Handlebars as Hidden Spears


Source: Winston FK, et al. Hidden spears: Handlebars as injury hazards to children. Pediatrics 1998;102:596-601.

The objectives of this single-institution, prospective, cross-sectional surveillance study were to describe the mechanism of serious bicycle handlebar-related injuries in children and to make recommendations for prevention and redesign. The Injury Circumstance Evaluation Study was devised to identify injury hazards to children, describe in detail injury mechanics, and use that information to develop interventions. An example of this study method is the description of airbag-related injuries in children and the preventive strategies developed in that scenario. Injury studies like this incorporate several disciplines, including engineers, clinicians, and epidemiologists. Surveys are employed to gather detailed information from many different sources, and on-site crash investigations are comprehensive.

During the two-year study period, 107 seriously injured children were identified. Seventeen of these children were injured exclusively by the handlebar apparatus of the bicycle (handlebars, stemcrown, or crossbar). Thirteen of these 17 had primarily abdominal/pelvic injuries. The majority of handlebar injuries resulted from relatively minor mechanisms of injury (simple fall while riding), as opposed to being struck by a car. Typically, as the child began to fall, the front wheel rotated into a plane perpendicular to the child’s body, and the child fell on the handlebar apparatus that was directed at the child’s trunk. Resultant injuries included liver lacerations, splenic injuries, pancreatic lacerations, and flail chest with pneumothorax.

Commentary by Glenn C. Freas, MD, JD

This article is interesting reading for a couple of reasons. First, it clearly describes the mechanism of handlebar injuries and the injury patterns that result. Second, it is a primer for the uninitiated on injury prevention and biomechanical epidemiology. One can only hope that a larger population from a multi-institution study will produce the second major objective of this study: use the detailed data to make recommendations for design improvements and preventive strategies.

The differences between handlebar impact and non-handlebar impact injuries were striking. The majority of the handlebar impact injuries resulted from minor mechanisms of injury and were abdominal in location. The majority of non-handlebar impact injuries resulted from severe mechanisms of injury (struck by car) and involved the head or extremities. This alerts emergency physicians to the very real possibility that children with relatively minor falls from bicycles may harbor serious intra-abdominal injuries. Several of the children in this study with major intra-abdominal trauma had no external evidence of injury. Most had only minor bruising. The importance of obtaining a detailed history of the fall is clear. Most of these children are not head-injured and should be able to relate the events that caused them to fall, whether they struck the handlebar apparatus, and whether they have truncal pain. If they did strike the handlebars and/or they present with abdominal pain, the potential for serious injury is clear.