Flyer Zoe, Schomberg John, Giron Andreina, Goodman Laura F
Division of Pediatric Surgery, Children's Hospital of Orange County, Orange, CA, United States.
CHOC Research Institute, Children's Hospital of Orange County, Orange, CA, United States.
Trauma Case Rep. 2025 Apr 16;57:101163. doi: 10.1016/j.tcr.2025.101163. eCollection 2025 May.
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.
自行车是儿童最常见的交通和娱乐工具之一，也是导致儿童创伤的重要因素。车把仍然是造成伤害的最常见自行车部件，不过大多数是钝器伤。关于儿童自行车穿刺伤或车把穿透性损伤的研究很少。本研究的目的是概述这些罕见损伤的评估、治疗及相关结果。
我们回顾了4年间在我们儿科创伤中心收治的8例儿童车把穿透伤病例。在同一时间段内，我们儿科创伤中心共治疗了2506例与自行车相关的创伤患者。研究前已按照方案获得机构审查委员会（IRB）的批准。所有8例车把穿透伤病例均继发于被自行车车把的手刹部分刺伤。我们回顾了患者的年龄、性别、免疫接种状况、影像学检查、手术干预类型、所用药物以及随访结果。
所回顾的8例病例均为男性患者，中位年龄9岁。6例患者下肢有穿透伤，2例患者腹部受伤。所有8例患者免疫接种均在有效期内，就诊时均接受了一剂静脉抗生素治疗。根据患者的临床表现进行了X线平片和CT检查，手术干预类型最终取决于医生。所有8例患者均口服抗生素出院，随访时均愈合良好，无感染迹象。
虽然罕见，但及时识别、评估和治疗儿童车把穿透伤对于改善临床结果至关重要。立即评估包括患者的免疫接种状况，必要时决定是否进行影像学检查和手术干预。在完全取出异物的情况下，术后预防性使用抗生素并非必需。可进一步回顾更多的车把穿透伤病例，以进一步明确针对该人群的最佳治疗方案
