Handlebar Injuries in Children: 20 Years of Experience at A Level I Pediatric Trauma Center

Background: Handlebar injuries in the pediatric population have been shown to cause devastating intra-abdominal injuries. We analyzed the impact of handlebar injuries in our pediatric trauma patients over the past 20 years. Methods: We reviewed all of the pediatric bicycle accidents ages 15 years old or younger, who required hospitalization for their injuries. Data was collected from 1995 to 2015. Each case was evaluated for mechanism and severity of injuries, physical and radiographic findings, treatment administered length of hospitalization and patient outcomes. Institutional Review Board approval was obtained. Results: There were 83 pediatric bicycle accidents, which required hospital admission over the past twenty years. 20 out of the 83 patients (24%) sustained direct handlebar injuries. There were 15 males and 5 females ranging from age of 5 to 15 years old (mean 10.3 ± 2.55). Type of injuries included traumatic hernia, bony fractures, and multiple solid organ injuries: spleen (5), liver (3), kidney (2), pancreas (3), and adrenal (1). Most patients were successfully managed nonoperatively with close ICU monitoring. Two patients required surgical intervention for traumatic Spigelian hernia and duodenal perforation. Length of hospitalization for handlebar injuries ranged from 2 to 24 days (mean 6.3 ± 5.81). Outpatient follow-up (between 1 to 8 months) with repeat imaging showed resolving injuries. Conclusion: Over the past 20 years, we have had successful management of severe intraabdominal injuries related to bicycle handlebar with no mortality. Since the implementation of state law to mandate helmets in young riders, the incidence of traumatic brain injuries has decreased. Handlebar injuries in children still continue to pose a problem.