Implications: Handlebar injuries can be bad. Extremity (4.7% vs 41.4%) and skull/spine/CNS (1.9% vs 43.2%) injuries were far less common in the handlebar vs non-handlebar group, respectively. The authors also found a large number of soft tissue injuries, such as thigh, abdominal wall, or genital lacerations requiring repair in the handlebar cohort vs not (23.4% vs 2.2%, respectively). Results: As expected, this study also found that both solid organ (34.6% vs 4.3%) and hollow viscus (9.3% vs 0.7%) injuries were far more common with a handlebar vs non-handlebar mechanism. Handlebar mustache = stylish! | Handlebar vs child = badness.ĭesign: This was a retrospective review of a single center trauma registry that identified 385 bicycle injuries in children, 107 (27.8%) of which involved handlebars. But do handlebars cause other injuries as well? Some children have bowel injury that may not be apparent even on CT. If you see a round handlebar mark on the abdomen, CT is negative, but the child is still very tender on exam, call pediatric surgery and admit. We know bicycle handlebars uniquely concentrate the force of impact to a small area and are associated with severe intra-abdominal injuries. Take handlebar injuries, especially those to the abdomen, very seriously. Pediatr Surg Int 2015 31:1021-1025.Handlebars can cause significant intra-abdominal injuries as well as other soft tissue injuries. Injury patterns and outcomes following pediatric bicycle accidents. Puskarich MA, Marx JA: Abdominal Trauma, in Marx JA, Hockberger RS, Walls RM, et al (eds): Rosen’s Emergency Medicine: Concepts and Clinical Practice, ed 8. Splenectomy is rarely required though vaccination for encapsulated bacteria should be performed in the setting of severe injuries. Grades 1-4 are non-operative per American Pediatric Surgical Association. Splenic injuries require serial hemoglobin/hematocrits, serial abdominal exams, and bed rest. If bilious vomiting ensues 24-48 hours after injury, consider a duodenal hematoma as hollow viscous injuries are rarely seen on CT scans. Persistent LUQ pain that radiates to left shoulder during serial exams will generally require further investigation including advanced imaging like CT with IV contrast. Patients with isolated injuries to the abdomen, a negative FAST, normal labs (including LFTs/lipase/UA), and clinical improvement over 24 hours are safe for discharge. Early laparotomy should occur in unstable patients, patients with significant peritonitis, or free air on x-ray. Your trauma survey places a lot of importance on the chest xray which can show diaphragmatic rupture or significant viscous perforation early on. Hemodynamically unstable patients should raise consideration for injury to the IVC or other abdominal vascular structures. It can present either as a longitudinal pattern of the bicycle handlebars strike the abdomen in collision or it may be a circular wound from the end of the handlebar impaling the abdomen.Īn estimated 10% of bicycle injuries are related to contact with handlebars. The second thing you do is ask to look at a video of what happened. The first thing you do is recognize the sign. Case: Pediatric patient arrives after being overzealous on his bicycle with the following wound.
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