title: Pediatric Orthopaedic Trauma and Associated Injuries of Snowmobile, ATV, and Dirtbike Accidents: A 19-Year Experience at a Level 1 Pediatric Trauma Center.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the type and severity of orthopaedic and associated injuries for snowmobile, All-terrain vehicles (ATV) and motorized dirtbike accidents in a pediatric patient population.
  
  
  METHODS
  A total of 758 patients who presented following either snowmobile (n=87), ATV-related (n=308) or dirtbike (n=363)-related trauma at our institution between 1996 and 2015 were retrospectively reviewed.
  
  
  RESULTS
  A total of 441 axial and appendicular fractures occurred requiring 533 procedures. Snowmobile and dirtbike accidents were associated with a higher rate of fractures (63%, 64%) than the ATV group (50%) (P=0.0008). Snowmobile injuries had the highest rate of spinal (23%) and lower extremity fractures (53%) (P=0.0004). Snowmobile and dirtbike cohorts had higher rate of femur fractures (22%, 17%, P=0.001) whereas the ATV cohort had higher rates of upper extremity (18%), hand (11%), scapula (4.6%), and open fractures (28.6%) (P<0.01). Head trauma was the most commonly associated injury in 275 patients with the highest rate in the ATV group (44%) who also had the highest rate of no helmet use (76%). Snowmobile and ATV patients had higher Injury Severity Score (11.3, 9.6) than dirtbike patients (7.8) (P=0.001). ATV patients were found to be younger (11.8 y) compared with snowmobile (13.2 y) and dirtbike (13.5 y) (P<0.01).
  
  
  CONCLUSIONS
  Pediatric snowmobile, ATV and dirtbike accidents result in severe orthopaedic and associated injuries with each vehicle demonstrating significantly different injury patterns. Injury prevention should focus on improved safety mechanisms, protective gear, safe areas for off-road vehicle use and strict laws with minimum age requirements LEVEL OF EVIDENCE:: Level IV.
authors.affiliation: Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Shannon
authors.forename: Nicholas M
authors.initials: NM
authors.lastname: Hernandez
authors.forename: Stephen A
authors.initials: SA
authors.lastname: Sems
authors.forename: Annalise N
authors.initials: AN
authors.lastname: Larson
authors.forename: Todd A
authors.initials: TA
authors.lastname: Milbrandt
mesh_terms: D000059:Accidents / Q000706:statistics & numerical data*; D000293:Adolescent; D017677:Age Distribution; D001642:Bicycling / Q000293:injuries; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000453:epidemiology*; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology* / Q000601:surgery; D006801:Humans; D015601:Injury Severity Score; D035002:Lower Extremity / Q000293:injuries; D008297:Male; D015541:Off-Road Motor Vehicles / Q000706:statistics & numerical data*; D019637:Orthopedic Procedures / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014193:Trauma Centers / Q000706:statistics & numerical data; D034941:Upper Extremity / Q000293:injuries