Plain radiography in children with spoke wheel injury: A retrospective cohort study.
OBJECTIVE
Bicycle spoke injury (BSI) mostly occurs in children as a result of entrapment of the leg in the bicycle spokes. No guideline or protocol exists that defines what type of radiography is indicated to diagnose or rule out a fracture commonly associated with these injuries. The aim of this study was (1) to evaluate the type of radiographs that are obtained in children with BSI, (2) to assess in which anatomical regions fractures occur and (3) to evaluate on which radiographs a fracture can be detected in children with BSI.


METHODS
A retrospective cohort study was performed in paediatric patients presenting at the Emergency Department (ED) of a university hospital with a paediatric surgery department between June 2008 and December 2013.


RESULTS
In 99 of the 320 children (31.4%) evaluated with radiography following BSI a fracture was diagnosed. In almost two third of the patients (63%) radiographic imaging of two or more anatomical regions was performed. In 98 children (99%) the fracture was located at the distal tibia or fibula. All fractures were diagnosed on a radiograph of the ankle or lower leg (including the ankle region). No fractures of the foot were diagnosed.


CONCLUSIONS
We suggest that in children with a clinical suspicion of a fracture at the ankle region, in which no fracture is seen at the radiograph of the ankle, no additional radiographs are necessary.
Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: a.slaar@amc.nl.
Annelie
A
Slaar
Emergency Department, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: i.h.karsten@amc.nl.
Ingrid H C M
IH
Karsten
Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: l.f.beenen@amc.nl.
Ludo F M
LF
Beenen
Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: m.maas@amc.nl.
Mario
M
Maas
Department of Paediatric Surgery, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: r.bakx@amc.nl.
Roel
R
Bakx
Department of Radiology, Academic Medical Centre, University of Amsterdam, The Netherlands. Electronic address: r.r.vanrijn@amc.nl.
Rick R
RR
van Rijn
Trauma Unit, Department of Surgery, Maasstad Ziekenhuis, Rotterdam, The Netherlands. Electronic address: schepn@maasstandziekenhuis.nl.
Niels W L
NW
Schep
D000293:Adolescent; D016512:Ankle Injuries / Q000000981:diagnostic imaging*; D000843:Ankle Joint / Q000000981:diagnostic imaging; D001642:Bicycling / Q000293:injuries* / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D050723:Fractures, Bone / Q000000981:diagnostic imaging*; D006801:Humans; D007223:Infant; D008297:Male; D011859:Radiography; D012189:Retrospective Studies; D013977:Tibia / Q000000981:diagnostic imaging
Ankle injury; Conventional imaging; Emergency care; Pediatric radiology; Spoke wheel injury