicles is experimentally tested, drivers fail to report approaching motorcycles on between 13% and 18% of occasions. This happens even when the driver is pulling out into a safety-critical gap in front of the motorcycle, and often happens despite the driver having directly fixated on the oncoming vehicle. These failures in reporting a critical vehicle were not associated with how long the driver looked at the vehicle for, but were associated with drivers' subsequent visual search and the time that elapsed between fixating on the oncoming vehicle and pulling out of the junction. Here, we raise the possibility that interference in short-term memory might prevent drivers holding important visual information during these complex manoeuvres. This explanation suggests that some junction crashes on real roads that have been attributed to LBFTS errors may have been misclassified and might instead be the result of 'Saw but Forgot' (SBF) errors. We provide a framework for understanding the role of short-term memory in such situations, the Perceive Retain Choose (PRC) model, as well as novel predictions and proposals for practical interventions that may prevent this type of crash in the future.

Effects of personality traits and sociocognitive determinants on risky riding behaviors among Chinese e-bikers

Objective: In the last few decades, the growing popularity of e-bikes in China has raised public concerns regarding an increasing number of fatalities and injuries involving e-bikes. Although previous studies have explored the impacts of personality on driving behaviors of automobile drivers and motorcyclists, little attention has been paid to safety-related issues involving e-bikers from the aspect of their personality traits and sociocognitive variables. The aim of this study was to examine the effects of personality on e-bikers' risk-taking behaviors and test the effectiveness of the model proposed by Ulleberg and Rundmo (2003) among e-bikers.Methods: Four hundred and five Chinese e-bikers aged 16 to 61 completed a self-administrated questionnaire, which included questions investigating their demographics, personality traits (anger, altruism, sensation-seeking, normlessness), risk perceptions, safety attitudes, and risky riding behaviors. The reliability and validity of all scales were first examined through reliability analysis and principal component analysis, respectively, and a structural equation model was developed and fitted to test the relationships among e-bikers' personality traits, risk perceptions, safety attitudes, and risky riding.Results: A satisfactory level of reliability and validity was reached for all variables. Anger, altruism, sensation-seeking, and normlessness were all significantly related to e-bikers' risk perceptions and unsafe riding, and only altruism correlated significantly to safety attitude. For 2 sociocognitive variables, safety attitudes was directly and negatively related to respondents' risky riding, and risk perception only exerted impacts on riding behaviors by affecting safety attitudes.Conclusions: Personality traits of e-bikers impacted their riding behaviors both directly and indirectly, and sociocognitive variables played an intermediate role in the personality-behavior relationship. The results revealed the importance of personality traits in influencing e-bikers' risky riding and also verified the applicability of the personality-behavior model proposed by Ulleberg and Rundmo (2003) among e-bikers. The findings of this study may provide an empirical basis for evidence-based safety interventions for e-bikers in China.

Characteristics and severity of motorcycle crashes resulting in hospitalization in Ho Chi Minh City, Vietnam

Objective: This study aims to describe the crash characteristics, injury outcomes, and risk factors associated with injury severity for motorcycle crashes resulting in hospitalization in Ho Chi Minh City (HCMC), Vietnam. Methods: A cross-sectional study was undertaken of motorcyclists who were injured as the result of a crash and were admitted to hospital for more than 24 h. Information was collected using a researcher-administered questionnaire and a medical record review. Descriptive statistics and a multiple logistic regression model were undertaken. The outcome of interest was severity of the injury, measured using the Injury Severity Score (ISS). Results: A total of 352 hospitalized motorcyclists were included in the study, of which 6.8% (n = 24) were classified as severe injuries (ISS > 15). At the time of the crash, 41% of participants were not licensed to drive a motorcycle, 26% were speeding, 13% were not wearing a helmet, and 9% were using their mobile phone. The results of the multiple logistic regression model found that not being licensed to drive a motorcycle (adjusted odds ratio [AOR] = 3.32; 95% confidence interval [CI], 1.18-9.34) and crashing at nighttime (AOR = 4.28; 95% CI, 1.33-13.78) were significantly associated with increased injury severity among hospitalized motorcyclists. Conclusions: This study highlighted several high-risk behaviors among hospitalized motorcyclists in Vietnam. In addition, the study found that being unlicensed and crashing at night were associated with higher injury severity among hospitalized motorcyclists. The findings suggest that prevention and enforcement interventions targeting high-risk behaviors may reduce the significant morbidity and mortality associated with motorcycle crashes in Vietnam.

Worldwide prevalence of alcohol in fatally injured motorcyclists: A meta-analysis

Objective: The aim of this study was to estimate the prevalence of alcohol in fatally injured motorcyclists and to determine the factors that are related to the prevalence worldwide. Methods: A systematic review was conducted using PubMed/Medline, ISI Web of Knowledge, and Google Scholar until 2018. Point prevalence with 95% confidence intervals was estimated. The variances of each study were calculated using by binomial distribution formula. Heterogeneity among the studies was tested using Cochran's Q test with a significance level less than .1. The index of changes attributed to heterogeneity (I²) was assessed. Regarding the heterogeneity of the studies, a random effects model was employed to combine the results of the studies. All statistical analyses were performed using STATA Ver. 11 using the meta-analysis commands. Results: Of 916 articles from 2011 to 2018, 12 studies were examined and analyzed based on inclusion criteria. The prevalence of alcohol in fatally injured motorcyclists was 0.30 (95% confidence interval [CI], 0.25-0.35). Subgroup analysis based on the type of country showed that the prevalence of alcohol in fatally injured motorcyclists in developing countries was 34% (95% CI, 0.18-0.49), which was higher than that in developed countries (29%; 95% CI, 0.24-0.33). In addition, the prevalence of alcohol among fatally injured motorcyclists aged 25-35 years was greater than that of other age groups (0.34; 95% CI, 0. 27-0.4). Conclusions: Motorcyclists dominated the picture of fatal crashes and deserve more attention by the public and government. With the proper planning and adoption of health policies, increasing prevalence and complications of the disease will be prevented.

How safe are standard certified motorcycle safety helmets? Malaysian postal delivery riders scenario

Objective: The objective of this study was to determine the proportion of motorcycle safety helmets (MSHs) used by postal delivery riders (PDRs) that comply with the Standards and Industrial Research Institute of Malaysia's (SIRIM) MSH standard guidelines and identify factors that contribute toward compliance of used MSHs with the standards. Methods: The presence of SIRIM certification label, the status of MSH, type of chinstrap, MSH crash history, and duration of MSH use were observed. The dependent variable was the results of the SIRIM testing procedures (SIRIM tests). MSHs that passed the SIRIM tests were considered "standard certified" MSHs. Results: The odds of the complimentary MSHs passing all of the SIRIM tests were 3.7 times the odds of the self-purchased MSHs passing the tests. The odds of MSHs with the SIRIM certification label passing all of the SIRIM tests were 24.2 times the odds of MSHs without the SIRIM certification label, and the odds of MSHs used <3 years passing the SIRIM tests were 3.75 times the odds of the MSHs used ≥3.8 years. Conclusion: PDRs provided with complimentary MSHs with the SIRIM certification label by the employer for their daily delivery routines and duration of MSH used for less than 3 years were found to be safe MSHs for male occupational riders in Malaysia.

Trends and patterns in fatal US motorcycle crashes, 2000-2016

Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics. Methods: We used the Fatality Analysis Reporting System (FARS) database (2000-2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000-2001 and 2007-2008, as well as 2009-2010 and 2015-2016. Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines-before and after the economic recession in 2008-2009. The overall fatality rate ratio between 2000-2001 and 2007-2008 was 1.60 [95% Confidence Interval (CI): 1.51-1.70], and between 2009-2010 and 2015-2016 was 1.09 (95% CI: 1.02-1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18-29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey. Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.

[Analysis of the frequency of polytraumatized patients in motorcycle accidents in the pediatric publication attended in the Pediatric Hospital of Sinaloa between the years 2015 and 2017]

OBJECTIVES

Determine the frequency of polytraumatized pediatric patients involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa between 2015 and 2017, as well as to determine the frequency of traumatic brain injuries, thoracic, abdominal, limb injuries, days of hospital stay and mortality.

MATERIAL AND METHODS

The selected population were patients under 18 years of age who were involved in motorcycle accidents treated at the Pediatric Hospital of Sinaloa in a period between January 1st, 2015 and December 31, 2017.

RESULTS

The most affected gender was the male with the most frequent age of 14 years, accidents occurred more frequently on Fridays and Saturdays at night. July was the month with the highest frequency of accidents. The number of accidents increased every year. Most of the injured were passengers, 98.4% did not use safety equipment, the most frequent injury was head injury, followed by injuries in lower extremities, upper chest trauma and less frequent abdominal traumatism.

DISCUSSION

There is a progressive increase in motorcycle accidents where the pediatric population is involved, the use of helmet is almost zero, most of the patients presented with head trauma, this study serves to see the current situation, as well as being the basis for Subsequent studies and conduct more campaigns for the prevention of motorcycle accidents and encourage the use of helmet in pediatric patients.

Could wearing motorcycle protective clothing compromise rider safety in hot weather?

Motorcycle protective clothing (PPE) effectively reduces the risk of injury in crashes, however in hot conditions many motorcyclists ride unprotected. Recent work found available motorcycle PPE to be thermally inefficient in hot weather with potential to cause significant thermal strain under average Australian summer conditions. The current study investigated the potential for the cognitive and psychophysical concomitants of thermal strain to compromise reaction times, mood and fatigue with potential consequences for motorcyclists' safety.

METHOD

Volunteers wearing motorcycle PPE participated in a 90 min trial (cycling 30 W) in 35 °C, 40%RH with overhead radiant heaters and a fan to simulate wind speed. Heart rate, core and skin temperature were recorded continuously. Reaction time and subjective ratings of thermal sensation and comfort, workload and mood were recorded at baseline, during rest breaks at 25 min intervals and on completion of the trail. Repeated measures analysis assessed each participant's performance against their own baseline.

RESULTS

Core temperatures increased by 2 °C (p < .0001), skin temperatures (3 °C, (p < .0001) and heart rates (66bpm, p < .0001). Reaction times fluctuated 36 ms 8% (p < .0001) over the trial. Subjective workload increased 68% (p = 0.001) and mood deteriorated 33 points (p < .0001) including feeling less alert (p = <.0001), contented (p = 0.001) and calm (p = 0.0004). Multivariate repeated measures analysis found significant associations between core temperature and workload (p = 0.01), mood (p = 0.001) and reaction time (<.0001). Skin temperature and workload (p = 0.02), mood (p = 0.01) and reaction time (<.0001). Subjective ratings of temperature sensation and wetness discomfort were associated respectively with increased workload (p = 0.0001, p = 0.004), mood change (p < .0001, p = 0.04) and reaction time (p < .0001, p < .0001).

CONCLUSIONS

The physiological impact of wearing thermally inefficient motorcycle PPE in hot conditions could impair motorcyclists cognitive and psychophysical functioning and, potentially, their riding performance and safety. These outcomes indicate an urgent need for manufacturers to develop motorcycle PPE that is effective and suitable for use, in hot conditions.

Rider factors associated with severe injury after a light motorcycle crash: A multicentre study in an emerging economy setting

Objective

In Taiwan, light motorcycles (LMCs) with cylinder capacities between 50 and 250 cc are widely used for daily commute. These vehicles are operated in a mixed traffic environment and prohibited on highways. In light of increasing motorcycle casualties, we conducted a multicentre study to analyse rider factors affecting injury severity.

Methods

Riders hospitalised upon LMC crashes were contacted. Information on demographics, comorbidities, and riding behaviours was collected through questionnaires and linked to hospital data. The injury severity score (ISS) and length of hospitalisation (LOH) were used as injury severity measures.

Results

In total, 725 patients (mean age: 37.7 years; 64% men) completed their questionnaires. Multivariate analysis results showed that age ≥ 65 years, half-face helmets, protective clothing, collisions with a bus/truck or car, and fatigue riding were risk factors for having an ISS of ≥9. Age ≥ 65 years; motorcycle crashes ≥2 times in the previous year; anaemia; rural crashes; half-face helmets; protective boots; collisions with a bus/truck, car, or a stationary object; alcohol/stimulating refreshment consumption; and fatigue riding were risk factors for increased LOH. A protective factor was individuals working in commerce. Collisions with opening car doors caused low risks of having an ISS of ≥9 and a short LOH.

Conclusion

Certain factors were significantly associated with riders’ injury severity and related medical resource consumption. Because of differences in the power output, use, and riding environment, risk factors for severe injuries in LMC crashes are dissimilar from those for heavy motorcycles (cylinder capacities > 250 cc) in developed countries and deserve more attention for injury prevention. Further in-depth evaluation of significant factors based on this study’s results can yield valuable information to reduce severe injuries after LMC crashes in countries and areas with a high dependency on motorcycles, even considering the popularity of electric motorcycles.

Fatal motorcycle crashes in wide urban area of Zagreb, Croatia-A 10-year review

Objective: The objective of our study was to determine the prevalence of alcohol and drug intoxication among fatally injured motorcyclists in a wide urban area of Zagreb, Croatia. Methods: We conducted a single-center observational retrospective study over a 10-year period (2007-2016) in 3 counties covering an area including 1.2 million residents. We reviewed the records on fatally injured motorcyclists, collecting information relating to sex, age, cause of death, time of death in relation to the time of the crash, and the circumstances of the crash (time of day, day of the week, season). Blood alcohol concentration (BAC) and toxicology analysis results were collected and analyzed. Results: We identified 163 deaths (95.7% males, 4.3% females). Overall, 64.2% of the victims were 20 to 39 years old. The majority (50.9%) of those fatally injured were responsible for causing the traffic crash; the rest were determined not to be responsible or the responsibility could not be determined. The most frequent causes of death were multiple injuries (55.8%) and isolated head trauma (23.3%). The rider's BAC was above the legal limit for driving (>0.50 g/kg) in 53.8% of cases, with a mean BAC of 1.91 g/kg. There was no difference in riding a motorcycle with a BAC above the legal limit between groups defined as younger (≤39 years of age) and older (≥40 years of age). The number of people with an illegal BAC was significantly higher during weekends than during the work week. The BAC of riders who were responsible for the crash was significantly higher than that of those who were not responsible or whose responsibility could not be determined. Use of illegal drugs or nontherapeutic use of legal drugs was not common and was detected in 10.4% of fatally injured riders. Conclusions: Alcohol intoxication has a major role in motorcycle crash-related mortality. A significant difference in BAC between fatally injured riders responsible for the accident and those who were not responsible implies that measures directed toward prevention of drinking and driving behavior could lower the number of fatal motorcycle crashes. Weekend measures, especially during spring and summer, could have particularly significant effects.

A multinomial logit analysis of factors associated with severity of motorcycle crashes in Ghana

Objective: The objective of this study was to explore the factors affecting motorcycle crash severity in Ghana. Methods: A retrospective analysis of motorcycle crash data between 2011 and 2015 was conducted using a motorcycle crash data set extracted from the National Road Traffic Crash Database at the Building and Road Research Institute (BRRI) in Ghana. Injury severity was classified into 4 categories: Fatal, hospitalized, injured, and damage only. A multinomial logit modeling framework was used to identify the possible determinants of motorcycle crash severity. Results: During the study period, a total of 8,516 motorcycle crashes were recorded, of which 22.9% were classified as fatal, 42.1% were classified as hospitalized injuries, 29.4% were classified as slight injuries, and 5.6% were classified as damage-only crashes. The estimation results indicate that the following factors increase the probability of fatal injuries: At a junction; weekend; signage; poor road shoulder; village settlement; tarred and good road surface; and collision between motorcycle and heavy goods vehicle (HGV). Motorcycle crashes occurring during the daytime and on the weekend increases the probability of hospitalized injury. The results also suggest that motorcycle crashes occurring during the daytime, in curves or inclined portions of roads, or in unclear weather conditions decrease the probability of fatal injury. Conclusions: This study provides further empirical evidence to support motorcycle crash modeling research, which is lacking in developing countries. The ability to understand the various factors that influence motorcycle crash severity is a step forward in providing an appropriate basis upon which informed motorcycle crash policies can be developed. Particular attention should be given to the provision of road signage at junctions and speed humps and controlling traffic during the weekend. In addition, road maintenance should be carried out periodically to address motorcycle safety in Ghana.

Outlaw biker violence and retaliation

The number of outlaw bikers is growing globally. Despite this, little research exists on these groups and their alleged violent tendencies. To address this, the current paper uses unique data to examine whether gang violence causes outlaw biker violence. The period examined runs from mid-2008 until early 2012 during which violent clashes occurred between outlaw bikers and street gang members involved in an alleged conflict in Copenhagen, Denmark. A precise description of each individual act of violence would make it possible to identify whether specific acts were carried out in furtherance of the alleged conflict. This would allow one to determine whether outlaw bikers commit violence on behalf of their club. However, such knowledge is unavailable. The paper therefore takes a different approach by examining whether acts of violence committed by the two groups are statistically associated. In other words, it considers whether one or more acts can be described as retaliatory during the observation periods. The sample consists of 640 individuals involved with the Hells Angels Motorcycle Club or with non-biker street gangs–both of which are present in Copenhagen. Statistical models are used to predict 143 violent events committed by 196 outlaw bikers. The results suggest that violence committed by gang members predicts violence committed by outlaw bikers. This indicates that violent acts committed by outlaw bikers are at least partly a form of retaliation carried out on behalf of their club. The paper expands the literature on the kinds of inter-group, micro-level processes that can lead to reciprocal violence by including outlaw bikers in a literature that has previously focused on non-biker street gangs.