title: Epidemiology and patterns of musculoskeletal motorcycle injuries in the USA.
abstract: BACKGROUND
  Motorcycles have become an increasingly popular mode of transportation despite their association with a greater risk for injury compared with automobiles. Whereas the recent incidence of annual passenger vehicle fatalities in the United States of America (USA) has progressively declined, motorcycle fatalities have steadily increased in the past 11 years. Although motorcycle injuries (MIs) have been studied, to the author's knowledge there are no published reports on MIs in the USA during this 11-year period. Methods : Study data were derived from a prospectively collected Level I trauma center database. Data sampling included motorcycle crash injury evaluations for the 10-year period ending on 31 August 2008. This retrospective analysis included patient demographic and medical data, helmet use, Glasgow coma scale (GCS) score, injury severity score (ISS), length of hospital stay (LOS), specific injury diagnosis, and death. Data statistics were analyzed using the Spearman correlation coefficient, Kruskal-Wallis tests, and logistic regression.
  
  
  RESULTS
  The study identified 1252 motorcycle crash injuries. Helmets were worn by 40.7% of patients for which helmet data were available. The rates of the most common orthopedic injuries were tibia/fibula (19.01%), spine (16.21%), and forearm (10.14%) fractures. The most common non-orthopedic motorcycle crash injuries were concussions (21.09%), skull fractures (8.23%), face fractures (13.66%), and hemo- and pneumothorax (8.79%). There was a significant correlation between greater age and higher ISS (r=0.21, P<0.0001) and longer LOS (r=0.22, P<0.0001). Older patients were also less likely to wear a helmet (OR=0.99, 95% CI: 0.98, 0.997), associated with a significantly higher risk for death (after adjustment for helmet use OR=1.03, 95% CI: 1.00, 1.05). All patients without helmets had a significantly lower GCS score (P=0.0001) and a higher mortality rate (after adjustment for patient demographic data OR=2.28, 95% CI: 1.13, 4.58).  Conclusion : Compared with historical reports, the prevalence of skull, face, spine, and pelvis fractures have increased in American motorcycle crashes. Compared to recent European studies, the incidence of USA skull and face fractures is much higher, while the incidence of USA spine and pelvis fractures is more comparable; however, this is not associated with increased in-hospital mortality.
authors: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, TX 77555, USA.
authors: Sean T
authors: ST
authors: Burns
authors: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, TX 77555, USA.
authors: Zbigniew
authors: Z
authors: Gugala
authors: Department of Surgery, The University of Texas Medical Branch, Galveston, TX, TX 77555, USA.
authors: Carlos J
authors: CJ
authors: Jimenez
authors: Department of Surgery, The University of Texas Medical Branch, Galveston, TX, TX 77555, USA.
authors: William J
authors: WJ
authors: Mileski
authors: Department of Orthopaedic Surgery and Rehabilitation, The University of Texas Medical Branch, Galveston, TX, TX 77555, USA.
authors: Ronald W
authors: RW
authors: Lindsey
keywords: epidemiology; fractures; musculoskeletal motorcycle injuries