Bicycle impalement: A case series of penetrating handlebar injuries

Bicycles are among the most common means of transportation and recreation in children, and significant contributor to trauma in the pediatric population. Handlebars remain the most common bicycle part responsible for injuries, though most are blunt trauma. Few studies exist about bicycle impalement, or penetrating handlebar injuries, in children. The objective of this study is an overview of the evaluation, treatment and associated outcomes of these rare injuries.

We review a total of 8 penetrating handlebar trauma cases in children at our pediatric trauma center over the course of 4 years. In the same time frame, our pediatric trauma center treated 2506 patients for bicycle-related trauma. Institutional review board (IRB) approval was obtained per protocol prior to the study. All 8 penetrating handlebar cases were secondary to impalement with the hand-brake portion of bicycle handlebars. Age, gender, immunization status, imaging, type of procedural intervention, medications given and outcomes at follow up visits are reviewed.

All 8 cases reviewed were in male patients, median age 9. 6 patients presented with penetrating injuries to the lower extremity, and 2 patients with injuries to the abdomen. All 8 cases were up to date on immunizations and received a dose of intravenous antibiotics at presentation. Plain film radiographs and CT images were obtained based on patient's clinical findings, and type of procedural intervention pursued was ultimately provider-dependent. All 8 patients were discharged on oral antibiotics, and all were noted to be healing well without signs of infection at follow-up.

While rare, prompt recognition, evaluation and treatment of penetrating handlebar injuries in the pediatric population is imperative to improving clinical outcomes. Immediate evaluation includes patient's immunization status, decision to obtain imaging and operative intervention when indicated. Post-operative prophylactic antibiotics are not mandatory in cases of complete foreign body removal. Review of a larger number of penetrating handlebar cases could be pursued to further delineate best-practice protocols for this population.