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Serious cycling-related fractures in on and off-road accidents: A retrospective analysis in the Australian Capital Territory region

  • Hayley SM Fancourt
    Correspondence
    Corresponding author.
    Affiliations
    Medical School, College of Health and Medicine, Australian National University. Building 4, The Canberra Hospital, Hospital Road, Garran, ACT, Australia 2605
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  • Sindy Vrancic
    Affiliations
    Trauma and Orthopaedic Research Unit, Canberra Health Services. Building 6, Level 1, The Canberra Hospital, PO Box 11, Woden, ACT, Australia 2606
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  • Teresa Neeman
    Affiliations
    Biological Data Science Institute, Australian National University. 46 Sullivans Creek Rd, Acton, ACT, Australia 2601
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  • Michael Phipps
    Affiliations
    Trauma and Orthopaedic Research Unit, Canberra Health Services. Building 6, Level 1, The Canberra Hospital, PO Box 11, Woden, ACT, Australia 2606
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  • Diana M Perriman
    Affiliations
    Medical School, College of Health and Medicine, Australian National University. Building 4, The Canberra Hospital, Hospital Road, Garran, ACT, Australia 2605

    Trauma and Orthopaedic Research Unit, Canberra Health Services. Building 6, Level 1, The Canberra Hospital, PO Box 11, Woden, ACT, Australia 2606
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      Highlights

      • Cycling-related fracture hospitalisations have increased, with off-road cycling admissions nearly doubling between 2013 and 2019.
      • On- and off-road cycling fracture profiles are similar except for wrist fractures which are more common off-road.
      • Almost one-fifth of all BMX-related fractures were skull fractures.
      • Following the one-metre rule introduction, road cycling admissions involving skull, hip, pelvis, or femoral shaft fracture fell; however, this decrease has not persisted.

      Abstract

      Cycling is an increasingly popular activity which is widely supported by health advocates. In the last year, more than a third of Australians used a bike [
      • Munro C.
      National cycling participation survey.
      ]. While road cycling remains popular, participation in off-road recreational cycling, including mountain biking, bicycle moto cross (BMX) riding, and outdoor leisure cycling, is increasing and this is associated with an increase in the number and cost of cycling injuries [
      • Kreisfeld R
      • Harrison JE.
      Pedal cyclists deaths and hospitalisations, 1990-00 to 2015-16.
      ,
      • Sikic M
      • Mikocka-Walus AA
      • Gabbe BJ
      • McDermott FT
      • Cameron PA.
      Bicycling injuries and mortality in Victoria, 2001-2006.
      ,
      • Beck B
      • Cameron PA
      • Fitzgerald MC
      • Judson RT
      • Teague W
      • Lyons RA
      • Gabbe BJ.
      Road safety: serious injuries remain a major unsolved problem.
      ,
      • Andrew NE
      • Gabbe BJ
      • Wolfe R
      • Cameron PA.
      Trends in sport and active recreation injuries resulting in major trauma or death in adults in Victoria, Australia, 2001-2007.
      ]. The aim of this study was to describe and compare contemporary patterns of cycling fracture requiring hospitalisation as a function of cycling mode in the Australian Capital Territory region.
      This retrospective analysis of cycling-related-fracture hospitalisations in the ACT region described data recorded between July 2012 and December 2019. Logistic regression models were used to calculate probabilities of sustaining a fracture at different sites for each of the cycling modes (on-road, mountain, BMX, leisure, unspecified). These likelihoods were then compared against the on-road fracture profile.
      Cycling-related-fracture hospitalisations increased by 32% in the seven years analysed. Of all fracture admissions, 442 (33%) were on-road, 658 (49%) off-road, and 242 (18%) unknown. The majority were male (79%), median age 37 (IQR 16, 52). Median length of stay was two days. The number of fractures per admission ranged from one to thirteen with a median of one. Wrist, clavicle, ribs, and skull were the four most frequent fracture sites for all cycling modes. Fracture profiles of on- and off-road accidents were similar, with the exception of wrist fractures which were more likely in off-road (OR 1.96, p < 0.01) and unspecified cycling accidents (OR 5.07, p < 0.01). Skull fractures comprised 19% of all BMX-related fractures. More than half of all fracture-related admissions required surgery.
      With increasing support for sustainable and healthy transport and recreation activities, the fracture profiles of different cycling modes must first be assessed in order to inform strategies to reduce and manage this injury burden.

      Keywords

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