Heel flap injuries in spoke wheel accidents

To compare and discuss motorcycle and bicycle spoke heel flap injuries and also to discuss the pathomechanics and treatment modalities of spoke wheel injuries.

The study comprises 42 heel flap injuries patients who were selected from amongst 216 cases of lower extremity trauma. The injuries were graded into three classes: I-III, depending upon the severity and extent of the injury. The management was based on this classification. Posterior heel injuries were covered with various flaps depending upon the defect size, its exact location, associated injuries, extent of zone of trauma, and complexity of the defect.

Eighty percent of the injuries were confined to the right side because of the existence of the chain guard on the left side of the two-wheeler. Inadequate footwear was a contributory factor. 57% of the cases were caused by motorcycle. The healing time was prolonged in motorcycle spoke injuries. No fracture was noted. Severity of injury in motorcycle was due to high momentum and rigidity of spokes.

Since the first report of bicycle spoke injuries, presented a half century ago, prevention has not improved. Protective footwear should be made compulsory. Changes should also be made in the design of the rear wheel of motorcycle.