title: Handlebar injuries in children.
abstract: BACKGROUND
  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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Pediatric Surgery, Inselspital, University Hospital and University of Bern, 3010 Bern, Switzerland. peter.klimek@insel.ch
authors.forename: Peter Michael
authors.initials: PM
authors.lastname: Klimek
authors.forename: Thomas
authors.initials: T
authors.lastname: Lutz
authors.forename: Enno
authors.initials: E
authors.lastname: Stranzinger
authors.forename: Zacharias
authors.initials: Z
authors.lastname: Zachariou
authors.forename: Ulf
authors.initials: U
authors.lastname: Kessler
authors.forename: Steffen
authors.initials: S
authors.lastname: Berger
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000628:therapy*; D000293:Adolescent; D000465:Algorithms; D001642:Bicycling / Q000293:injuries*; D002648:Child; D002675:Child, Preschool; D003288:Contusions / Q000628:therapy; D005260:Female; D005383:Finger Injuries / Q000601:surgery; D006406:Hematoma / Q000628:therapy; D006547:Hernia / Q000628:therapy; D046449:Hernia, Abdominal / Q000601:surgery; D006801:Humans; D007416:Intestinal Perforation / Q000601:surgery; D007668:Kidney / Q000293:injuries; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000293:injuries; D008297:Male; D010179:Pancreas / Q000293:injuries / Q000601:surgery; D012189:Retrospective Studies; D012421:Rupture / Q000628:therapy; D013154:Spleen / Q000293:injuries; D035441:Thoracic Wall; D061665:Time-to-Treatment / Q000706:statistics & numerical data; D001743:Urinary Bladder / Q000293:injuries; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000628:therapy*