gms | German Medical Science

Objectives: Two-wheeled vehicles such as electric bicycles (e-bikes), conventional bicycles and motorcycles are popular means of transport in all age groups, with e-bikes having gained enormous popularity in recent years. With the increasing popularity of e-bikes, accident statistics have shown that e-bikes are also increasingly involved in traffic accidents. A recent study by our study group showed that the injury pattern of e-bike accidents is more similar to bicycle accidents than motorcycle accidents. The aim of the present study was to assess differences in severity and localization of injuries to the lower extremity after accidents with the aforementioned two-wheeled vehicles.

Methods: A retrospective cohort-analysis of patients who sustained traumatic accidents with two-wheeled vehicles transferred to a level 1 trauma center in Switzerland was performed. We assessed patient demographics, injury pattern, and trauma severity (ISS), with subgroup analysis of outcomes stratified by vehicle.

Results and conclusion: In total, 624 patients (71% male) with injuries to the lower extremity after bicycle (n=279), electric bike (n=19) and motorcycle (n=326) accident were included. The mean age of all assessed patients was 42.4 years (SD 15.8) with a significantly higher age in the e-bike cohort (p=0.0001). High-velocity injuries (e.g., femur shaft and C-fractures according to the AO-classification) were found significantly more often in the motorcycle and e-bike group. Open fractures according to the Gustilo-Anderson-Classification, and especially Type 3 open fractures, were most often found in the motorcycle group (p=0.001). The majority of patients (77.7%) had injuries to both the lower extremities and upper body. The mean ISS across all patients was 16.0 (SD 10.6). The motorcycle group had a significantly higher mean ISS (17.6) than the other groups (p=0.0001). Male patients showed a significantly higher mean ISS (16.6, SD 10.9) than their female counterparts (13.1, SD 9.0) (p=0.004). Motorcyclists showed significantly more complete dislocations of the ankle joint-foot-complex than the other vehicle groups (p=0.0001) and bicyclists showed more contusions than their counterparts (p=0.001).

E-bike accidents produce a different injury profile to the lower extremity compared to motorcycle or bicycle accidents. Higher age, higher velocity and different protective equipment seem to have an impact on these fracture patterns.