Craniofacial Soft Tissue Injuries: An Observational Study of Bicycling Injuries From a Level 1 Trauma Center

Craniofacial injuries in bicycling accidents are common, yet limited information exists on associated soft tissue injuries. This study aims to investigate the prevalence and anatomic patterns of such injuries, and their association with helmet use and craniofacial fractures. The study included 1543 patients with bicycle injuries from a level 1 trauma center. Retrospective chart review was conducted for patients with craniofacial soft tissue injuries. Craniofacial soft tissue injuries were identified in 646 cyclists (41.9%). Odds of injury increased with years of age [aOR 1.02 (1.01-1.02), P <0.001], and women were at a higher risk compared with men [aOR 1.35 (1.05-1.75), P =0.02]. Injuries were distributed across the scalp (19%), upper third (56%), midface (69%), and lower third (32%) of the face. Helmets were used by 38% of the patients with soft tissue injuries. Helmet use reduced the odds of craniofacial soft tissue injuries overall [aOR 0.49 (0.39-0.62), P <0.001], scalp injuries [aOR 0.17 (0.10-0.28), P <0.001], and upper facial injuries [aOR 0.41 (0.31-0.54), P <0.001]. Conversely, helmet use increased the odds of lower facial injuries [aOR 1.48 (1.07-2.05), P =0.018]. Strong associations were found between lower face soft tissue injuries and mandible fractures [aOR 29.27 (15.50-55.30), P <0.001] and between soft tissue injuries of the midface and nasal bone fractures [aOR 22.70 (12.52-41.16), P <0.001]. Thus, craniofacial soft tissue injuries in cyclists are influenced by age, sex, and helmet use. Helmet use is associated with decreased odds of soft tissue injury of the upper face but with increased odds of soft tissue injury of the lower facial third.