Bicycle and moped spoke injuries in children. Analysis of 103 consecutive cases

The series consists of 60 boys and 43 girls, aged from 1 to 14 years, mean 4.95 years, whose right (42) or left (61) foot was caught between the bicycle (97) or moped (6) spokes. The skin was involved with ankle sprain, with fracture or without other injuries in 97 children; lateral aspect of the ankle and foot in 65 and heel in 21 patients. The X-rays revealed 10 tibial fractures, 4 fractures of the tibia and fibula, one fracture of the medial malleolus, one of the lateral malleolus and one bimalleolar fracture. Hence an X-ray of the leg should always be taken. Twenty-six patients were treated on the ward, 77 as outpatients. The mean total time of healing in the group as a whole was 25 days and 44 days in patients having a fracture. Heel avulsion injuries caused by the spokes need special attention. The vitality of the crushed and dirty, caudally or medially based skin flap is minimal and very often yields a marginal or total necrosis if primary suture is done.