Stationary bike injuries prompting emergency department presentation in pediatric patients: an epidemiological study.

OBJECTIVES: Potential harms of stationary bike injuries in pediatric patients have been highlighted in the literature, but prior work is limited to case series and without population-level analysis. The purpose of this study is to examine the epidemiology of pediatric stationary bike injuries occurring in the US over the last decade using a national database. METHODS: Injuries resulting from stationary bike use in pediatric patients from 2012 to 2021 were identified using coding from the National Electronic Injury Surveillance System (NEISS) database. Patient demographics, injury characteristics, and case narratives were examined. National annual estimates of injury frequency/incidence were calculated using weighting and survey package in R. Univariate analyses were used to compare injuries among groups. RESULTS: We identified 525 stationary bike injuries representing an estimated total of 15,509 injuries in the population. Pediatric patients sustained an average of 1,551 injuries annually, with an estimated yearly increase of 288 injuries (p < 0.01) after 2019. While males sustained more injuries, there were age-dependent differences in frequency of injuries between sexes (p < 0.01). The upper extremity was the most commonly injured body region overall, but children 5 and under sustained more injuries to the head/neck. The most common overall injury type was lacerations, while fractures predominated in the 6 to 11-year-old age group. Fifty-six percent of injuries were sustained not while riding the bike, most notably among children under 12. CONCLUSION: Our findings indicate that the impact of stationary bike injury in the pediatric population is not insignificant, and most injuries are related to improper play rather than traditional exercise use. Gender and age-related patterns differed in regard to the type and mechanism of injury sustained. Children 5 and under sustain a disproportionate amount of injuries to the head, neck, and upper extremity. As stationary bikes grow in popularity, preventative measures should be considered to reduce injuries to young children.

Does Skeletal Maturity Predict the Pattern of Tibial Tubercle Avulsion Fracture?

BACKGROUND: Proximal tibial physeal development and closure is thought to relate to tibial tubercle avulsion fracture (TTAF) patterns. Prior work has yet to formally evaluate the relationship between skeletal maturity and fracture pattern.  Using 2 knee radiograph-derived skeletal maturity assessments [growth remaining percentage (GRP) and epiphyseal union stage], we examined their association with TTAF injury patterns using the Ogden and Pandya fracture classifications. We hypothesized that different TTAF injuries would occur during unique periods of skeletal development. METHODS: Pediatric patients sustaining TTAFs treated at a single institution (2008-2022) were identified using diagnostic and procedural coding. Demographics and injury characteristics were collected. Radiographs were reviewed to assign epiphyseal union stage, Ogden and Pandya classifications and for measurements to calculate GRP. Univariate analyses examined the relationship between injury subgroups, patient demographics, and skeletal maturity assessments. RESULTS: Inclusion criteria identified 173 patients with a mean age of 14.76 (SD: 1.78) and 2.95% (SD: 4.46%) of growth remaining. The majority of injuries were classified Ogden III/Pandya C. Most (54.9%) were the result of the axial loading mechanism. Ogden groups showed no significant differences across all patient characteristics studied including age and GRP. With the exception of Pandya A fractures, we did not identify a direct relationship between GRP, age, and Pandya groups. Epiphyseal union stage differed for Pandya A and D groups. CONCLUSIONS: A predictable pattern in TTAF characteristics across skeletal (GRP), epiphyseal union, or chronologic age was not identified in this study. Distal apophyseal avulsions (Ogden I/II and Pandya A/D) occurred across a broad chronologic and skeletal age range. No differences were identified in epiphyseal or posterior extension (Ogden III/IV and Pandya B/C) injuries. Although differences in age and GRP were identified among Pandya As, this is thought to be due to the degree of skeletal immaturity that is a prerequisite for differentiation from Pandya Ds. LEVEL OF EVIDENCE: Level III-retrospective cohort study.

Use of the Wattbike Cycle Ergometer for Attenuation of Bilateral Pedaling Asymmetry in Trained Cyclists.

Kell, DT and Greer, BK. Use of the Wattbike cycle ergometer for attenuation of bilateral pedaling asymmetry in trained cyclists. J Strength Cond Res 31(2): 468-473, 2017-Experienced cyclists typically pedal with a 5-20% bilateral asymmetry in regards to power output. The aim of this study was to determine if visual feedback (VF) through the Wattbike cycle ergometer is an effective tool in reducing bilateral pedaling asymmetry in trained cyclists. Twelve subjects completed three 10-minute cycling trials on the Wattbike at a power output consistent with 60% V[Combining Dot Above]O2 peak. The 3 trials consisted of a baseline (BASE) trial in which cyclists pedaled without instruction, a conscious control (CC) trial during which cyclists attempted to pedal symmetrically, and another trial in which cyclists attempted to pedal symmetrically while using VF of their bilateral power outputs (%) through the Wattbike. Although the BASE trial was always performed first, the order of the CC and VF trials was counterbalanced to minimize the influence of the order effect. For the primary analysis, the Asymmetry Index percentages (AI%s) for the 3 trials were not significantly different (p > 0.05). However, secondary analysis of subjects who had baseline AI%s within the normal, reported range showed significantly decreased AI%s during the VF trial as compared with BASE (p ≤ 0.05). These results suggest that cyclists with normal AI%s can pedal more symmetrically while using VF of their asymmetry as opposed to merely attempting conscious correction without feedback. It is currently unknown whether adopting a more bilaterally symmetrical pedaling style will improve cycling performance or decrease injury rates in cyclists.

The resolution of neuropathic hyperalgesia following motor and sensory functional recovery in sciatic axonotmetic mononeuropathies.

Nerve lesions producing extensive axonal loss can induce painful hyperalgesic states in man. The affect of axonal regeneration and end-organ reinnervation on hyperalgesia and pain is controversial. This study used two axonotmetic models, the sciatic crush injury (CI) and the sciatic chronic constrictive injury (CCI), to investigate the affects of nerve regeneration and reinnervation on hyperalgesia and presumed painful behavior in rats. The sciatic CI resulted in a transient loss of both sciatic motor function and the withdrawal response to pinch and heat in the sciatic distribution. Extensive recovery of motor function, pinch and heat response occurred over days 23-38 post-crush injury. This temporally corresponded with a plateau in the hindpaw autotomy score and a resolution of the saphenous-mediated pressure and heat hyperalgesia (adjacent neuropathic hyperalgesia; ANH) which developed over the medial dorsum of the hindpaw following the sciatic CI. In contrast, with sciatic transection and distal stump excision, no motor recovery occurs, large areas of the hindpaw remain unresponsive to heat and pinch, and the saphenous mediated ANH fails to resolve over a period of 3 months. When sciatic CI was compared to contralateral sciatic transection within the same rat, the bilateral saphenous-mediated pressure and heat thresholds were initially identical, but by 23-27 days post-crush, the crush side thresholds became hypoalgesic relative to the section side. This demonstrates an attenuation of the crush-induced ANH which temporally corresponds to the recovery of motor and sensory function. When the sciatic nerve was proximally crushed and distally transected (3 cm below the crush site), the saphenous-mediated pressure and heat threshold changes were identical (over 6 weeks of serial testing) to those produced by a contralateral sciatic transection within the same rat. This indicates that the microenvironments surrounding the regenerating axon tips did not differentially affect the development of ANH following sciatic CI or transection. The sciatic CCI resulted in a transient loss of hindpaw motor function without the loss of pinch or heat withdrawal responses in the sciatic distribution. Motor function recovery occurred primarily over days 23-59 post-ligature. During this prolonged period of motor function recovery there was a resolution of the sciatic-mediated plantar surface heat hyperalgesia and the saphenous-mediated heat ANH. The above data support the hypothesis that the successful regeneration of distal axons after axonotmetic lesions can initiate the resolution of neuropathic hyperalgesia.