Outcome of proximal femoral fractures caused by cycling in the young and mid-aged



      Cycling is gaining more popularity both as a sport, on and off-road and also as a means of commute. Cycling accidents harbour significant injury risks including fractures. Proximal femoral fractures are uncommonly associated with cycling in the young adult population. The purpose of this study is to describe this unique pattern of injury as well as the outcome of proximal femoral fractures caused by cycling in the young to mid age population.


      Study design: retrospective cohort study. 23 fractures in 22 patients were available for analysis. 11 were femoral neck fractures, with six displaced ones, and the rest trochanteric fractures. 21 patients were male patients, and the average age was 42 (range 27–60). All patients but two were operated within 24 h from admission. Radiographic analysis included reduction quality, fracture classification and arthritic changes. Clinical outcome was measured using SF-12 and Oxford hip scores.


      All fractures healed. Two patients with displaced femoral neck fractures developed avascular necrosis requiring arthroplasty. One patient developed an AVN 2 years after a stable trochanteric fracture but did not require an arthroplasty as of yet. Eight patients required hardware removal due to symptoms. 77% of patients had resumed cycling at the pre-injury level. Mean SF-12 score was 47.1 ± 11.7 for the physical component and 53.7 ± 6.3 for the mental component. Mean oxford hip score as was 40.1 ± 12.2. Radiographic analysis revealed good to acceptable reduction quality. Fracture type, age, cycling type and reduction were not significantly associated with outcome.


      Proximal femoral fractures caused by cycling in young to mid-aged adults are an emerging pattern of injury. Overall favourable result can be expected in the majority of cases, with displaced femoral neck fractures having a risk for AVN. Further delineation of the exact cause for this phenomenon is required with possible intervention for injury prevention.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Schepers J.P.
        • Heinen E.
        How does a modal shift from short car trips to cycling affect road safety?.
        Accid Anal Prev. 2013; 50: 1118-1127
        • Oja P.
        • Vuori I.
        • Paronen O.
        Daily walking and cycling to work: their utility as health-enhancing physical activity.
        Patient Educ Couns. 1998; 33: S87-S94
        • Rutter H.
        • Cavill N.
        • Racioppi F.
        • Dinsdale H.
        • Oja P.
        • Kahlmeier S.
        Economic impact of reduced mortality due to increased cycling.
        Am J Prev Med. 2013; 44: 89-92
        • De Bernardo N.
        • Barrios C.
        • Vera P.
        • Laiz C.
        • Hadala M.
        Incidence and risk for traumatic and overuse injuries in top-level road cyclists.
        J Sports Sci. 2012; 30: 1047-1053
        • Chow T.K.
        • Kronisch R.L.
        Mechanisms of injury in competitive off-road bicycling.
        Wilderness Environ Med. 2002; 13: 27-30
        • Kim P.T.
        • Jangra D.
        • Ritchie A.H.
        • Lower M.E.
        • Kasic S.
        • Brown D.R.
        • et al.
        Mountain biking injuries requiring trauma center admission: a 10-year regional trauma system experience.
        J Trauma. 2006; 60: 312-318
        • Greve M.W.
        • Modabber M.R.
        An epidemic of traumatic brain injury in professional cycling: a call to action.
        Clin J Sport Med. 2012; 22: 81-82
        • Amoros E.
        • Chiron M.
        • Thélot B.
        • Laumon B.
        The injury epidemiology of cyclists based on a road trauma registry.
        BMC Public Health. 2011; 11: 1-12
        • Andrew N.E.
        • Gabbe B.J.
        • Wolfe R.
        • Cameron P.A.
        Trends in sport and active recreation injuries resulting in major trauma or death in adults in Victoria, Australia, 2001–2007.
        Injury. 2012; 43: 1527-1533
        • Boeke P.S.
        • House H.R.
        • Graber M.A.
        Injury incidence and predictors on a multiday recreational bicycle tour: the Register's Annual Great Bike Ride Across Iowa, 2004 to 2008.
        Wilderness Environ Med. 2010; 21: 202-207
        • Marks R.
        • Allegrante J.P.
        • Ronald MacKenzie C.
        • Lane J.M.
        Hip fractures among the elderly: causes, consequences and control.
        Ageing Res Rev. 2003; 2: 57-93
        • Davidovitch R.I.M.J.
        • Charles J.
        • Egol M.D.
        • Kenneth A.
        • Vrahas M.D.
        • Mark S.M.D.
        Challenges in the treatment of femoral neck fractures in the nonelderly adult.
        J Trauma. 2010; 68 ([Review]): 7
        • Verettas D.A.
        • Galanis B.
        • Kazakos K.
        • Hatziyiannakis A.
        • Kotsios E.
        Fractures of the proximal part of the femur in patients under 50 years of age.
        Injury. 2002; 33: 41-45
        • Swiontkowski M.F.
        • Winquist R.A.
        • Hansen Jr., S.T.
        Fractures of the femoral neck in patients between the ages of twelve and forty-nine years.
        J Bone Joint Surg Am. 1984; 66: 837-846
        • Jenkinson C.
        • Layte R.
        Development and testing of the UK SF-12 (short form health survey).
        J Health Serv Res Policy. 1997; 2: 14-18
        • Murray D.W.
        • Fitzpatrick R.
        • Rogers K.
        • Pandit H.
        • Beard D.J.
        • Carr A.J.
        • et al.
        The use of the Oxford hip and knee scores.
        J Bone Joint Surg Br. 2007; 89-B: 1010-1014
        • Karanicolas P.J.
        • Bhandari M.
        • Walter S.D.
        • Heels-Ansdell D.
        • Sanders D.
        • Schemitsch E.
        • et al.
        Interobserver reliability of classification systems to rate the quality of femoral neck fracture reduction.
        J Orthop Trauma. 2009; 23: 408-412
        • Kellgren J.H.
        • Lawrence J.S.
        Radiological assessment of osteo-arthrosis.
        Ann Rheum Dis. 1957; 16: 494-502
        • Scheiman S.
        • Moghaddas H.S.
        • Bjornstig U.
        • Bylund P.O.
        • Saveman B.I.
        Bicycle injury events among older adults in Northern Sweden: a 10-year population based study.
        Accid Anal Prev. 2010; 42: 758-763
        • Al-Ani A.N.
        • Neander G.
        • Samuelsson B.
        • Blomfeldt R.
        • Ekstrom W.
        • Hedstrom M.
        Risk factors for osteoporosis are common in young and middle-aged patients with femoral neck fractures regardless of trauma mechanism.
        Acta Orthop. 2013; 84: 54-59
        • Yamaner F.
        • Atmaca H.
        • Bayraktaroglu T.
        • Aydin M.
        • Aydemir S.
        Gonadal function in male mountain bikers.
        J Strength Cond Res. 2011; 25: 2311-2315
        • McCoy G.F.
        • Johnstone R.A.
        • Kenwright J.
        Biomechanical aspects of pelvic and hip injuries in road traffic accidents.
        J Orthop Trauma. 1989; 3: 118-123
        • Riley P.O.
        • Arregui-Dalmases C.
        • Purtserov S.
        • Parent D.
        • Lessley D.J.
        • Shaw G.
        • et al.
        Kinematics of the unrestrained vehicle occupants in side-impact crashes.
        Traffic Inj Prev. 2012; 13: 163-171
        • Rosenkranz K.M.
        • Sheridan R.L.
        Trauma to adult bicyclists: a growing problem in the urban environment.
        Injury. 2003; 34: 825-829
        • Yan L.
        • Zhou B.
        • Prentice A.
        • Wang X.
        • Golden M.H.
        Epidemiological study of hip fracture in Shenyang, People's Republic of China.
        Bone. 1999; 24: 151-155