Open iliac wing fracture caused by penetrating injury from a bicycle handlebar

Bicycle accidents have been documented as one of the most common mechanisms of accidents in children. Several reports describe intra-abdominal injury secondary to bicycle handlebars. Reported injuries include liver and spleen trauma, bowel perforation, and pancreatitis. However, there are few reports of penetrating handlebar injuries. We report a case of a penetrating bicycle handlebar producing an open iliac wing fracture. A number of reports have stressed the dichotomy between the benign external appearance and the potential severity of the intra-abdominal injury after a bicycle handlebar injury. Thus, a high index of suspicion must be maintained when evaluating a child after such an injury. All patients with a significant mechanism should have a thorough and complete evaluation, including radiographs. As with all traumatic injuries, a multidisciplinary approach is often required to efficiently manage these injuries. Although uncommon, open pelvic injuries in children do occur. The principles of management are the same in children as they are in adults. All children with open pelvic fractures require emergent operative debridement and, if indicated, stabilization. Special attention should be given to ensure that the gastrointestinal and genitourinary tracts do not communicate with the fracture. With attention to these fundamental principles, severe pelvic injuries in children can be managed with few long-term sequelae.