Paediatric off-road vehicle injury in rural and regional Australia.

OBJECTIVE: Off-road riding of quad bikes and motorcycles is common among children across rural and remote Australia, but is a significant source of injury and hospitalisation. An in-depth analysis of paediatric off-road vehicle crashes was undertaken to inform injury prevention countermeasures by characterising injury patterns and sources of injury. DESIGN: This is a prospective in-depth case series. PARTICIPANTS: Participants are children aged 16 and under who have been hospitalised due to injury sustained from the use of an off-road motorcycle or quad bike in New South Wales, Australia. INTERVENTIONS: Crash investigation techniques (medical data, structured interview, vehicle and crash site inspection) were used to ascertain details of the crash event, protective gear, injury information and contributory factors. RESULTS: Thirty children were recruited, 27 boys and 3 girls, ranging in age from 4 to 16 years, having crashed on off-road motorcycles (n = 27) or quads (n = 3). Most (73.3%) were participating in unstructured social riding. A total of 67 separate injuries were observed, with overall Injury Severity Scores between 1 and 35. There were high rates of wearing helmets and motorcycle-specific garments. The most commonly injured areas were the upper and lower extremities. The most common sources of injury were from impacting the ground, obstacles/other riders or the vehicle. CONCLUSION: This study demonstrates the patterns of riding and injury in rural paediatric off-road vehicle riders, occurring despite high rates of helmet/protective gear use. This underscores the need for investigation into the injury mitigation and fit properties of protective gear and the inherent risks for physically and developmentally maturing children.

An Epidemiological Study of Foot and Ankle Motocross Motorcycling Injuries in the United Kingdom.

BACKGROUND: Motocross is a recreational and competitive sport involving motorcycle racing on off-road circuits. Participants have enjoyed their sport worldwide for over 100 years. In the United Kingdom, there are over 200 clubs, with over 900 events annually. Unfortunately, little evidence exists on motocross injuries and their prevention. The aim of this study is to report and to quantify the different foot and ankle injuries observed in motocross. METHODS: Data was collected prospectively between August 2010 to August 2015 at our regional trauma unit, regardless of whether the sport was performed competitively or recreationally. RESULTS: Foot and ankle related injuries were identified in 210 patients (age range 4-78 years), with the majority being male participants (189, 90%). The majority of injuries occurred within the 21- to 30-year-old-age group. Most injuries were sustained around the start of the motocross season, in early spring and the summer months. A total of 76 patients (36%) required operative intervention. The most common injury was ankle fracture (49, 23%), followed by ankle sprain (44, 21%). CONCLUSION: This is the first epidemiological study in the United Kingdom documenting foot and ankle injuries in motocross. The frequency and severity of motocross-related injuries is presented. This may serve to provide recommendations and guidelines in the governing bodies of this sport. The surge in motocross popularity is correlates with an increase in injuries and inevitably the resources required to treat them. LEVEL OF EVIDENCE: Prospective descriptive epidemiological study. Level 1.

Comparison of baseline ImPACT performance in amateur motocross riders to football and basketball athletes.

PRIMARY OBJECTIVE: The American Motorcyclist Association requires professional riders to undergo baseline computerized neurocognitive testing (CNT) using the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) test for concussion management. It is recommended this practice be expanded to the amateur level, but limited research has explored whether baseline testing is necessary for youth when normative data is available. This study evaluates the utility of baseline testing for amateur riders by comparing their performance to those of traditional youth sports comprising normative datasets. DESIGN/METHODS: An cross-sectional study comparing amateur motocross (N = 100) riders matched by age and sex to football (N = 100) and basketball (N = 100) athletes performance on baseline ImPACT testing. RESULTS: ANCOVAs revealed a significant medium effect of group on measures of visual motor speed (F = 11.25, p < 0.001) and reaction time (F = 13.61, p < 0.001). Post hoc analyses revealed that motocross riders were significantly slower compared to football and basketball athletes. There were no significant differences (p > .05) between sport on measures of memory or symptoms. CONCLUSIONS: Youth motocross riders performed significantly slower on speed measures compared to football and basketball athletes, providing preliminary support for the expansion of baseline ImPACT testing to the amateur level.

Pediatric and adolescent injury in motocross.

Motocross is a competitive outdoor extreme sport in which motorcyclists race across vast courses of jumps, berms and long straightaways of unpredictable terrain. While the sport has gained notoriety in adult popular culture through contests like the X Games, motocross is also increasingly popular among youth in the Unites States and beyond. In the setting of contemporary discussions on traumatic brain injury, this poses an obvious challenge to those advising children and parents on the risks of motocross to the developing brain and spine. The available literature demonstrates that even when practiced with appropriate protective equipment, motocross poses an increased risk for acquiring major trauma to the brain, spine and limbs for which the long-term consequences have been poorly studied. Riders and parents should be counseled about the risks of these injuries prior to participation and in accordance with state laws. Furthermore, formal return-to-play guidelines following concussions should be developed.

Motocross-associated head and spine injuries in adult patients evaluated in an emergency department.

BACKGROUND: Motor vehicle-related injuries (including off-road) are the leading cause of traumatic brain injury (TBI) and acute traumatic spinal cord injury in the United States. OBJECTIVES: To describe motocross-related head and spine injuries of adult patients presenting to an academic emergency department (ED). METHODS: We performed an observational cohort study of adult ED patients evaluated for motocross-related injuries from 2010 through 2015. Electronic health records were reviewed and data extracted using a standardized review process. RESULTS: A total of 145 motocross-related ED visits (143 unique patients) were included. Overall, 95.2% of patients were men with a median age of 25years. Sixty-seven visits (46.2%) were associated with head or spine injuries. Forty-three visits (29.7%) were associated with head injuries, and 46 (31.7%) were associated with spine injuries. Among the 43 head injuries, 36 (83.7%) were concussions. Seven visits (16.3%) were associated with at least 1 head abnormality identified by computed tomography, including skull fracture (n=2), subdural hematoma (n=1), subarachnoid hemorrhage (n=4), intraparenchymal hemorrhage (n=3), and diffuse axonal injury (n=3). Among the 46 spine injuries, 32 (69.6%) were acute spinal fractures. Seven patients (4.9%) had clinically significant and persistent neurologic injuries. One patient (0.7%) died, and 3 patients had severe TBIs. CONCLUSION: Adult patients evaluated in the ED after motocross trauma had high rates of head and spine injuries with considerable morbidity and mortality. Almost half had head or spine injuries (or both), with permanent impairment for nearly 5% and death for 0.7%.

Effect of cadence selection on peak power and time of power production in elite BMX riders: A laboratory based study.

The aims of this study were to analyse the optimal cadence for peak power production and time to peak power in bicycle motocross (BMX) riders. Six male elite BMX riders volunteered for the study. Each rider completed 3 maximal sprints at a cadence of 80, 100, 120 and 140 revs · min-1 on a laboratory Schoberer Rad Messtechnik (SRM) cycle ergometer in isokinetic mode. The riders' mean values for peak power and time of power production in all 3 tests were recorded. The BMX riders produced peak power (1105 ± 139 W) at 100 revs · min-1 with lower peak power produced at 80 revs · min-1 (1060 ± 69 W, (F(2,15) = 3.162; P = .266; η2 = 0.960), 120 revs · min-1 (1077 ± 141 W, (F(2,15) = 4.348; P = .203; η2 = 0.970) and 140 revs · min-1 (1046 ± 175 W, (F(2,15) = 12.350; P = 0.077; η2 = 0.989). The shortest time to power production was attained at 120 revs · min-1 in 2.5 ± 1.07 s. Whilst a cadence of 80 revs · min-1 (3.5 ± 0.8 s, (F(2,15) = 2.667; P = .284; η2 = 0.800) 100 revs · min-1 (3.00 ± 1.13 s, (F(2,15) = 24.832; P = .039; η2 = 0.974) and 140 revs · min-1 (3.50 ± 0.88 s, (F(2,15) = 44.167; P = .006; η2 = 0.967)) all recorded a longer time to peak power production. The results indicate that the optimal cadence for producing peak power output and reducing the time to peak power output are attained at comparatively low cadences for sprint cycling events. These findings could potentially inform strength and conditioning training to maximise dynamic force production and enable coaches to select optimal gear ratios.

Oral lacerations during motocross: A case report.

Motocross is a high-risk sport that can cause serious injuries including oral injuries. However, mouthguard use is not mandatory in motocross. This report describes a case of an oral laceration with exposure of bilateral inferior alveolar nerves as a result of a motocross accident in which the patient was not wearing a mouthguard.

A Distal Femoral Salter-Harris IV Fracture Secondary to a Motocross Accident: A Case Report.

High-grade physeal fractures, such as Salter-Harris types III, IV, and V fractures, are rare pediatric injuries observed disproportionately in teenage males. Such fractures are at high risk for complications such as growth retardation and arrest, arthrofibrosis, and post-traumatic arthritis. Consultation with the orthopedic specialist is imperative to ensure appropriate imaging, management, and potential transfer to a pediatric specialty hospital. The authors present a case of a 15-year-old male who sustained a Salter-Harris IV fracture of the distal femur extending from the intercondylar notch to the metadiaphysis from a motocross accident.

The Perils of Riding Motocross: A Summary of this Extensive, Prospective Study.

Background: Motocross is a high-risk form of motorbiking where serious injuries occur regularly, although little data have been collected to illustrate this relationship. Over 5 years, teams from RJAH Oswestry and RSH sought to demonstrate the impact of Motocross on orthopaedic presentation and workload. Method: Data were collected prospectively over 5 years including 615 orthopaedic injuries associated with both recreational and competitive motocross. Results: An increase in injury and operation frequency was observed, young males were identified as the highest risk participant. This was evident over winter and weekends, during the competitive racing season. A variety of injuries have been implicated, some with life threatening or disabling consequences. Conclusion: Motocross has seen exponential growth in popularity with increases in injuries and operations. This implicates major impacts on finances and healthcare, especially at times of seasonal vulnerability. The authors encourage event organisers to explore the avenues of rider safety in this increasingly popular sport.

Injuries in supercross - Evaluation of trauma during a two-day international indoor motocross event.

INTRODUCTION: Supercross is characterized by fast and skillful movements, with high concentration being required on an indoor competition circuit, due to the demanding jumps and short distances to the next obstacle. The injuries can turn out to be diverse, including polytraumatization. This paper aims to evaluate the accidents and possible injuries in a single Supercross competition. To what extent is the presence of medical staff required? METHODS: During the 17th International Supercross Event in Chemnitz, 93 participants started in 5 classes. Severe injuries were treated at the track, through the emergency department and hospital stay to their discharge. RESULTS: Overall 5 participants (4.65%) had to be admitted to the clinic. CONCLUSION: Injuries from risky jumps at relatively high speed can range from minor contusions to fractures and serious injuries. The permanent readiness of medical staff and emergency doctors at the site is therefore justified and required. The variety of injuries in a Supercross event can affect the head and face, the upper- and lower extremities, thoracal- and abdominal traumas and especially the spine. In addition, a special training concept in terms of preventive measures to prevent falls would be desirable.

The epidemiology of paediatric off-road motorcycle trauma attended by emergency medical services in Victoria, Australia.

BACKGROUND: Paediatric participation in competitive and recreational off-road motorcycle sports is increasing in popularity worldwide, however injuries frequently occur and the sport is associated with significant morbidity. OBJECTIVE: This study describes the profile of paediatric off-road motorcycle trauma attended by emergency medical services (EMS) in Victoria, Australia. METHODS: A retrospective review included paediatric (<16 years) competitive and recreational off-road motorcycle patients attended by EMS between 2010 and 2017 in the State of Victoria, Australia. Patient characteristics and injuries sustained were described using descriptive statistics. Predictors of EMS transport were identified using multivariable logistic regression analyses. RESULTS: There were 1,479 paediatric motocross patients attended by EMS between 2010 and 2017. This represents 1.6% of the total state-wide EMS paediatric trauma (<16 years) workload, and equates to an average incidence of 22.2 per 100,000 population. The median age of patients was 13 years (IQR: 10-14) and 89.5% were male. The most common final diagnoses recorded by paramedics were 'fractures' (25.5%, n = 377) and 'unspecified pain' (19.5%, n = 289). Administration of analgesia (76.3%) was the most common EMS management, followed by spinal immobilisation (54.7%) and splinting (33.4%). The vast majority (91.5%) of patients were transported to hospital by EMS. Following admission, 38 (2.6%) patients were confirmed to have sustained major trauma, 78.9% of which had been transported direct from scene to a major trauma centre for definitive care. Median ISS for confirmed major trauma patients was 14 (IQR: 14-22). Four (0.4%) patients received pre-hospital CPR. All four sustained injuries from recreational off-road, motorcycle activities and all four cases died, two at the scene and two in-hospital. CONCLUSION: Off-road motorcycle activities are an important cause of death and injury in Victorian children, as highlighted and demonstrated by the four deaths and high EMS transport rates borne out in this study. Riders and parents need to be aware of these risks, and organised events must have adequate on-site medical care resources.

Microhemorrhages in Professional Motocross Athletes: A Case Series.

Introduction: Motocross is a sport in which riders race 250-450 cc four-stroke dirt bikes and are potentially subjected to a high frequency of head injuries starting at a very young age. The objective of this case series is to present the findings following gradient echo T2-weighted MRI (SWI) upon clinical evaluation after a concussion in 4 young professional motocross racers. Clinical Findings: Microhemorrhages were found in 2 of 4 riders. Areas of microhemorrhages were not aligned with a previously positive CT finding from a prior concussion in 1 rider. Conclusions: Microhemorrhages were found in 2 young motocross riders following a gradient echo T2-weighted MRI upon a clinical evaluation after a concussion. Long-term consequences of these findings are not yet known, and longitudinal studies are needed to provide further understanding to improve concussion management in motocross athletes.

Spinal Motocross Injuries in the United Kingdom.

BACKGROUND: Motocross is a form of motorcycle racing held on established off-road circuits and has been a recreational and competitive sport across the world for >100 years. In the United Kingdom alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country, permitting >900 events annually. PURPOSE: To assess the current trend of spine-related motocross injuries over the past 5 years. STUDY DESIGN: Descriptive epidemiology study. METHODS: Data were prospectively collected over 5 years (August 2010-August 2015) at our regional trauma and spine unit, regardless of whether the rider was performing the sport competitively or recreationally. RESULTS: During the study period, spine-related injuries were identified for 174 patients (age range, 6-75 years) who were directly referred to our department following recreational or competitive motocross, with most injuries being sustained within the early spring and summer months, representing the start of the motocross season. A significant number of injuries were in males (n = 203, 94%), with the majority of injuries occurring within the 21- to 30-year-old age group. A total of 116 (54%) injuries required operative treatment. The most common spinal injury was thoracolumbar burst fracture (n = 95), followed by chance fractures (n = 26). CONCLUSION: This data series emphasizes the prevalence and devastation of motocross-related spinal injuries in the United Kingdom and may serve in administering sanctions and guidelines to governing bodies of motocross. The spinal injuries that occur during motocross have significant capital connotations for regional spinal centers. The recent surge in motocross popularity is correlated with the number of injuries, which have increased over the past 5 years by almost 500%.

Injuries in the competitive paediatric motocross athlete.

PURPOSE: The purpose of this study is to report the spectrum of injuries sustained by competitive paediatric motocross athletes at a level I trauma centre. PATIENTS AND METHODS: A retrospective study of paediatric competitive motocross injuries treated at a level I trauma centre between 2004 and 2014 was performed. Athletes were included if aged less than 18 years and injured while practising or competing on a competitive motocross track. Medical records were reviewed for age, gender, race, location of accident, use of safety equipment, mechanism of injury, injury type and severity, Glasgow Coma Score at hospital presentation and Injury Severity Score (ISS). RESULTS: In total, 35 athletes were studied. The average age was 14 years. One athlete died. Thirty athletes were injured during competition; five were injured during practice. Twenty-four athletes (69%) suffered an orthopaedic injury with a total of 32 fractures and two dislocations. Two fractures were open (6.3%). Lower extremity fractures were twice as common as upper extremity fractures. Surgery was more common for lower extremity fractures-83% versus 30%. The most common fractures were femoral shaft (18.8%), fibula (12.5%), clavicle (12.5%), tibial shaft (9.4%) and forearm (9.4%). CONCLUSIONS: Competitive paediatric motocross athletes suffer serious, potentially life-threatening injuries despite the required use of protective safety equipment. Femoral shaft, fibula and clavicle were found to be the most commonly fractured bones. Further prospective research into track regulations, protective equipment and course design may reduce the trauma burden in this athlete population.

Effect of gear ratio on peak power and time to peak power in BMX cyclists.

The aim of this study was to ascertain if gear ratio selection would have an effect on peak power and time to peak power production in elite Bicycle Motocross (BMX) cyclists. Eight male elite BMX riders volunteered for the study. Each rider performed three, 10-s maximal sprints on an Olympic standard indoor BMX track. The riders' bicycles were fitted with a portable SRM power meter. Each rider performed the three sprints using gear ratios of 41/16, 43/16 and 45/16 tooth. The results from the 41/16 and 45/16 gear ratios were compared to the current standard 43/16 gear ratio. Statistically, significant differences were found between the gear ratios for peak power (F(2,14) = 6.448; p = .010) and peak torque (F(2,14) = 4.777; p = .026), but no significant difference was found for time to peak power (F(2,14) = 0.200; p = .821). When comparing gear ratios, the results showed a 45/16 gear ratio elicited the highest peak power,1658 ± 221 W, compared to 1436 ± 129 W and 1380 ± 56 W, for the 43/16 and 41/16 ratios, respectively. The time to peak power showed a 41/16 tooth gear ratio attained peak power in -0.01 s and a 45/16 in 0.22 s compared to the 43/16. The findings of this study suggest that gear ratio choice has a significant effect on peak power production, though time to peak power output is not significantly affected. Therefore, selecting a higher gear ratio results in riders attaining higher power outputs without reducing their start time.

Endoscopic Fascia Release for Forearm Chronic Exertional Compartment Syndrome: Case Report and Surgical Technique.

BACKGROUND: Chronic exertional compartment syndrome (CECS) of the forearm is traditionally treated with open compartment release requiring large incisions that can result in less than optimal esthetic results. The purpose of this study is to describe a case report of 2 professional motocross patients with forearm CECS treated endoscopically using a minimally invasive technique. METHODS: Two professional motocross racers presented with a history of chronic proximal volar forearm pain when motocross riding. Other symptoms included paresthesia and weakness, which, at times, led to an inability to continue riding. Both failed conservative management. Compartment pressure measurements were performed before and after provocative exercises to confirm diagnosis of CECS. Release of both the volar and dorsal compartments was performed endoscopically through a single incision. RESULTS: Symptoms resolved after surgery. The first patient resumed riding at 1 week, competing at 3 weeks, and continues to ride competitively without symptoms at 3 years postoperative. The second patient began riding at 1 week and won second place in the National Supercross finals 5 weeks after simultaneous bilateral release. CONCLUSIONS: This technique is simple and effective. The cannula used protects the superficial nerves while allowing release through a small, cosmetically pleasing incision.

A rare case of bilateral complex wrist injury in a professional motocross rider.

We describe the treatment of a 29 year-old professional motocross rider, who sustained a perilunate dislocation in his right wrist and a distal radius fracture and dorsal dislocation of his left wrist during a race. Both wrists were treated acutely during a single operating session. Surgery consisted in open reduction, k-wire fixation and mini-anchor repair of the scapho-lunate and luno-triquetrium ligaments on the right wrist, while closed reduction and percutaneous k-wire fixation was used in the left wrist. Follow-up at 6 months has shown satisfying radiological and functional outcomes in both wrists. The rider ultimately returned to motocross 5 months following surgery.

An epidemiological study of paediatric motocross injuries in the United Kingdom.

PURPOSE: Although off-road motorcycling is one of the most popular sports activities practised by millions of people worldwide, little has been written on motocross injuries and their prevention. In the UK alone, motocross has grown into a phenomenally ambitious and popular franchise. There are >200 motocross clubs across the country holding >900 events annually. The aim of this study is to categorise and quantify the magnitude of motocross paediatric injuries and associated morbidity. METHODS: Data were collected prospectively over 4 years (2010-2014) at our unit. All injuries caused by motocross biking that were referred to our trauma and orthopaedic department were included in this study, regardless of whether the rider was performing the sport competitively or recreationally. RESULTS: During the study period, 130 patients (aged 4-17 years) were identified with a total of 142 injuries, ranging from one to six injuries per patient. Most of the injuries were sustained within the early spring and summer months, representing the start of the motocross season; 76 patients required hospital admission, with 60 (42 %) requiring surgical intervention. CONCLUSION: We present the first epidemiological study of motocross paediatric injuries in the UK. The results from this study highlight the frequency and severity of motocross-related injuries in the paediatric population in the UK. This may assist in providing recommendations and guidelines to governing bodies and to parents. The injuries sustained during motocross have significant resource implications, especially for smaller rural hospitals, as shown by the number of injuries doubling over the past 4 years.

A comparison of injuries sustained from recreational compared to organized motorized vehicle use in children.

PURPOSE: To examine the injury severity and patterns of injury for pediatric motorized recreational vehicle (MRV) drivers injured during organized events (OE) compared to recreational use (RU). METHODS: All pediatric MRV injuries between 2006 and 2012 in our institutional trauma registry were studied for mechanism of injury, initial evaluation, and treatment. Injuries with an Abbreviated Injury Scale ≥2 were categorized by body region and diagnosis. RESULTS: Out of 589 collisions, 92 (16%) occurred during an OE. Compared to RU drivers, OE drivers were more likely to wear helmets (92% vs. 40%, p<0.001) and other protective equipment (79% vs. 6%, p<0.001). There was no difference in rates of hospital admission, rates of surgical intervention, injury severity scores, rates of intensive care unit admission, or lengths of stay. There were no differences in injuries by body region or injury type, except that dislocations were more common in OE drivers (2% vs. 0%, p=0.038). CONCLUSION: Despite higher rates of helmet and protective gear use, pediatric MRV drivers participating in OEs sustain similarly severe injuries as drivers using MRVs recreationally. No differences were observed in body regions involved or outcomes. Public perception that OE use of MRV for children is safe should be addressed.

Degenerative changes in adolescent spines: a comparison of motocross racers and age-matched controls.

OBJECT: Motocross racing is a popular sport; however, its impact on the growing/developing pediatric spine is unknown. Using a retrospective cohort model, the authors compared the degree of advanced degenerative findings in young motocross racers with findings in age-matched controls. METHODS: Patients who had been treated for motocross-related injury at the authors' institution between 2000 and 2007 and had been under 18 years of age at the time of injury and had undergone plain radiographic or CT examination of any spinal region were eligible for inclusion. Imaging was reviewed in a blinded fashion by 3 physicians for degenerative findings, including endplate abnormalities, loss of vertebral body height, wedging, and malalignment. Acute pathological segments were excluded. Spine radiographs from age-matched controls were similarly reviewed and the findings were compared. RESULTS: The motocross cohort consisted of 29 riders (mean age 14.7 years; 82% male); the control cohort consisted of 45 adolescents (mean age 14.3 years; 71% male). In the cervical spine, the motocross cohort had 55 abnormalities in 203 segments (average 1.90 abnormalities/patient) compared with 20 abnormalities in 213 segments in the controls (average 0.65/patient) (p = 0.006, Student t-test). In the thoracic spine, the motocross riders had 51 abnormalities in 292 segments (average 2.04 abnormalities/patient) compared with 25 abnormalities in 299 segments in the controls (average 1.00/patient) (p = 0.045). In the lumbar spine, the motocross cohort had 11 abnormalities in 123 segments (average 0.44 abnormalities/patient) compared with 15 abnormalities in 150 segments in the controls (average 0.50/patient) (p = 0.197). CONCLUSIONS: Increased degenerative changes in the cervical and thoracic spine were identified in adolescent motocross racers compared with age-matched controls. The long-term consequences of these changes are unknown; however, athletes and parents should be counseled accordingly about participation in motocross activities.