Handlebar injuries in children
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ORIGINAL ARTICLE
Handlebar injuries in children Peter Michael Klimek • Thomas Lutz • Enno Stranzinger • Zacharias Zachariou Ulf Kessler • Steffen Berger
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Accepted: 19 November 2012 / Published online: 11 December 2012 Ó Springer-Verlag Berlin Heidelberg 2012
Abstract Introduction Handlebar injuries in children may lead to severe organ lesions despite minimal initial signs and without visible skin bruise. We present our experiences applying a diagnostic and therapeutic algorithm for blunt abdominal trauma, and present the history of two selected cases. Materials and methods We retrospectively assessed the charts of children below 16 years of age, only who were observed for 24 h or more in our institution due to a handlebar injury between 2004 and 2011. All children were treated according to an institutional algorithm. Results 40 patients with a median age of 9.5 years were included. Diagnosed lesions were: ruptures of the liver (n = 6), spleen (n = 5), kidney (n = 1), and pancreas (n = 2), small bowel perforation (n = 3), and hernias of the abdominal (n = 2) or thoracic wall (n = 1). Surgical interventions were performed in 8 patients. The outcome was favorable in all the cases. Overall median hospitalization duration was 4.5 days (range 1–19 days). The overall duration between the accident and arrival at our emergency unit was 2.75 h (median, range 1–19 h). 20 children presented directly at our emergency unit after a median of 1.7 h (range 1–19.5 h). 20 children were referred by a family physician or a primary hospital after a median of 4.0 h (range 1–46 h). P. M. Klimek (&) T. Lutz Z. Zachariou U. Kessler S. Berger Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, 3010 Bern, Switzerland e-mail: [email protected] E. Stranzinger Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
Conclusion Handlebar injuries in children resulted in serious trunk lesions in half of the present patient series. The spectrum of injuries in handlebar accidents varies widely, especially injuries to the abdomen can unmask often only in the course. We advocate close observation of patients with thoracic and abdominal handlebar injuries which may be regarded as blunt stab wounds. An institutional algorithm for blunt abdominal trauma management is supportive for emergency care in patients with handlebar injuries. Keywords hernia
Handlebar injury Children Traumatic
Introduction Blunt abdominal trauma is one of the most frequent reasons for hospital admission following trauma in children [1]. Bicycle accidents are responsible for a significant part of trauma in children. Serious injuries mostly involve head and brain, associated with polytrauma from bicycle accidents or collisions with other vehicles. The second major injury mechanism is a direct handlebar impact resulting from lower speed crashes. In case of a direct abdominal trauma, the abdominal organs of children are at a higher risk of organ lesions when compared
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