Severe street and mountain bicycling injuries in adults: a comparison of the incidence, risk factors and injury patterns over 14 years

Bicycle injuries: A systematic review for forensic evaluation

Bicycles are employed as means of transportation across various age groups, from young students to the elderly, for work, education, health, and leisure trips. Despite not achieving high speeds, bicyclists remain vulnerable to severe and even fatal injuries when they are involved in traffic accidents. Although the rising awareness of ecological issues and traffic law enforcement mean that cyclists are increasingly susceptible to road traffic crashes and injuries. Injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence. The aim of this study is to provide a systematic review of the literature on injuries sustained in cyclists involved in road accidents describing and analysing elements useful for forensic assessment. The literature search was performed using PubMed, Scopus, and Web of Science from January 1970 to March 2023. Eligible studies have investigated issues of interest to forensic medicine about traffic accidents involving bicycles. A total of 128 studies satisfied the inclusion criteria and were categorized and analyzed according to the anatomical regions of the body affected (head, neck, thoraco-abdominal, and limb injuries), and the assessment of lesions in reconstruction of the bicycle accident was examined and discussed. This review highlights that injuries resulting from a traffic accident involving cyclists can show distinct and specific characteristics depending on the manner of occurrence and the energy levels involved in the crash. The assessment of injuries offers valuable insights that integrated with circumstantial and engineering data perform the reconstruction of accident dynamics.

Epidemiology and Severity of Medical Events for Mountain Bikers and Hikers Transported by Ambulance in Western Australia, 2015 to 2020

INTRODUCTION

Outdoor activities offer physical and mental health benefits. However, incidents can occur requiring ambulance transport to hospital. This study aimed to describe the epidemiology and severity of traumatic and medical incidents for mountain bikers and hikers transported by ambulance within Western Australia.

METHODS

This was a retrospective cohort study of ambulance-transported mountain bikers and hikers within Western Australia from 2015 to 2020. Data were extracted from ambulance electronic patient care records. Multivariable analyses were undertaken to identify variables associated with higher patient severity based on the National Early Warning Score 2 (NEWS2).

RESULTS

A total of 610 patients required ambulance transport to hospital while mountain biking (n=329; 54%) or hiking (n = 281; 46%). Median age of mountain bikers and hikers was 38 (24-48) y and 49 (32-63) y, respectively. Paramedics reported a fracture in 92 (28%) mountain bikers and 78 (28%) hikers. The predominant injury locations for mountain bikers were upper limbs and for hikers, lower limbs. Cases were trauma related in 92% of mountain bikers and 55% of hikers. A significant association (P<0.001) between the etiology of the ambulance callout and patient severity was found. In trauma etiology cases, the frequency of medium-risk+ NEWS2 severity was 21.4%. In medical cases, the frequency of medium-risk+ severity was 40.8%.

CONCLUSION

Both mountain bikers and hikers experienced incidents requiring ambulance transport to hospital. Incidents of a medical etiology had a higher clinical risk, as determined by the NEWS2 scores, regardless of activity being undertaken.

Sex Differences in Mountain Bike Accidents in Austria from 2006 to 2018: A Retrospective Analysis

Woyke, Simon, Anja Hütter, Christopher Rugg, Willi Tröger, Bernd Wallner, Mathias Ströhle, and Peter Paal. Sex differences in mountain bike accidents in Austria from 2006 to 2018: a retrospective analysis. High Alt Med Biol. 25:89-93, 2024. Introduction: Mountain biking is becoming increasingly popular, and mountain bike (MTB) accidents are on the rise. The aim of this study was to assess sex differences in mountain biking accidents in the Austrian Alps. Methods: This retrospective study includes all MTB accidents in Austria from 2006 to 2018. Data were collected by Alpine Police officers and recorded in a national digital registry. Results: The accidents involved 5,095 mountain bikers (81% men and 19% women). The number of MTB accidents rose markedly from 208 in 2006 to 725 in 2018. Men wore a helmet more often than did women (95% vs. 92%; p = 0.001). The most common injury category was "wound/bleeding" for both sexes (men 40% and women 41%). Women were more frequently transported by helicopter or terrestrially (p > 0.001). Conclusion: In the Austrian Alps, the number of MTB accidents more than tripled between 2006 and 2018. Women were involved in only one fifth of all accidents. Sex differences in MTB accidents include (1) women wearing helmets less often, (2) women being less frequently injured, (3) women suffering fewer serious injuries, and (4) women being more frequently transported by helicopter or terrestrially, while men more often did not require transportation.

Recreational athletes during downhill-mountain biking (DMB) show high incidence of upper extremity fractures in combination with soft-tissue injuries

Downhill-mountain biking (DMB) is a high-risk sport and often leads to several injuries, especially in non-professional athletes. We retrospectively analyzed the most common injuries and profiled the injury mechanism. Until now, there is no such analysis of injuries by non-professional mountain bike athletes. We collected patient data from patients who suffered from an injury during DMB. The inclusion criteria were (1) injury during the summer season of 2020 and 2021, (2) injury during off-road and downhill mountain bike sports activity, and (3) treatment at the Department of Traumatology of the Klinik Diakonissen Schladming. Patient data was analyzed regarding the type of injury, location of the injury, patient age and gender of the patients. Most patients with injury are at the age of 26-35. Second most are between 36 and 71 years old. The type of injury differs between age and gender. Mostly upper-extremity injuries occur with a high probability of shoulder injuries. In the elderly patients, we found additional injuries of the thorax and chest. To conclude, most common types of injuries are soft-tissue injuries, often in combination with fractures. The risk for injuries is higher for recreational athletes with different injury characteristics than professional athletes.

Health Service Impacts and Risk Factors for Severe Trauma in Mountain Biking: A Narrative Review

Mountain biking is growing in participation but carries risk for severe injury and burden on health systems. Little is known about the impact of these injuries on emergency medical services, definitive healthcare, and factors contributing to accidents. This review aimed to determine the health service impacts of severe mountain bike trauma and risk factors, with a view to understanding critical gaps and needs. A systematic online search was conducted using the databases PubMed and MEDLINE complete and grey literature relating to mountain bike injury since the databases' inception to July 2023. The results show that although mountain biking has relatively high injury rates that are increasing, the impacts on health services were rarely documented, with some evidence indicating that even small increases in injuries from race events can overwhelm local health services. Severe injuries were more common in downhill disciplines. However, the definitions of what constitutes severe injury were variable. Severe injuries were more common in downhill disciplines, influenced by the rider skill level, demographics, participation in competitive events, trail design, environmental factors, and healthcare availability. Further research in these areas is needed, along with the more consistent reporting of injury severity.

Analgesic agents administered by ambulance personnel to mountain bikers and hikers on trails in Western Australia

Objective

To describe the types of analgesic medications administered to patients who were attended by ambulance on recreational trails while mountain biking or hiking and report on the reduction in pain by these agents.

Methods

This is a retrospective cohort study of patients attended by ambulance (2015-2021) after mountain biking or hiking, on Western Australia (WA) trails. All data were extracted from electronic patient care records created by ambulance personnel who attended the patient. We compared patient and case characteristics between mountain bikers and hikers and the reduction in pain scores achieved by different analgesics.

Results

A total of 717 patients were included. Paramedics reported traumatic aetiology for mountain bikers in 92 % of cases and hikers in 58 % of cases. A pain score out of 10 was recorded for 538 (75 %) patients. The median (inter-quartile range) initial pain score was 6 (2-8) and the median final pain score was 3 (1-5). Around 48 % of these 538 patients reported ≥25 % reduction in their pain score. A reduction of ≥25 % in their pain score was greatest in those patients who received intravenous fentanyl (81 %), followed by patients administered multiple analgesics (72 %) and methoxyflurane only (52 %). Even 37 % of 134 patients who received no analgesia still reported ≥25 % reduction in their pain score by hospital arrival.

Conclusion

Trauma was the most common reason mountain bikers and hikers on trails called an ambulance and a large proportion of these patients were in pain on ambulance arrival. Further work assessing the effectiveness of safe, non-opioid analgesics, additional to methoxyflurane, is needed to ensure non-registered practitioners such as first aid providers and event medical teams can offer suitable safe analgesics to these patients. Additionally, among patients given no pharmacological analgesic agent, almost half still achieved a >25 % reduction in their pain scores which reiterates the importance of non-pharmacological pain reduction strategies.

Types and anatomical locations of injuries among mountain bikers and hikers: A systematic review

BACKGROUND

Mountain biking and hiking continue to grow in popularity. With new participants to these sports, it is likely the number of injuries will increase. To assist medical personnel in the management of these patients we attempted to quantify the types and locations of injuries sustained by mountain bikers and hikers. Objective The objective of this systematic review is to identify the type and anatomical location of injuries for both mountain bikers and hikers.

METHODS

A systematic search was undertaken using CINAHL, Cochrane, ProQuest, PubMed and Scopus databases. Reviewers assessed the eligibility of articles by a title/abstract review and final full-text review. Studies were included if the types of injuries were reported by medical personnel and contained anatomical locations. Studies were excluded if it did not take place on a trail or if the injuries were self-reported. Risk of bias was assessed utilising the Joanna Briggs Institute (JBI) checklists for study quality. No meta-analysis or comparison between mountain bikers and hikers was possible due to the high heterogeneity of the definition of injury.

RESULTS

A total of 24 studies met the inclusion criteria, 17 covering mountain biking and 7 hiking. This represented 220,935 injured mountain bikers and 17,757 injured hikers. The most common type of injuries sustained by mountain bikers included contusions, abrasions and minor lacerations, which made up between 45-74% of reported injuries in studies on competitive racing and 8-67% in non-competitive studies. Fractures represented between 1.5-43% of all reported injuries. The most injured region was the upper limbs reported in 10 of 17 studies. For hikers the most common injuries included blisters and ankle sprains with blisters representing 8-33% of all reported injuries. The most common body location to be injured by hikers was a lower limb in all 7 studies.

CONCLUSIONS

This is the first systematic review to report on the injury epidemiology of the two most common trail users; mountain bikers and hikers. For participants in both activities the majority of injuries were of minor severity. Despite this, the high proportions of upper limb fractures in mountain bikers and ankle sprains in hikers cannot be ignored.

TRIAL REGISTRATION

Registration: This systematic review was prospectively registered with the University of York PROSPERO database on the 12/4/2021 (CRD42021229623) https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021229623.

Serious cycling-related fractures in on and off-road accidents: A retrospective analysis in the Australian Capital Territory region

Cycling is an increasingly popular activity which is widely supported by health advocates. In the last year, more than a third of Australians used a bike [1]. While road cycling remains popular, participation in off-road recreational cycling, including mountain biking, bicycle moto cross (BMX) riding, and outdoor leisure cycling, is increasing and this is associated with an increase in the number and cost of cycling injuries [2-5]. The aim of this study was to describe and compare contemporary patterns of cycling fracture requiring hospitalisation as a function of cycling mode in the Australian Capital Territory region. This retrospective analysis of cycling-related-fracture hospitalisations in the ACT region described data recorded between July 2012 and December 2019. Logistic regression models were used to calculate probabilities of sustaining a fracture at different sites for each of the cycling modes (on-road, mountain, BMX, leisure, unspecified). These likelihoods were then compared against the on-road fracture profile. Cycling-related-fracture hospitalisations increased by 32% in the seven years analysed. Of all fracture admissions, 442 (33%) were on-road, 658 (49%) off-road, and 242 (18%) unknown. The majority were male (79%), median age 37 (IQR 16, 52). Median length of stay was two days. The number of fractures per admission ranged from one to thirteen with a median of one. Wrist, clavicle, ribs, and skull were the four most frequent fracture sites for all cycling modes. Fracture profiles of on- and off-road accidents were similar, with the exception of wrist fractures which were more likely in off-road (OR 1.96, p < 0.01) and unspecified cycling accidents (OR 5.07, p < 0.01). Skull fractures comprised 19% of all BMX-related fractures. More than half of all fracture-related admissions required surgery. With increasing support for sustainable and healthy transport and recreation activities, the fracture profiles of different cycling modes must first be assessed in order to inform strategies to reduce and manage this injury burden.

Mortality in Recreational Mountain-Biking in the Austrian Alps: A Retrospective Study over 16 Years

Despite recreational mountain-biking's growing popularity worldwide, the literature on mortality in this leisure sporting activity is scarce. Therefore, the aim of the present study was to investigate the characteristics of fatal accidents as well as resulting dead victims during recreational mountain-biking in the Austrian Alps over the past 16 years. For this purpose, a retrospective study based on Austrian institutional documentation from 2006 to 2021 was conducted. In total, 97 fatalities (1 woman) with a mean age of 55.6 ± 13.9 years were recorded by the Austrian Alpine Police. Of those, 54.6% died due to a non-traumatic (mostly cardio-vascular) and 41.2% due to a traumatic event. Mountain-bikers fatally accidented for non-traumatic reasons frequently belonged to older age classes (p = 0.05) and mostly (73.6%) died during the ascent, whereas traumatic events mainly (70.0%) happened during the descent (p < 0.001). Throughout the examined period, the absolute number of fatalities slightly increased, whereas the mortality index (proportion of deaths/accidented victims) did not (mean value: 1.34 ± 0.56%). Factors such as male sex in general, above average age and uphill riding for non-traumatic accidents, as well as downhill riding for traumatic events, seem to be associated with fatalities during recreational mountain-biking in the Austrian Alps. These results should be considered for future preventive strategies in recreational mountain-biking.

Pelvic ring injuries after road and mountain bike accidents

PURPOSE

The purpose of this study was to compare patients with traumatic pelvic ring injuries sustained in road and mountain bicycling accidents to evaluate for differences in injury types and hospital courses.

METHODS

A retrospective review of 60 patients presenting with pelvic ring injuries after road (n = 46) and mountain (n = 14) bicycling accidents was performed to compare patient/injury characteristics and hospital course.

RESULTS

LC1 injuries were the most common pelvic ring injury (n = 31, 51.7%), 38.7% (n = 12) of which were considered unstable, followed by isolated iliac wing (n = 11, 18.3%), pubic rami (n = 6, 10.0%), and sacral fractures (n = 6, 10.0%). Hospital admission was required for 41 (68.3%) patients. The median hospital LOS was 4 days (IQR 2-9) and 12 (20%) patients received operative treatment. Patients in road versus mountain bicycling accidents were more likely to be older tobacco users and were similar in sex, body mass index, and injury severity score. Road bicycling resulted in more LC1 injuries (58.7% vs 28.6%, p = 0.04), while mountain bicycling resulted in more iliac wing fractures (42.9% vs. 10.9%, p = 0.01). Road cycling injuries required more days in the hospital to clear PT (median difference 2, CI 0-4, p = 0.04) and had longer hospital stays (median difference 2, CI 0-6, p = 0.02) but had no difference in the rate of admission, operative intervention, or discharge to rehabilitation facilities.

CONCLUSION

The majority of pelvic ring injuries from road and mountain bicycling accidents were LC1 injuries that were frequently unstable and often required hospital admission and operative fixation.

Development and Validation of Indicators for Population Injury Surveillance in Hong Kong: Development and Usability Study

BACKGROUND

Injury is an increasingly pressing global health issue. An effective surveillance system is required to monitor the trends and burden of injuries.

OBJECTIVE

This study aimed to identify a set of valid and context-specific injury indicators to facilitate the establishment of an injury surveillance program in Hong Kong.

METHODS

This development of indicators adopted a multiphased modified Delphi research design. A literature search was conducted on academic databases using injury-related search terms in various combinations. A list of potential indicators was sent to a panel of experts from various backgrounds to rate the validity and context-specificity of these indicators. Local hospital data on the selected core indicators were used to examine their applicability in the context of Hong Kong.

RESULTS

We reviewed 142 articles and identified 55 indicators, which were classified into 4 domains. On the basis of the ratings by the expert panel, 13 indicators were selected as core indicators because of their good validity and high relevance to the local context. Among these indicators, 10 were from the construct of health care service use, and 3 were from the construct of postdischarge outcomes. Regression analyses of local hospitalization data showed that the Hong Kong Safe Community certification status had no association with 5 core indicators (admission to intensive care unit, mortality rate, length of intensive care unit stay, need for a rehabilitation facility, and long-term behavioral and emotional outcomes), negative associations with 4 core indicators (operative intervention, infection rate, length of hospitalization, and disability-adjusted life years), and positive associations with the remaining 4 core indicators (attendance to accident and emergency department, discharge rate, suicide rate, and hospitalization rate after attending the accident and emergency department). These results confirmed the validity of the selected core indicators for the quantification of injury burden and evaluation of injury-related services, although some indicators may better measure the consequences of severe injuries.

CONCLUSIONS

This study developed a set of injury outcome indicators that would be useful for monitoring injury trends and burdens in Hong Kong.

Injuries in alpine summer sports - types, frequency and prevention: a systematic review

Introduction

Summer alpine sports, including mountain biking, hiking and airborne pursuits, have experienced a recent surge in popularity. Accordingly, trauma associated with these activities has increased. There is a scarcity of literature exploring clinical aspects surrounding injuries. Specifically, no single article provides a general overview, as individual studies tend to focus on one particular sport. In the present study, we performed a systematic literature review to summarize existing knowledge and explore the potential for prevention and clinical decision making in this group.

Method

Literature searches were performed using the PubMed and Scopus database for the most commonly ventured sports associated with injury: mountain biking, climbing, airborne sports, paragliding, and base jumping. From this search, studies were identified for qualitative and quantitative analyses. These searches were done according to PRISMA guidelines for systematic reviews. Studies were then analyzed regarding epidemiology of injuries, relevant anatomical considerations and prevention strategies were discussed.

Results

A broad spectrum of injury sites and mechanisms are seen in mountain biking, climbing or airborne sports. Mountain biking related injuries commonly involve the upper extremity, with fractures of the clavicle being the most common injury, followed by fractures of the hand and wrist. Scaphoid fractures remain of paramount importance in a differential diagnosis, given their often subtle clinical and radiological appearance. Paragliding, skydiving, and base jumping particularly affect transition areas of the spine, such as the thoracolumbar and the spinopelvic regions. Lower limb injuries were seen in equal frequency to spinal injuries. Regarding relative risk, mountain biking has the lowest risk for injuries, followed by climbing and airborne sports. Male alpinists are reported to be more susceptible to injuries than female alpinists. Generally, the literature surrounding hiking and water-related mountain sports is insufficient, and further work is required to elucidate injury mechanisms and effective preventative measures. A helmet seems to decrease the likelihood of face and head injuries in mountain sports and be a meaningful preventive measurement.

Severe and Fatal Cycling Crash Injury in Britain: Time to Make Urban Cycling Safer

Pedal cycling is advocated for increasing physical activity and promoting health and wellbeing. However, whilst some countries have achieved zero cyclist deaths on their roads, this is not the case for Great Britain (GB). A retrospective cross-sectional analysis was conducted of STATS19 cyclist crash data, a dataset of all police-reported traffic crashes in GB. Information about crash location, casualty, driver and vehicles involved were included as predictors of casualty severity (fatal or severe vs. slight). Sixteen thousand one hundred seventy pedal cycle crashes were reported during 2018. Severe or fatal cyclist crash injury was associated with increasing age of the cyclist (35-39 years, OR 1.38, 95% CI 1.11 to 1.73; 55-59 years, OR 1.73, 95% CI 1.35 to 2.2; 70 years and over, OR 2.87, 95% CI 2.12 to 3.87), higher road speed limits (50 MPH OR 2.10, 95% CI 1.43 to 3.07; 70 MPH OR 4.12, 95% CI 2.12 to 8.03), the involvement of goods vehicles (OR 2.08, 95% CI 1.30 to 3.33) and the months of May and June (OR 1.34 to 1.36, 95% CI 1.06 to 1.73). Urban planning that includes physical separation of pedal cyclists from other road users, raising awareness around the risks from goods vehicles and reducing road speed should be the urgent focus of interventions to increase the benefits and safety of cycling.

Do Mountain Bikers Know When They Have Had a Concussion and, Do They Know to Stop Riding?

OBJECTIVE

To establish the prevalence of concussions in mountain bikers and to determine factors that increase their risk of concussion. Secondary objectives include determination of whether mountain bikers have undiagnosed concussions, continue to ride after experiencing concussion symptoms, and if they knowingly ride with a broken helmet.

DESIGN

Retrospective survey.

SETTING

Seven-day mountain bike stage race.

PARTICIPANTS

Two hundred nineteen mountain bikers.

MAIN OUTCOME MEASURES

Number of rider concussions diagnosed, number of riders experiencing concussion symptoms without diagnosed concussions, number of riders who continue to ride after experiencing a concussion symptom, and number of riders who rode with a broken helmet.

INDEPENDENT VARIABLES

The independent variables studied included age, gender, nationality, number of times riding in past year, style of riding (cross-country, downhill, or freeride), years mountain biking, years mountain bike racing, whether they are a sponsored cyclist, and whether they also ride a road bike.

RESULTS

Fifteen of 219 mountain bikers (6.9%) had a diagnosed concussion after being hit in the head while mountain biking within the past year, with older riders having a decreased risk [odds ratio (OR), 0.91; P = 0.04], and sponsored riders having a 5-fold increased risk compared with nonsponsored riders (OR, 4.20; P = 0.05). Twenty-eight riders (12.8%) experienced a concussion symptom without being diagnosed with a concussion and 67.5% of the riders who experienced a concussion symptom continued to ride afterward. Overall, 29.2% of riders reported riding with a broken helmet.

CONCLUSIONS

The yearly prevalence of diagnosed concussions in mountain bikers is 6.9%. More than one-third of mountain bikers do not recognize when they have had a concussion and continue riding after experiencing concussion symptoms or with a broken helmet. These behaviors increase their risk of worsening concussion symptoms and acquiring a second injury.

The National Interscholastic Cycling Association Mountain Biking Injury Surveillance System: 40,000 Student-Athlete-Years of Data

ABSTRACT

A web-based injury surveillance system was implemented through a collaboration between University of Utah researchers and the National Interscholastic Cycling Association (NICA) to better understand injury characteristics in mountain biking. Data were collected from NICA leagues during the 2018 and 2019 seasons. Injuries were tracked in 41,327 student-athlete-years, identifying 1750 unique injuries during 1155 injury events. Rider-dependent and rider-independent variables were analyzed. The most commonly reported injuries were concussion (23.6%), injuries to the wrist/hand (22.3%), and shoulder (15.6%). Half of all injury events occurred on downhills. Men and women reported similar yet significantly different injury rates (2.69% and 3.21%, respectively; P = 0.009). Women sustained more lower-limb injuries (37.8% vs 28.3%; P = 0.003). Nearly 50% of crashes resulted in an emergency room visit. Youth mountain bike racing is a rapidly growing sport. Acute traumatic injuries are common. Injury surveillance system data are now being used to inform injury prevention strategies and direct future research.

The NICA injury surveillance system: Design, methodology and preliminary data of a prospective, longitudinal study of injuries in youth cross country mountain bike racing

OBJECTIVES

To describe the design and implementation of an injury surveillance system for youth mountain bike racing in the United States, and to report preliminary first-year results.

DESIGN

Descriptive sports injury epidemiology study.

METHODS

After two and a half years of development and extensive beta-testing, an electronic injury surveillance system went live in January, 2018. An automated email is sent to a Designated Reporter on each team, with links to the injury reporting form. Data collected include demographic information, injured body part, injury diagnosis, trail conditions and other factors associated with injury occurrence.

RESULTS

837 unique injuries were reported in 554 injury events among 18,576 student-athletes. The overall injury event proportion was 3.0%. The most common injury among student-athletes was concussion/possible concussion (22.2%), followed by injuries to the wrist and hand (19.0%). Among 8,738 coaches, there were 134 unique injuries reported that occurred in 68 injury events, resulting in an overall injury event proportion of 0.8%. The shoulder (38.2%) was the most commonly injured body part among coaches. Injuries among coaches tended to more frequently result in fractures, dislocations and hospital admission compared with injuries among student-athletes. Among student-athletes, female riders sustained lower limb injuries more than male riders (34.0% vs. 20.7%, p<0.001).

CONCLUSIONS

A nationwide injury surveillance system for youth mountain bike racing was successfully implemented in the United States. Overall injury event proportions were relatively low, but many injury events resulted in concussions/possible concussions, fractures, dislocations and 4 weeks or longer of time loss from riding.

Road bike accidents involving cervical fractures presenting as cardiac arrest: a report of two cases

We present two cases in which elderly male recreational cyclists suffered from cervical fractures and coinciding injuries of the spinal cord that subsequently led to cardiac arrest.

Based on reports from eye witnesses and due to the low impact nature of the crashes, the two patients were initially considered as having cardiac arrest before falling of their bikes.

The spinal cord injuries triggering cardiac arrest were acknowledged with delay, as the primary eliciting cause was considered cardiac disease in conjunction with all-out exercise. We suggest that increased focus should be made on possible cervical injuries even following low energy crashes in road cycling.

Mountain Biking Injuries

With the increasing popularity of mountain biking, also known as off-road cycling, and the riders pushing the sport into extremes, there has been a corresponding increase in injury. Almost two thirds of acute injuries involve the upper extremities, and a similar proportion of overuse injuries affect the lower extremities. Mountain biking appears to be a high-risk sport for severe spine injuries. New trends of injury patterns are observed with popularity of mountain bike trail parks and freeride cycling. Using protective gear, improving technical proficiency, and physical fitness may somewhat decrease the risk of injuries. Simple modifications in bicycle-rider interface areas and with the bicycle (bike fit) also may decrease some overuse injuries. Bike fit provides the clinician with postural correction during the sport. In this review, we also discuss the importance of race-day management strategies and monitoring the injury trends.

Recreational Sporting Activity Vehicle-Related Deaths

Deaths occurring in the setting of nonprofessional, vehicle-related, recreational sporting activities occurring on land or in water during warm or winter months represent a diverse group of cases. These deaths tend to involve scenarios where the participants are purposefully attempting to enjoy themselves prior to experiencing sudden, catastrophic accidents resulting in lethal outcomes. Ultimately, many of the deaths are related to the high speed at which these vehicle-related activities normally occur. Three broad categories of factors may play contributory roles in death: human factors, vehicle factors, and environmental factors. A series of selected cases are presented, representing examples of varying activity types, involving motorized and nonmotorized vehicles, land and water activities, and warm weather and cold weather environments. For each case, the various human, vehicle and environmental factors believed to be contributory to the accident are considered, and strategies for prevention of these and similar deaths involving recreational sporting vehicles are presented.

Bicycling injury hospitalisation rates in Canadian jurisdictions: analyses examining associations with helmet legislation and mode share

OBJECTIVES

The purpose of this study was to calculate exposure-based bicycling hospitalisation rates in Canadian jurisdictions with different helmet legislation and bicycling mode shares, and to examine whether the rates were related to these differences.

METHODS

Administrative data on hospital stays for bicycling injuries to 10 body region groups and national survey data on bicycling trips were used to calculate hospitalisation rates. Rates were calculated for 44 sex, age and jurisdiction strata for all injury causes and 22 age and jurisdiction strata for traffic-related injury causes. Inferential analyses examined associations between hospitalisation rates and sex, age group, helmet legislation and bicycling mode share.

RESULTS

In Canada, over the study period 2006-2011, there was an average of 3690 hospitalisations per year and an estimated 593 million annual trips by bicycle among people 12 years of age and older, for a cycling hospitalisation rate of 622 per 100 million trips (95% CI 611 to 633). Hospitalisation rates varied substantially across the jurisdiction, age and sex strata, but only two characteristics explained this variability. For all injury causes, sex was associated with hospitalisation rates; females had rates consistently lower than males. For traffic-related injury causes, higher cycling mode share was consistently associated with lower hospitalisation rates. Helmet legislation was not associated with hospitalisation rates for brain, head, scalp, skull, face or neck injuries.

CONCLUSIONS

These results suggest that transportation and health policymakers who aim to reduce bicycling injury rates in the population should focus on factors related to increased cycling mode share and female cycling choices. Bicycling routes designed to be physically separated from traffic or along quiet streets fit both these criteria and are associated with lower relative risks of injury.

Does a minimal invasive approach reduce anterior chest wall numbness and postoperative pain in plate fixation of clavicle fractures?

BACKGROUND

Fractures of the clavicle present very common injuries with a peak of incidence in young active patients. Recently published randomized clinical trials demonstrated an improved functional outcome and a lower rate of nonunions in comparison to non-operative treatment. Anterior chest wall numbness due to injury of the supraclavicular nerve and postoperative pain constitute common surgery related complications in plate fixation of displaced clavicle fractures. We recently developed a technique for mini open plating (MOP) of the clavicle to reduce postoperative numbness and pain. The purpose of this study was to analyze the size of anterior chest wall numbness and the intensity of postoperative pain in MOP in comparison to conventional open plating (COP) of clavicle fractures.

METHODS

24 patients (mean age 38.2 ± 14.2 yrs.) with a displaced fracture of the clavicle (Orthopaedic Trauma Association B1.2-C1.2) surgically treated using a locking compression plate (LCP) were enrolled. 12 patients underwent MOP and another 12 patients COP. Anterior chest wall numbness was measured with a transparency grid on the second postoperative day and at the six months follow-up. Postoperative pain was evaluated using the Visual Analog Scale (VAS).

RESULTS

Mean ratio of skin incision length to plate length was 0.61 ± 0.04 in the MOP group and 0.85 ± 0.06 in the COP group (p < 0.05). Mean ratio of the area of anterior chest wall numbness to plate length was postoperative 7.6 ± 5.9 (six months follow-up 4.7 ± 3.9) in the MOP group and 22.1 ± 19.1 (16.9 ± 14.1) in the COP group (p < 0.05). Mean VAS was 2.6 ± 1.4 points in the MOP group and 3.4 ± 1.6 points in the COP group (p = 0.20).

CONCLUSIONS

In our study, MOP significantly reduced anterior chest wall numbness in comparison to a conventional open approach postoperative as well as at the six months follow-up. Postoperative pain tended to be lower in the MOP group, however this difference was not statistically significant.

TRIAL REGISTRATION

ClinicalTrials.gov NCT02247778 . Registered 21 September 2014.

Contribution of exposure, risk of crash and fatality to explain age- and sex-related differences in traffic-related cyclist mortality rates

This study was designed to quantify the percent contribution of exposure, risk of collision and fatality rate to the association of age and sex with the mortality rates among cyclists in Spain, and to track the changes in these contributions with time. Data were analyzed for 50,042 cyclists involved in road crashes in Spain from 1993 to 2011, and also for a subset of 13,119 non-infractor cyclists involved in collisions with a vehicle whose driver committed an infraction (used as a proxy sample of all cyclists on the road). We used decomposition and quasi-induced exposure methods to obtain the percent contributions of these three components to the mortality rate ratios for each age and sex group compared to males aged 25-34 years. Death rates increased with age, and the main component of this increase was fatality (around 70%). Among younger cyclists, however, the main component of increased death rates was risk of a collision. Males had higher death rates than females in every age group: this rate increased from 6.4 in the 5-14 year old group to 18.8 in the 65-79 year old group. Exposure, the main component of this increase, ranged between 70% and 90% in all age categories, although the fatality component also contributed to this increase. The contributions of exposure, risk of crash and fatality to cyclist death rates were strongly associated with age and sex. Young male cyclists were a high-risk group because all three components tended to increase their mortality rate.

Cyclists' clothing and reduced risk of injury in crashes

INTRODUCTION

A majority of cyclists' hospital presentations involve relatively minor soft tissue injuries. This study investigated the role of clothing in reducing the risk of cyclists' injuries in crashes.

METHODS

Adult cyclists were recruited and interviewed through hospital emergency departments in the Australian Capital Territory. This paper focuses on 202 who had crashed in transport related areas. Eligible participants were interviewed and their self-reported injuries corroborated with medical records. The association between clothing worn and injury was examined using logistic regression while controlling for potential confounders of injury.

RESULTS

A high proportion of participants were wearing helmets (89%) and full cover footwear (93%). Fewer wore long sleeved tops (43%), long pants (33%), full cover gloves (14%) or conspicuity aids (34%). The primary cause of injury for the majority of participants (76%) was impact with the ground. Increased likelihood of arm injuries (Adj. OR=2.06, 95%CI: 1.02-4.18, p=0.05) and leg injuries (Adj. OR=3.37, 95%CI: 1.42-7.96, p=0.01) were associated with wearing short rather than long sleeves and pants. Open footwear was associated with increased risk of foot or ankle injuries (Adj. OR=6.21, 95%CI: 1.58-23.56, p=0.01) compared to enclosed shoes. Bare hands were associated with increased likelihood of cuts, lacerations or abrasion injuries (Adj. OR=4.62, 95%CI: 1.23-17.43, p=0.02) compared to wearing full cover gloves. There were no significant differences by fabric types such as Lycra/synthetic, natural fiber or leather.

CONCLUSIONS

Clothing that fully covers a cyclist's body substantially reduced the risk of injuries in a crash. Coverage of skin was more important than fabric type. Further work is necessary to determine if targeted campaigns can improve cyclists' clothing choices and whether impact protection can further reduce injury risk.

Longboard and skateboard injuries

INTRODUCTION

The causes and events related to skateboarding injuries have been widely documented. However, little is known about longboard-related injuries. With five deaths linked to longboarding in the United States and Canada in 2012, some cities are already considering banning the practice. This study compared the types and causes of longboarding-related injuries to those associated with skateboarding.

METHODS

We conducted a retrospective cohort study, using an emergency-based surveillance system, on patients under the age of 18 who had been injured while longboarding or skateboarding between 2006 and 2010.

RESULTS

A total of 287 longboarding and 4198 skateboarding cases were identified. There were more females in the longboarding group (18.8%) than in the skateboarding one (10.7%, p < 0.002). All the injured longboarders were older than 10 years of age while a fifth of the injured skateboarders were under the age of 11. Longboarders' injuries occurred mainly on streets and roads (75.3% vs. 34.3% in skateboarders, p < 0.000) and rarely in skate parks (1.4% vs. 26.4% in skateboarders, p < 0.000). Longboarders suffered twice as many injuries to their heads and necks (23.3% vs. 13.1%, p < 0.000) and twice as many severe neurological traumas (8.6 vs. 3.7%, p < 0.000) while skateboarders suffered more injuries to their lower extremities (33.7% vs. 24.7%, p < 0.002).

CONCLUSION

Longboarding is associated with a different pattern of injuries than skateboarding. Because longboarders suffer more intracranial injuries, the importance of helmet use should be especially strongly reinforced.

A booming economy means a bursting trauma system: association between hospital admission for major injury and indicators of economic activity in a large Canadian health region

BACKGROUND

Injury epidemiology fluctuates with economic activity in many countries. These relationships remain unclear in Canada.

METHODS

The annual risk of admission for major injury (Injury Severity Score ≥12) to a high-volume, level-1 Canadian trauma center was compared with indicators of economic activity over a 16-year period using linear regression.

RESULTS

An increased risk of injured patient admissions was associated with rising mean gross domestic product (GDP [millions of chained 2002 dollars]) (.36 person increase per 100,000 population/$1,000 increase in GDP; P = .001) and annual gasoline prices (.47 person increase per 100,000 population/cent increase in gasoline price; P = .001). Recreation-related vehicle injuries were also associated with economic affluence. The risk of trauma patient mortality with increasing mean annual GDP (P = .72) and gasoline prices (P = .32) remained unchanged.

CONCLUSION

Hospital admissions for major injury, but not trauma patient mortality, were associated with economic activity in a large Canadian health care region.