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Vandewalle RJ, Barker SJ, Raymond JL, Brown BP, Rouse TM. Pediatric Handlebar Injuries: More Than Meets the Abdomen. Pediatr Emerg Care 2021; 37:e517-e523. [PMID: 30672898 DOI: 10.1097/pec.0000000000001690] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
OBJECTIVES Injuries associated with bicycles can generally be categorized into 2 types: injuries from falling from/off bicycles and injuries from striking the bicycle. In the second mechanism category, most occur as a result of children striking their body against the bicycle handlebar. The purpose of this study was to evaluate the presentation, body location, injury severity, and need for intervention for pediatric handlebar injuries at a single level one pediatric trauma center and contrast these against other bicycle-related injuries in children. METHODS This work is a retrospective review of the trauma registry over an 8-year period. Individual charts were then reviewed for patients' demographic factors, injury details, and other clinical/radiographic findings. Each patient was then categorized as either having a handlebar versus nonhandlebar injury. Additionally, each patient's injuries were classified according to affected body "zone(s)" and the need for intervention in relation to these injuries. During the course of chart review, several unique radiographic and history/physical findings were noted and are also reported. RESULTS During the study period, 385 patients were identified that met study criteria. Bicycle handlebars were involved in 27.8% (107/385) of injuries and 72.2% (278/385) were nonhandlebar injuries. There were differences in injury severity score, Head Abbreviated Injury Scale, length of stay between patients with handlebar versus nonhandlebar injuries, respectively. There were also differences in incidence of injuries across most body zones between patients with handlebar versus nonhandlebar injuries. There was statistically significant difference in need for intervention for abdominal solid organ injuries among handlebar versus nonhandlebar injuries mechanisms (21.6% vs 0%; P = 0.026), respectively. Sixteen patients with a handlebar injury underwent abdominal computed tomography (CT), which found only pericolic/pelvic free fluid or were negative for any disease and had normal/mildly elevated liver function test results at the time of arrival with otherwise normal laboratory workup results. Two patients required laparotomy for bowel injury and presented with peritonitis less than 12 hours after injury. The remaining patients did not have peritonitis on examination and were discharged without operative intervention 12 to 24 hours after injury without further event. CONCLUSIONS The bicycle handlebar is a unique mechanism of injury. The location, need for intervention, and the nature of the injury can vary significantly compared to other bicycle injuries. Handlebar injuries are more likely to cause abdominal and soft tissue injuries, whereas nonhandlebar injuries are more likely to cause extremity and skull/neck/central nervous system injuries. Because more than 20% of the reported handlebar injuries did not involve the abdomen or thoracoabdominal/extremity soft tissue as well as the variable presentation of handlebar injuries, it is imperative for the physician to consider this mechanism in all bicycle injuries. In addition, even within the same area of the body, handlebar injuries can be very different compared to nonhandlebar (i.e., orthopedic vs vascular injuries in the extremities). Physical examination and observation remain paramount when laboratory and radiographic workups are equivocal.
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Affiliation(s)
- Robert J Vandewalle
- From the Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine
| | | | - Jodi L Raymond
- Riley Hospital for Children at Indiana University Health
| | - Brandon P Brown
- Division of Pediatric Radiology, Department of Radiology, Indiana University School of Medicine
| | - Thomas M Rouse
- From the Division of Pediatric Surgery, Department of Surgery, Indiana University School of Medicine
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Grosek J, Čebron Ž, Janež J, Tomažič A. Bicycle handlebar injury in a child resulting in complex liver laceration with massive bleeding and bile leakage: A case report. Int J Surg Case Rep 2020; 72:386-390. [PMID: 32563827 PMCID: PMC7306525 DOI: 10.1016/j.ijscr.2020.06.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 06/09/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION Bicycle accidents are a significant cause of traumatic morbidity in the paediatric population. The handlebar injuries are usually isolated and remain a major source of bicycle related morbidity. We present a case of severe liver laceration with left hepatic duct transection caused by handlebar trauma in a 13-year-old boy. CASE PRESENTATION An otherwise healthy 13-year-old Caucasian male patient was rushed to the hospital following a blunt abdominal trauma from a bicycle handlebar. An ultrasound revealed extensive free intraperitoneal fluid with accompanying features of hemodynamic instability. Operative findings included massive haemoperitoneum, a deep laceration almost separating left and right liver lobes, and a near-complete interruption of the left hepatic duct. Interestingly, the vascular anatomy of the left liver lobe was preserved. After haemostasis was established a duct-to-duct anastomosis of the ruptured left hepatic duct was performed. A T-tube biliary drainage was inserted, and intraoperative cholangiography showed no extraluminal spillage of contrast. During the recovery phase, cholangiography was performed several times revealing leakage from left hepatic duct. The leakage was managed conservatively and finally stopped. DISCUSSION Management of blunt hepatic injuries has remarkably changed from mandatory operation to mostly nonoperative interventions with selective operative management. Hemodynamic instability remains the main reason for exploratory laparotomy. Near-isolated laceration of main hepatic ducts is an extremely rare finding, and immediate reconstruction is the best option if an experienced surgeon is available. CONCLUSION Due to limited evidence, we recommend consultation with an experienced HPB surgeon on a case-by-case basis for every paediatric biliary injury.
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Affiliation(s)
- Jan Grosek
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Žan Čebron
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia.
| | - Jurij Janež
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
| | - Aleš Tomažič
- Department of Abdominal Surgery, University Medical Centre Ljubljana, Zaloska 7, 1000, Ljubljana, Slovenia; Medical Faculty, University of Ljubljana, Vrazov trg 2, 1000, Ljubljana, Slovenia
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Mendoza-Moreno F, Furtado-Lobo I, Pérez-González M, Díez-Gago MDR, Medina-Reinoso C, Díez-Alonso M, Hernández-Merlo F, Noguerales-Fraguas F. Duodenal Rupture after Blunt Abdominal Trauma by Bicycle Handlebar: Case Report and Literature Review. Niger J Surg 2019; 25:213-216. [PMID: 31579380 PMCID: PMC6771178 DOI: 10.4103/njs.njs_31_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Blunt abdominal trauma is most frequent in the pediatric population. Duodenal lesions after abdominal trauma in children are infrequent and tend to be secondary to traffic accidents. It is up to five times more frequent in males, with an average age between 16 and 30 years. Bicycle accidents continue to lead to morbidity and mortality in children, representing between 5% and 14% of total blunt abdominal injuries. The diagnosis of duodenal injuries after trauma is difficult and requires a high index of clinical suspicion. We present the case of a 17-year-old patient seen in the emergency room after falling off his bicycle and presented a blunt trauma in the epigastric region. On physical examination, there was a swelling in the upper right abdominal quadrant and epigastrium with tenderness on deep palpation. He presented with hematemesis without hemodynamic repercussion. A contrast abdominal computed tomography was performed and he was diagnosed with third-part duodenal rupture. A resection of the perforated third-part duodenal rupture was performed, and the transit was reconstructed using a Roux-Y duodenojejunostomy. The postoperative period was uneventful and the patient was discharged after 16 days of stay. Duodenal injury is very rare, produced by high-energy trauma. They rarely present as single lesions as other visceral lesions are usually associated. The early diagnosis is important to reduce the morbidity and mortality.
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Affiliation(s)
- Fernando Mendoza-Moreno
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Isabel Furtado-Lobo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Marina Pérez-González
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Maria Del Rocío Díez-Gago
- Department of Emergency Medicine, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Carlos Medina-Reinoso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Manuel Díez-Alonso
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Francisco Hernández-Merlo
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
| | - Fernando Noguerales-Fraguas
- Department of General and Digestive Surgery, Príncipe de Asturias Teaching Hospital, Alcalá de Henares, Madrid, Spain
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Abstract
The aim of this article is to review the pertinent literature and to analyse our own data on facial trauma related to bicycling and mountain-biking. This article focuses on the mechanisms and the variety of bicycle related injuries and addresses the advantages of wearing protection clothes. Within the world of bicycling, the popularity of mountain-biking has increased the most dramatically. The main risk factors for the growing number of bicycle-related injuries are not wearing a helmet, age, male sex, unsafe riding techniques and intoxication. Bikers most commonly collide or fall in daily traffic whereas mountain-bikers get hurt whilst descending. The most common types of injury apart from superficial lesions are dentoalveolar trauma and facial fractures. Wearing protective clothing such as a helmet is demonstrably beneficial and so we suggest that the obligatory use of protective wear should be introduced. For a better insight into overall cycling-related trauma further research will be required.
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Affiliation(s)
| | | | | | - R Gassner
- Department for Cranio-Maxillofacial and Oral Surgery, University of Innsbruck, Innsbruck, Austria
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Hirose T, Ogura H, Kiguchi T, Mizushima Y, Kimbara F, Shimazaki J, Shiono S, Yamamura H, Wakai A, Takegawa R, Matsumoto H, Ohnishi M, Shimazu T. The risk of pediatric bicycle handlebar injury compared with non-handlebar injury: a retrospective multicenter study in Osaka, Japan. Scand J Trauma Resusc Emerg Med 2015; 23:66. [PMID: 26382735 PMCID: PMC4574182 DOI: 10.1186/s13049-015-0146-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 08/25/2015] [Indexed: 11/12/2022] Open
Abstract
Background Bicycle accidents are one of the major causes of unintentional traumatic injury in childhood. The purpose of this study was to examine characteristics and risks of handlebar injury in childhood. Methods We conducted a more than 5-year retrospective survey of patients under 15 years of age with bicycle-related injuries admitted to eight urban tertiary emergency centers in Osaka, Japan. Patients were divided into the direct-impact handlebar injury (HI) group and the non-handlebar injury (NHI) group. Results The HI group included 18 patients and the NHI group included 308 patients. Median Injury Severity Score (ISS) in the HI group was 9. Injury sites included the chest, 2 (chest bruise, 1; tracheal injury, 1) and abdomen, 16 (hepatic injury, 6; pancreatic injury, 2; duodenal injury, 1; splenic injury, 1; small intestinal injury, 1; retroperitoneal hemorrhage, 1; renal injury, 1; abdominal wall musculature injury, 2; bladder injury, 1; and perineal laceration, 1). There were no significant differences in age, sex, ISS, and prognosis between the two groups. However, significant differences were seen in the abdominal median Abbreviated Injury Scale (AIS) score, which was higher in the HI group (3 vs 0, p < 0.01), and in the head median AIS score, which was higher in the NHI group (0 vs 2, p < 0.01). As mechanisms of injury, falling while riding a bicycle occurred significantly more frequently in the HI group (17 [94.4 %] vs 65 [21.1 %], p < 0.01). Direct transportation from the scene of the accident occurred significantly more often in the NHI group (5 [27.8 %] vs 255 [82.8 %], p < 0.01), whereas transfer from another hospital occurred significantly more frequently in the HI group (11 [61.1 %] vs 45 [14.6 %], p < 0.01). Conclusions Handlebar injuries in children have significant potential to cause severe damage to visceral organs, especially those in the abdomen.
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Affiliation(s)
- Tomoya Hirose
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hiroshi Ogura
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takeyuki Kiguchi
- Department of Emergency Medicine, Osaka General Medical Center, 3-1-56 Bandai-Higashi, Sumiyoshi-ku, Osaka, 558-8558, Japan.
| | - Yasuaki Mizushima
- Senshu Trauma and Critical Care Center, Rinku General Medical Center, 2-23 Rinku-orai kita, Izumisano, 598-8577, Japan.
| | - Futoshi Kimbara
- Senri Critical Care Medical Center, Osaka Saiseikai Senri Hospital, 1-1-6 Tsukumodai, Suita, Osaka, 565-0862, Japan.
| | - Junya Shimazaki
- Emergency and Critical Care Medical Center, Osaka Police Hospital, 10-31 Kitayama-cho, Tennouji-ku, Osaka, 543-0035, Japan.
| | - Shigeru Shiono
- Osaka Prefectural Nakakawachi Medical Center of Acute Medicine, 3-4-13 Nishiiwata, Higashiosaka City, Osaka, 578-0947, Japan.
| | - Hitoshi Yamamura
- Department of Trauma and Critical Care Medicine, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abenoku, Osaka, 545-8585, Japan.
| | - Akinori Wakai
- Traumatology and Critical Care Medical Center, National Hospital Organization Osaka National Hospital, 2-1-14 Hoenzaka Chuo-ku, Osaka, Osaka, 540-0006, Japan.
| | - Ryosuke Takegawa
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Hisatake Matsumoto
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Mitsuo Ohnishi
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
| | - Takeshi Shimazu
- Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamadaoka, Suita, Osaka, 565-0871, Japan.
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Liu HT, Rau CS, Liang CC, Wu SC, Hsu SY, Hsieh HY, Hsieh CH. Bicycle-related hospitalizations at a Taiwanese level I Trauma Center. BMC Public Health 2015; 15:722. [PMID: 26219341 PMCID: PMC4517401 DOI: 10.1186/s12889-015-2075-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 07/20/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to investigate differences in injury severity and mortality between patients who met with bicycle or motorcycle accidents and were hospitalized at a Level I trauma center in Taiwan. METHODS We performed a retrospective analysis of bicycle-related injuries that have been reported in the Trauma Registry System in order to identify and compare 699 bicyclists to 7,300 motorcyclists who were hospitalized for treatment between January 1, 2009 and December 31, 2013. Statistical analyses of the injury severity, associated complications, and length of stay in the hospital and intensive care unit (ICU) were performed to compare the risk of injury of bicyclists to that of motorcyclists with the corresponding unadjusted odds ratios and 95 % confidence intervals (CIs). Adjusted odds ratios (AORs) and 95 % CIs for mortality were calculated by controlling for confounding variables that included age, and an Injury Severity Score (ISS) was calculated. RESULTS More of the cyclists were under 19 years of age or over 70 than were the motorcyclists. In contrast, fewer bicyclists than motorcyclists wore helmets, arrived at the emergency department between 11 p.m. and 7 a.m., and had a positive blood alcohol concentration test. The bicyclists sustained significantly higher rates of injuries to the extremities, while motorcyclists sustained significantly higher rates of injuries to the head and neck, face, and thorax. Compared to motorcyclists, the bicyclists had significantly lower ISSs and New Injury Severity Scores, shorter length hospital stays, and a smaller proportion of admittance into the ICU. However, the bicyclists had higher AORs for in-hospital mortality (AOR: 1.2, 95 % CI: 1.16-1.20). In terms of critical injury severity (ISS ≥ 25), the bicyclists had 4.4 times (95 % CI: 1.95-9.82) the odds of mortality than motorcyclists with the same ISSs. CONCLUSIONS Data analysis indicated that the bicyclists had unique injury characteristics including bodily injury patterns and lower ISSs, but had higher in-hospital mortality compared to motorcycle riders. In this study, given that only 9 % of bicyclists reported wearing helmets and considering the high mortality associated with head injury, it is possible that some bicycle riders underestimated the gravity of cycling accidents.
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Affiliation(s)
- Hang-Tsung Liu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Cheng-Shyuan Rau
- Department of Neurosurgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Chi-Cheng Liang
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Shao-Chun Wu
- Department of Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung City, Taiwan.
| | - Shiun-Yuan Hsu
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Hsiao-Yun Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
| | - Ching-Hua Hsieh
- Department of Trauma Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, No.123, Ta-Pei Road, Niao-Song District, Kaohsiung City, 833, Taiwan.
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Isolated jejunal perforation following bicycle handlebar injury in adults: a case report. Case Rep Emerg Med 2013; 2013:678678. [PMID: 23984116 PMCID: PMC3748403 DOI: 10.1155/2013/678678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2013] [Accepted: 07/18/2013] [Indexed: 11/17/2022] Open
Abstract
The small intestine is the third in frequency intraperitoneal organ which is injured after blunt trauma of the abdomen. In most of the cases, this type of injuries is accompanied by other injuries, which make it more difficult to diagnose. Failure of diagnosis and delay in treating these injuries significantly increase the morbidity and mortality of these patients. Abdominal visceral injuries after flipping the handlebar of the bike are common in children. Such injuries can cause injury to both solid and hollow abdominal viscera. Unlike children, adults' abdominal visceral injuries after flipping the bike's handlebar are extremely rare. A 25-year-old man was admitted to our department due to progressively abdominal pain after an accident with the handlebar of his bike. The subsequent CT scan after per os administration of contrast medium revealed the presence of free intraperitoneal contrast. It is a rare case of jejunal perforation after flipping the handlebar of the bicycle which was treated by partial removal of the injured part of jejunum and end-to-end anastomosis. To the best of our knowledge this is the first time we describe such an injury with this mechanism to an adult.
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Klimek PM, Lutz T, Stranzinger E, Zachariou Z, Kessler U, Berger S. Handlebar injuries in children. Pediatr Surg Int 2013; 29:269-73. [PMID: 23229342 DOI: 10.1007/s00383-012-3227-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/19/2012] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases. MATERIALS AND METHODS We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 2004 and 2011. All children were treated according to an institutional algorithm. RESULTS 40 patients with a median age of 9.5 years were included. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). Surgical interventions were performed in 8 patients. The outcome was favorable in all the cases. Overall median hospitalization duration was 4.5 days (range 1-19 days). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1-19 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1-19.5 h). 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1-46 h). CONCLUSION Handlebar injuries in children resulted in serious trunk lesions in half of the present patient series. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries.
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Affiliation(s)
- Peter Michael Klimek
- Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, 3010 Bern, Switzerland.
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Klin B, Rosenfeld-Yehoshua N, Abu-Kishk I, Efrati Y, Kozer E, Jeroukhimov I, Eshel G, Lotan G. Bicycle-related injuries in children: disturbing profile of a growing problem. Injury 2009; 40:1011-3. [PMID: 19535061 DOI: 10.1016/j.injury.2009.01.135] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 01/04/2009] [Accepted: 01/26/2009] [Indexed: 02/02/2023]
Abstract
CONTEXT We observed a changing pattern of bicycle-related injuries in children, with the focus changing from head trauma to thoracic and abdominal injuries, and a trend to increasingly severe injuries. OBJECTIVE To assess the changing injury pattern, and investigate the development of preventive measures to improve safety. DESIGN, SETTING, AND PARTICIPANTS Retrospective record review of 142 paediatric patients admitted to our Department of Paediatric Surgery between 1996 and 2005 following bicycle-related injuries. Clinical, laboratory, diagnostic, and therapeutic aspects were analysed. Additional information concerning children's bicycle-related injuries in Israel was obtained from the Gertner Institute (Israel National Center for Trauma and Emergency Medicine Research) and from Beterem (The National Center for Children's Safety & Health, the Safe Kids Israeli Chapter) National Report on Child Injuries in Israel 2006. MAIN OUTCOME MEASURES The nature and severity of injuries were reviewed, and two 5-year periods compared-from 1996 to 2000 (53 children-Group 1), and from 2001 to 2005 (89 children-Group 2). RESULTS Head trauma was more common in the Group 1 patients (52.6% vs. 45.2%), but skull fractures and intracranial haemorrhage occurred more frequently in Group 2 (28.5% vs. 16.7%; 21.3% vs. 8.3%, respectively). Injury to the stomach or duodenum, kidneys and liver were all more common in Group 2. Splenic injury occurred with equal frequency in both groups, but more severe injuries were seen in Group 2. More children in Group 2 required intensive care (31% vs. 19.3%). CONCLUSIONS There is a changing pattern of bicycle-related injuries in children, with chest and abdominal injuries dominating, and an increasing incidence of more severe injury. These findings are important in decision-making regarding preventive measures.
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Affiliation(s)
- B Klin
- Department of Pediatric Surgery, Assaf Harofeh Medical Center, Zerifin, Israel (affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel)
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10
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A hidden danger of childhood trauma: bicycle handlebar injuries. Surg Today 2009; 39:572-4. [PMID: 19562443 DOI: 10.1007/s00595-008-3931-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2008] [Accepted: 08/26/2008] [Indexed: 10/20/2022]
Abstract
PURPOSE To evaluate childhood bicycle handlebar injuries. METHODS We evaluated retrospectively 14 patients who presented with bicycle handlebar injuries within a 3-year period. Bicycle injuries not caused by the handlebar were excluded. RESULTS The mean age of the patients was 8.8 +/- 2 years (range, 5-12 years) and 79% were boys. The injuries comprised gastrointestinal perforation in 21%, traumatic abdominal hernia in 21%, and spleen laceration in 14%. The three children with intestinal perforation and the one with a penetrating abdominal injury underwent surgery, whereas the others were treated medically. An isolated traumatic abdominal hernia resolved spontaneously. There was no mortality. CONCLUSIONS Although bicycle handlebar injuries occur at relatively low speeds, the transfer of energy from the end of the handlebar, with a small cross-sectional area, to a small field leads to intra-abdominal injuries that are more severe than predicted. Thus, bicycle handlebar injuries should be considered as a serious intraabdominal injury until proven otherwise.
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Bohmer JH, Proust AF. Adult bicycle handlebar injury. Am J Emerg Med 2006; 24:624-5. [PMID: 16938607 DOI: 10.1016/j.ajem.2005.12.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2005] [Accepted: 12/17/2005] [Indexed: 11/17/2022] Open
Affiliation(s)
- Jeffrey H Bohmer
- Department of Emergency Medicine, Delnor Community Hospital, Geneva, IL 60134, USA
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Nadler EP, Potoka DA, Shultz BL, Morrison KE, Ford HR, Gaines BA. The High Morbidity Associated with Handlebar Injuries in Children. ACTA ACUST UNITED AC 2005; 58:1171-4. [PMID: 15995465 DOI: 10.1097/01.ta.0000170107.21534.7a] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Although injury prevention strategies for bicyclists have focused on legislation requiring helmet use to prevent head trauma, direct impact handlebar injuries account for a significant proportion of bicycle-related injuries. Little attention, however, has been paid to strategies that prevent direct impact handlebar injuries. We reviewed our experience with bicycle-related injuries and compared outcome for children who flipped over the handlebars to those for children who sustained direct impact from the handlebars. METHODS We queried our prospective trauma database for all bicycle injuries from 1998 to 2003. All patients with the descriptor "handlebar" in the subtext were selected. Patients were divided into two groups: those who flipped over the handlebars (n = 160) and those who sustained direct impact from the handlebars (n = 61). We examined age, gender, helmet use, injury severity score (ISS), Glasgow Coma Score (GCS), length of stay (LOS) and the need for operation. The Student's t test was used to compare continuous variables when the data were normally distributed and the Mann-Whitney was used when the data were skewed. Chi-square analysis or Fisher's exact test was used to compare categorical data. RESULTS There was no difference between the two groups with respect to age, gender, helmet use, ISS, and GCS. However, children who suffered from handlebar injuries were more likely to require operative intervention (19/61 versus 28/160, p = 0.04) and had a significantly longer LOS (3 days versus 1 day, p < 0.001). Children who sustained direct impact from the handlebars and required operative intervention were statistically more likely to suffer from abdominal or soft tissue injuries, while those who flipped over the handlebars were statistically more likely to suffer from facial or skeletal injuries. CONCLUSIONS Children who suffer from direct impact of the handlebars are more likely to require operative intervention and have a longer LOS than those who flip over the handlebars. While helmet utilization by bicyclists may have reduced the number of serious head injuries, direct impact from the handlebars remains a major source of bicycle-related morbidity since nearly one third of these patients required surgery. Future injury prevention strategies for bicyclists should be aimed at reducing the incidence of direct impact handlebar-related injuries.
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Affiliation(s)
- Evan P Nadler
- Division of Pediatric Surgery, New York University School of Medicine, New York, NY 10016, USA.
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Abstract
Through insights into the molecular genetics of neuroendocrine tumors (NETs), the genes predisposing to multiple endocrine neoplasia (MEN) syndromes were identified. In MEN1, tumors occur in the parathyroids, endocrine pancreas, anterior pituitary, adrenal glands and thymic neuroendocrine tissues. The MEN1 gene encodes a putative growth-suppressor protein, menin, binding JunD, a transcriptional factor belonging to the AP-1 complex. However, new partners binding menin remain to be found. The MEN1 gene might be involved in 1-50% of sporadic NETs. Another critical mechanism involved in NETs is the deregulation of the RET-signalling pathways by oncogenic point mutations responsible for MEN2 syndromes. MEN2 refers to the inherited forms of medullary thyroid carcinoma. The RET proto-oncogene, a tyrosine-kinase receptor, is activated by missense mutations occurring either in the extracellular dimerization domain or intracellular tyrosine kinase catalytic regions. In both cases the receptor is constitutionally activated in the absence of natural ligands. Endocrine tumors also belong to the clinical pattern of Recklinghausen (NF1) and von Hippel-Lindau (VHL) diseases. The genes for both syndromes have been characterized and provide new pathways for endocrine tumorigenesis related to G-protein physiology (NF1) and transcriptional regulation and/or endothelial cell proliferation (VHL), respectively. Here, we propose a basic overview of recent data on genetic events leading a normal endocrine cell towards a fully malignant phenotype.
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Affiliation(s)
- A Calender
- Department of Genetics and Cancer, Hôpital Edouard-Herriot, Lyon, France.
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