Plain radiography in children with spoke wheel injury: A retrospective cohort study

• In 31.4% patients with bicycle spoke injury (BSI) a fracture was diagnosed.
• In 99% of the patients with a fracture, the fracture was located at the ankle.
• No fractures of the foot were diagnosed.
• In BSI radiography of the ankle is sufficient in detecting or ruling out a fracture.

Background and purposeBicycle spoke injury (BSI) mostly occurs in children as a result of entrapment of the leg in the bicycle spokes. No guideline or protocol exists that defines what type of radiography is indicated to diagnose or rule out a fracture commonly associated with these injuries. The aim of this study was (1) to evaluate the type of radiographs that are obtained in children with BSI, (2) to assess in which anatomical regions fractures occur and (3) to evaluate on which radiographs a fracture can be detected in children with BSI.Patients and methodsA retrospective cohort study was performed in paediatric patients presenting at the Emergency Department (ED) of a university hospital with a paediatric surgery department between June 2008 and December 2013.ResultsIn 99 of the 320 children (31.4%) evaluated with radiography following BSI a fracture was diagnosed. In almost two third of the patients (63%) radiographic imaging of two or more anatomical regions was performed. In 98 children (99%) the fracture was located at the distal tibia or fibula. All fractures were diagnosed on a radiograph of the ankle or lower leg (including the ankle region). No fractures of the foot were diagnosed.ConclusionWe suggest that in children with a clinical suspicion of a fracture at the ankle region, in which no fracture is seen at the radiograph of the ankle, no additional radiographs are necessary.