====== Bicycle trauma ====== Early results suggest a greater relative incidence of serious trauma and an alternative pattern of injury among [[Electric Scooter]] users compared with bicycles. Trial registration number: TARN210101 ((Clough RA, Platt E, Cole E, Wilson M, Aylwin C. Major trauma among E-Scooter and bicycle users: a nationwide cohort study. Inj Prev. 2023 Apr;29(2):121-125. doi: 10.1136/ip-2022-044722. Epub 2023 Feb 28. PMID: 36854628.)) ---- [[Cycling]] is associated with a greater risk of [[traumatic brain injury]] (TBI) than other recreational activities, and is more common in children, adolescents, and elderly people than young adults ((Collins BA, Langley JD, Marshall SW. Injuries to pedal cyclists resulting in death and hospitalisation. N Z Med J. 1993 Dec 8;106(969):514-6. PMID: 8183490.)) ((Sacks JJ, Holmgreen P, Smith SM, Sosin DM. Bicycle-associated head injuries and deaths in the United States from 1984 through 1988. How many are preventable? JAMA. 1991 Dec 4;266(21):3016-8. PMID: 1820476.)). ---- It is responsible for an increased need for [[hospitalization]] and eventually imposes significant [[healthcare cost]]s on individuals and [[society]] ((Scholten AC, Polinder S, Panneman MJ, van Beeck EF, Haagsma JA. Incidence and costs of bicycle-related traumatic brain injuries in the Netherlands. Accid Anal Prev. 2015 Aug;81:51-60. doi: 10.1016/j.aap.2015.04.022. Epub 2015 May 6. PMID: 25939135.)). ---- In bicycle-related head injuries, collision with [[motor vehicle]] is one of the most important risk factor for high grade of head injury severity and outcome. In addition, bicycle-related head injuries are often accompanied by injuries of other parts of the body ((Park JC, Chang IB, Ahn JH, Kim JH, Oh JK, Song JH. Epidemiology and Risk Factors for Bicycle-Related Severe Head Injury: A Single Center Experience. Korean J Neurotrauma. 2017 Oct;13(2):90-95. doi: 10.13004/kjnt.2017.13.2.90. Epub 2017 Oct 31. PMID: 29201840; PMCID: PMC5702764.)). ---- Over half a million injuries related to bicycle crashes were seen in U.S. hospital emergency rooms in 1982. The data reviewed show a strong link between bicycle/motor vehicle collisions, head injury, and serious morbidity and mortality ((Friede AM, Azzara CV, Gallagher SS, Guyer B. The epidemiology of injuries to bicycle riders. Pediatr Clin North Am. 1985 Feb;32(1):141-51. doi: 10.1016/s0031-3955(16)34762-9. PMID: 3975084.)). ---- Population-based incidence rates for head injuries and total injuries resulting from bicycle crashes were calculated in a Seattle, Washington health maintenance organization population. Overall rates were 163 per 100,000 for all injuries and 42/100,000 for head injuries. Individuals between 5 and 14 years of age are at highest risk for bicycle-related injuries. The data are presented for their potential utility in program planning ((Thompson DC, Thompson RS, Rivara FP. Incidence of bicycle-related injuries in a defined population. Am J Public Health. 1990 Nov;80(11):1388-90. doi: 10.2105/ajph.80.11.1388. PMID: 2240316; PMCID: PMC1404908.)). ---- During 25,971 days of cycling, 198 crashes were reported, comprising approximately equal numbers of falls and collisions. The overall crash rate was 0.290 (95% CI, 0.264-0.319) per 1000km or 6.06 (95% CI, 5.52-6.65) per 1000h of travel. The rate of crashes causing any injury (self-treated, or medically attended without overnight hospital stay) was 0.148 (95% CI, 0.133-0.164) per 1000km or 3.09 (95% CI, 2.79-3.43) per 1000h of travel. The rate of crashes causing a medically attended injury (without overnight hospital stay) was 0.023 (95% CI, 0.020-0.027) per 1000km or 0.49 (95% CI, 0.43-0.56) per 1000h of travel. No injuries requiring an overnight stay in hospital were reported on days meeting the inclusion criteria. After adjustment for exposure in hours, or for the risks associated with different infrastructure utilisation, the rates of crashes and medically attended injuries were found to be greater for females than males, less experienced than more experienced cyclists, and for those who rode mainly for transport rather than mainly for recreation. Comparison of estimated crash and injury rates on different infrastructure types were limited by the small number of events, however findings suggest that the separation of cyclists from motorised traffic is by itself not sufficient to ensure safe cycling ((Poulos RG, Hatfield J, Rissel C, Flack LK, Murphy S, Grzebieta R, McIntosh AS. An exposure based study of crash and injury rates in a cohort of transport and recreational cyclists in New South Wales, Australia. Accid Anal Prev. 2015 May;78:29-38. doi: 10.1016/j.aap.2015.02.009. Epub 2015 Feb 27. PMID: 25732133.)). ---- A Dutch study showed that in 2012, 31% of the lethal traffic accidents and 59% of the traffic accident victims treated in the emergency room were cyclists ((Polinder S, Haagsma J, Panneman M, Scholten A, Brugmans M, Van Beeck E. The economic burden of injury: Healthcare and productivity costs of injuries in the Netherlands. Accid Anal Prev. 2016 Aug;93:92-100. doi: 10.1016/j.aap.2016.04.003. Epub 2016 May 10. PMID: 27177394.)) ===== Bicycle helmet ===== [[Bicycle helmet]]. ---- Dentoalveolar injuries are fairly common in trauma patients admitted to a trauma center following bicycling accidents. Bicycling helmets are associated with an increased risk of dentoalveolar injuries ((Døving M, Galteland P, Eken T, Sehic A, Utheim TP, Skaga NO, Helseth E, Ramm-Pettersen J. Dentoalveolar injuries, bicycling accidents and helmet use in patients referred to a Norwegian Trauma Centre: A 12-year prospective study. Dent Traumatol. 2021 Apr;37(2):240-246. doi: 10.1111/edt.12627. Epub 2020 Dec 6. PMID: 33220164.)). ===== Electrically Assisted Pedal Cycles ===== [[Electrically Assisted Pedal Cycles]]. ===== Spinal cord injury ===== Automobile, motorcycle, and bicycle related SCIs occur primarily in the cervicothoracic region. SCIs due to motorcycle accidents have a higher predilection for the thoracic region, and there is a statistically higher percentage of motor complete injuries. A higher percentage of cervical SCIs occur as a result of automobile and bicycle accidents. Extrapolations from motor vehicle usage data suggest that the relative rate of occurrence of SCI for motorcycles is higher than for automobiles ((Medina O, Singla V, Liu C, Fukunaga D, Rolfe K. Patterns of spinal cord injury in automobiles versus motorcycles and bicycles. Spinal Cord Ser Cases. 2020 Aug 20;6(1):75. doi: 10.1038/s41394-020-00324-y. PMID: 32820149; PMCID: PMC7441156.)). ===== Case series ===== [[Bicycle trauma case series]]. ===== Case reports ===== A 46-year-old man who experienced [[orthostatic headache]] after a [[bicycle]] [[accident]] at age 45. Computed tomography (CT) myelography revealed Cerebrospinal fluid fistulas at the C1-2 level. He underwent epidural blood patch therapy, but it was unsuccessful. Next, we performed direct surgery and found a meningeal diverticulum originating from the left C2 nerve root; therefore, we ligated the diverticulum. His symptoms and image findings strikingly improved after surgery ((Enomoto N, Mure H, Okazaki T, Azumi M, Okita S, Nagahiro S, Takagi Y. Posttraumatic Cerebrospinal fluid fistula Associated with an Upper Cervical Meningeal Diverticulum. World Neurosurg. 2018 Aug;116:50-55. doi: 10.1016/j.wneu.2018.05.061. Epub 2018 May 17. PMID: 29777885.)).