To the Editor: In bicycle accidents, direct impact with the bicycle handlebar can cause serious abdominal injuries. These injuries occur not only in high-speed collisions, where the rider is thrown from the bicycle, but also in low-speed crashes, where the bicycle handlebar strikes the rider in the abdomen or pelvic region.1

We retrospectively reviewed all children who presented to Princess Margaret Hospital for Children with abdominal bicycle handlebar injuries from January 2002 to July 2007. The patients were identified from the emergency department trauma database; 60 boys and 10 girls were identified, aged 5–15 years.

Significant injuries (defined as injuries to the liver, spleen, kidney, pancreas, small bowel, stomach or urinary bladder) were noted in 25 of the 70 patients (36%), and 15 of the 70 patients (21%) required surgery. Twenty-one patients (30%) had handlebar imprints on the abdomen (Box, A), and 17 of them (81%) had significant injuries. Traumatic abdominal wall hernia (TAWH) was present in three patients (Box, B).

The odds of a significant injury were 21.8 times higher (95% CI, 5.8–82.1) for patients with handlebar imprints than for those with no handlebar imprints. Computed tomography (CT) was the main method of diagnosis of significant injury, and there was a statistically significant association between handlebar imprints and a positive CT scan result, defined as evidence of a solid or hollow viscus injury (2-sided Fisher’s exact test, P = 0.01). Of those patients who underwent CT scanning, 89% of those with handlebar imprints (16/18) had a positive CT scan, compared with 36% of those with no handlebar imprints (4/11). The odds of a positive CT scan were 14 times higher (95% CI, 2.1–95.1) for patients with handlebar imprints than for those with no handlebar imprints.

Similar rates of significant injury resulting from impact with handlebars have been reported previously.2 TAWH was first described in 1906,3 and 31 cases of handlebar-related TAWH in children have been reported to date, excluding our cases.4,5 TAWH is produced by sudden application of blunt force to the abdomen that does not penetrate the skin, but is strong enough to disrupt muscle and fascia. Surgical repair is usually required to prevent complications.5

Children with handlebar imprints should be observed closely, and assessed by CT scan and treated surgically as indicated. They should be encouraged to use protective gear, such as handlebar padding, helmets and protective clothing, when riding bicycles.

Injuries caused by bicycle handlebars in children

A: Handlebar imprint on abdomen.

B: Traumatic abdominal wall hernia, caused by handlebar injury, with omentum protruding through the defect.