title: Complex shoulder girdle injuries following mountain bike accidents and a review of the literature.
abstract: BACKGROUND
  Mountain and road bike accidents are particularly common with the increased popularity of the sport. We reviewed the attendances in our emergency department over a 4-year period looking at cycling injuries to detect the level and grade of these injuries and their outcomes.
  
  
  METHODS
  Royal Blackburn Hospital caters for a population of 550 000. A search through the Hospital information system revealed 104 patients with fractures following mountain bike injuries. These were looked at in more detail. We present a series of 5 severe shoulder girdle injuries following mountain bike accidents in this cohort, to highlight the serious level of injury sustained in this sport. We searched MEDLINE and EMBASE databases over the past 10 years using the keywords, mountain, biking and fracture. This yielded 7 papers. We compared our series with the literature.
  
  
  RESULTS
  104 fractures following mountain bike accidents between 2008 and 2011. Fractures of the upper limb were the most common (88.5%) with the clavicle being the most commonly fractured bone (28.8%).
  
  
  CONCLUSIONS
  Major scapular injuries with destruction or disruption of the four bar linkage of the shoulder girdle are very common following mountain accidents. Clavicular fractures are the commonest upper limb injury. It is easy to miss a disruption to the four-bar linkage associated with a clavicular injury. This paper highlights the severity of the injuries sustained in mountain bike accidents of the upper limb and requirement of adequate protection in this exhilarating sport.
authors.affiliation: Orthopaedic Department , Royal Blackburn Hospital , Blackburn , UK.
authors.forename: Matthew Alexander
authors.initials: MA
authors.lastname: Lea
authors.affiliation: Orthopaedic Department , NHS Tayside , Dundee , UK.
authors.forename: Navnit
authors.initials: N
authors.lastname: Makaram
authors.affiliation: Orthopaedic Department , Royal Blackburn Hospital , Blackburn , UK.
authors.forename: Makaram S
authors.initials: MS
authors.lastname: Srinivasan
keywords: Mountain biking; Shoulder; Trauma