Intramural duodenal hematoma following blunt bicycle handle bar injury

Injuries sustained by bicyclists

Although generally a safe activity with considerable health benefit, the wide social prevalence of cycling, its performance by both young and elderly riders, and the increasing operation of bicycles in complex urban environments results in a significant incidence of trauma. Orthopedic injuries, followed by head and facial trauma, are most frequent but all anatomic regions can be affected and the spectrum of injury ranges from minor to severe and potentially fatal. Clinicians need to be aware of the range of injuries and causative mechanisms as many patients may present with relatively minor signs and symptoms despite significant underlying pathology. Non-commuter, recreational cyclists are also at risk for injury due to: variable terrain and environmental conditions; increased competitive and risk-taking behavior; technical equipment failure; and poor compliance with protective equipment. Numerous injury preventative strategies have been advocated including: increased rider training; creation of dedicated traffic lanes for commuting cyclists; bike-awareness education for motorists and interventions to improve cyclist visibility; increased utilization of protective equipment and programs to reduce concomitant drug or alcohol use. Of all preventative strategies, bicycle helmets have received the most study, leading to legislated use in some jurisdictions. As urban environments become more congested for commuter cyclists, and interest in recreational and competitive cycling grows, bicycle injury is likely to become more prevalent.