Bicycle injury pattern among children in rural India.

205 children treated with bicycle injuries during the four year period 1979-1982 at General Hospital, Sangli, in rural Western Maharashtra were reviewed. Amputation of the right toe was the most common injury comprising 74% of all the injuries. This occurred in children carried as passengers on the rear carrier of the bicycle, who hang their legs on either side of the spoke wheel. The right big toe of the passenger is then trapped by the chain above, the spokes at the extreme inner end, horizontal fork below and the free wheel posteriorly. Peddling of the bicycle in a reverse direction followed by forward propulsion results in amputation of the toe by the rotating teeth of the free wheel. In 122 cases amputation was through the proximal phalanx, in 28 cases through the distal phalanx and in 2 cases at the level of the metatarso phalangeal joint. A disarticulation through the proximal joint was performed in these cases. A four year follow up showed no residual disability.