Limitations in the field of vision of young operators of utility all-terrain vehicles.

PROBLEM: All-Terrain Vehicles (ATVs) cause a distressing number of fatalities and injuries among farm youth in the United States. The number of severe injuries caused by ATV crashes on farms, which stood at 25 children in 2019, is expected to rise due to increased ATV sales during the COVID-19 pandemic. Existing research into children's injuries has explored physical capabilities like anthropometry, strength, and visual acuity. Yet, studies assessing youths' physical ability to operate ATVs remain limited. This study tests the hypothesis that diminished vision field in young ATV operators raises crash risks. METHODS: This study used SAMMIECAD digital human modeling system to simulate and compare the field of vision of youth and adult ATV operators. The simulations incorporated 3-D mockups of ATVs, humans, sprayer tanks, windshields, and obstacles. Ten utility ATVs and children of both genders across nine ages (8-16) and three height percentiles (5th, 50th, 95th) were evaluated. RESULTS: Simulations showed that young ATV operators generally have a more restricted field of vision than adults, particularly those aged 6-11 years. DISCUSSION: Visual limitations hinder riders' ability to see ATV controls, potentially leading to vehicle control loss. Moreover, they impair environmental perception during riding, compromising youths' ATV operation abilities and increasing crash risks. PRACTICAL APPLICATIONS: These findings offer crucial data in support of modifying ATV safety guidelines. Additionally, they can guide youth occupational health professionals in preventing ATV-related incidents in agricultural settings.

Oropharyngeal Swelling and Airway Obstruction from Environmental Cold Exposure: A Case Report.

A 19-year-old male presented with facial frostbite and severe oropharyngeal edema after prolonged riding of a snowmobile without any facial covering. The diffuse swelling eventually progressed to airway obstruction, requiring a surgical airway. No alternative explanation was found for his presentation, making this the first case found in the literature of airway obstruction secondary to environmental cold exposure.

Spike of Motorbike Accidents in Bangladesh: An Emerging Public Health Concern.

The on-road traffic accident is a significant public health concern for Bangladesh, impeding the country's way to building safe, resilient, and sustainable cities and human settlements. On-road accidents and causalities doubled in the country between 2011 and 2020, and it increased by 30% in 2021, a shifting pattern of traffic accidents with an increasing number of motorbike accidents. The fatalities by motorcycle traffic accidents were only 4% in 1995 and rose substantially to 35% in 2021, and the situation has been more alarming during the festivals, especially Eid in Bangladesh.

Quad bike related trauma in Ireland.

INTRODUCTION: A quad bike or an all-terrain vehicle is a four-wheeled powered vehicle generally designed for off-road use. They are widely used for farm-related work and more recently for recreational purposes. The potential for serious injury and death with quad bike use is a growing public health concern. There is an inherent instability in their design and they are typically used on rugged terrain characterised by dangerous driving surfaces. This study examines quad bike related trauma in Ireland using a national trauma registry to identify patient demographics, injury mechanism and type, treatments received and outcomes. METHODS: All quad bike related trauma cases recorded on the Major Trauma Audit (MTA), National Office of Clinical Audit in Ireland for the period 2014-2019 were gathered and analysed. RESULTS: There were 69 cases identified and 63 (91 %) of these were male. The median (IQR) age was 27 (19 - 49.1). There were 25 % (n = 17) aged 0-18 years, 64 % (n = 44) aged 19-65 and 12 % (n = 8) aged greater than 65 years. The median injury severity score (ISS) was 10 (IQR 9-22). The most severely injured body region was the head (n = 21, 30 %). No helmet use was recorded in 50 % (n = 34) of cases. October recorded the highest number of cases (n = 9, 13 %), and Sunday was the most common day (n = 17, 25 %). The median length of hospital stay was five days (IQR 3-9). One patient died after arrival to hospital. CONCLUSION: Quad bike related trauma predominantly affects a young male cohort with serious injury characteristics. A sizeable proportion of patients are under 18 years of age. This data can better inform national policies and public awareness campaigns targeting this trauma subset. The head was the most common severely injured body region, highlighting the potential need for legislative intervention regarding mandatory helmet use. A large cohort of patients required transfer for definitive care which has implications for trauma care pathways and advocates for the development of an integrated trauma system in Ireland.

Pediatric Upper Extremity Trauma Secondary to All-terrain Vehicle Use.

All-terrain vehicles (ATVs) have become popular with respect to recreational activities. Multiple orthopaedic and pediatric organizations currently recommend limiting use of ATVs to older age groups of children with supervision. These recommendations have not generally been adhered to, resulting in a disproportionate number of pediatric orthopaedic trauma, specifically of the upper extremities. A retrospective review of patients 18-years-old and younger who presented to a single, Level I Trauma Center with ATV-related upper extremity trauma between 1996 and 2006 was undertaken to determine the impact of ATV use on the upper extremities of children. A total of 65 patients were identified with an average age of 12.3. Only 29.2% wore helmets and 73.8% were drivers. The hand and elbow were the most common injury sites in patients under age 12, elbow for those between ages 12 and 16, and wrist for those over age 16 (p = 0.031). Fractures/Dislocations were the most common injury in all age groups (p = 0.0077). The most performed surgical procedure was open reduction internal fixation of fractures, and patients required an average of 4.8 total operations. Patients who had non-isolated upper extremity injuries were associated with longer hospital stays (p = 0.011) but not ICU stays (p = 0.10). In order to reduce pediatric upper extremity injuries from ATVs, restrictions must be more stringent and safety education made a priority. (Journal of Surgical Orthopaedic Advances 32(2):088-091, 2023).

Utilization of digital tools to enhance COVID-19 and tuberculosis testing and linkage to care: A cross-sectional evaluation study among Bodaboda motorbike riders in the Nairobi Metropolis, Kenya.

Kenya has registered over 300,000 cases of COVID-19 and is a high-burden tuberculosis country. Tuberculosis diagnosis was significantly disrupted by the pandemic. Access to timely diagnosis, which is key to effective management of tuberculosis and COVID-19, can be expanded and made more efficient through integrated screening. Decentralized testing at community level further increases access, especially for underserved populations, and requires robust systems for data and process management. This study delivered integrated COVID-19 and tuberculosis testing to commercial motorbike (Bodaboda) riders, a population at increased risk of both diseases with limited access to services, in four counties: Nairobi, Kiambu, Machakos and Kajiado. Testing sheds were established where riders congregate, with demand creation carried out by the Bodaboda association. Integrated symptom screening for tuberculosis and COVID-19 was conducted through a digital questionnaire which automatically flagged participants who should be tested for either, or both, diseases. Rapid antigen-detecting tests (Ag-RDTs) for COVID-19 were conducted onsite, while sputum samples were collected and transported to laboratories for tuberculosis diagnosis. End-to-end patient data were captured using digital tools. 5663 participants enrolled in the study, 4946 of whom were tested for COVID-19. Ag-RDT positivity rate was 1% but fluctuated widely across counties in line with broader regional trends. Among a subset tested by PCR, positivity was greater in individuals flagged as high risk by the digital tool (8% compared with 4% overall). Of 355 participants tested for tuberculosis, 7 were positive, with the resulting prevalence rate higher than the national average. Over 40% of riders had elevated blood pressure or abnormal sugar levels. The digital tool successfully captured complete end-to-end data for 95% of all participants. This study revealed high rates of undetected disease among Bodaboda riders and demonstrated that integrated diagnosis can be delivered effectively in communities, with the support of digital tools, to maximize access.

Comparison of Injuries Associated With Electric Scooters, Motorbikes, and Bicycles in France, 2019-2022.

Importance: Electric scooter (e-scooter) use is increasing in France and in many urban environments worldwide. Yet little is known about injuries associated with use of e-scooters. Objective: To describe characteristics and outcomes of major trauma involving e-scooters. Design, Setting, and Participants: A multicenter cohort study was conducted in France using the national major trauma registry between January 1, 2019, and December 20, 2022. All patients admitted to a participating major trauma center following a road traffic crash (RTC) involving an e-scooter, a bicycle, or a motorbike were included. Exposure: Included patients were compared according to the 3 mechanisms. Main Outcomes and Measures: The primary outcome was trauma severity as defined by the Injury Severity Score (ISS). Secondary outcomes included the trends of the number of patients per year, a comparison of the RTC epidemiologic factors, injury severity, resources used, and in-hospital outcomes. Results: A total of 5233 patients involved in RTCs were admitted (median age, 33 [IQR, 24-48] years; 4629 [88.5%] men; median ISS, 13 [IQR, 8-22]). The population included 229 e-scooter RTCs (4.4%), 4094 motorbike RTCs (78.2%), and 910 bicycle RTCs (17.4%). The number of patients treated following e-scooter RTCs increased by 2.8-fold in 4 years (from 31 in 2019 to 88 in 2022), while bicycle RTCs increased by 1.2-fold and motorbike RTCs decreased by 0.9-fold. At admission, 36.7% of e-scooter users had a blood alcohol content higher than the legal threshold (n = 84) and 22.5% wore a protective helmet (n = 32). Among e-scooter RTCs, 102 patients (45.5%) had an ISS of 16 or higher. This proportion was similar for patients with motorbike RTCs (1557 [39.7%]; P = .10) and bicycle RTCs (411 [47.3%]; P = .69). With a proportion of 25.9% (n = 50), patients with e-scooter RTCs had twice as many severe traumatic brain injuries (Glasgow Coma Scale ≤8) as motorbike RTCs (445 [11.8%]) and a proportion comparable to bicycle RTCs (174 [22.1%]). The mortality of e-scooter RTCs was 9.2% (n = 20), compared with 5.2% (n = 196) (P = .02) for motorbikes and 10.0% (n = 84) (P = .82) for bicycles. Conclusions and Relevance: The findings of this study suggest that trauma involving e-scooters in France has significantly increased over the past 4 years. These patients presented with injury profiles as severe as those of individuals who experienced bicycle or motorbike RTCs, with a higher proportion of severe traumatic brain injury.

ATV-Related Trauma in the Pediatric Population.

BACKGROUND: All-terrain vehicles (ATVs) are prevalent in Appalachia and cause significant morbidity and mortality in the pediatric population. This study investigated the injury types and severity in pediatric patients over a 15-year period. METHODS: A retrospective chart review was performed on pediatric ATV-related traumas presenting to our institution from 2005 to 2020. Patients were divided into 3 age groups (0-7, 8-12, and 13-17 y) to evaluate differences in accident demographics, hospitalization, Glasgow Coma Scale, Injury Severity Score, substance use, characterization of orthopaedic and nonorthopaedic injuries, and procedures performed. RESULTS: Inclusion criteria were met by 802 patients. Males represented 71.7% (n=575) and females 28.3% (n=227); the mean age was 12.4 years. The majority (88.5%, n=710) of patients admitted following their accident had a mean stay length of 3.3 days. Of admissions, intensive care unit admission was required by 23.8%, n=191 (mean stay 4.0 d). There were 7 fatalities. The vast majority of accidents occurred between May and September (79.2%, n=635). In patients with documented helmet status, 45% (n=271) were helmeted. Roughly half of all patients (n=393) sustained a fracture (excluding fractures to the head), 370 sustained an injury to the head/face, 129 sustained intra-abdominal/intra-thoracic injuries, and 29 sustained injuries to all 3 systems. The most common fractures involved the forearm (n=98), femur (n=65), and spine (n=59). The most common open fractures were the tibia (n=12), humerus (n=8), and forearm (n=8). The oldest group was more likely than the middle or younger groups to sustain spine ( P <0.0001), pelvis ( P =0.0001), hand ( P =0.0089), and foot ( P =0.0487) fractures. Ethanol testing was positive in 5.0% (n=25) of the oldest group and cannabinoids were present in 6.8% (n=34). The youngest group was significantly more likely to sustain a fracture of the humerus than the middle or older groups ( P <0.0001). Orthopaedic surgical management was required in 24.4% (n=196) of patients. CONCLUSIONS: Pediatric ATV accidents present a significant source of morbidity and mortality. Further intervention is necessary to minimize pediatric ATV injuries. LEVEL OF EVIDENCE: Level IV-Retrospective Case Series.

Severity of All-Terrain Vehicle-Related Injuries by Age in Canada, 2002-2019.

Importance: Rates of pediatric hospitalizations following an injury while riding an all-terrain vehicle (ATV) are increasing. Few studies have compared the rates of severe injuries among children, adolescents, and adults. Objectives: To investigate whether younger ATV riders are at risk for more severe ATV-related injuries. Design, Setting, and Participants: This cross-sectional study was conducted using administrative data from hospitals in 9 provinces in Canada. Participants included patients admitted to hospitals with ATV-related injuries between 2002 and 2019. Statistical analysis was performed from June 2020 to September 2021. Exposures: The primary exposure was age younger than 16 years. Comparison groups were youths aged 16 to 20 years and adults aged 21 years and older. Main Outcomes and Measures: The main outcomes of interest were death, spinal cord injury, and an Injury Severity Score (ISS) greater than 25. Secondary outcomes were less severe injuries, including head injuries, crush type injuries, and fractures. Results: Among 52 745 patients with complete data, 15% were youths younger than 16 years, 13% were youths aged 16 to 20 years, 82% were male, and 47% lived in rural areas. After adjusting for covariates, the odds of dying were higher among youths aged 16 to 20 years (adjusted odds ratio [aOR], 1.64; 95% CI, 1.04-2.60) compared with those younger than 16 years. Youths aged 16 to 20 years also had higher odds of spinal cord injury (aOR, 2.72; 95% CI, 1.80-4.20) and an injury severity score greater than 25 (aOR, 1.63; 95% CI, 1.36-1.96) compared with youths 16 years of age or less. Sex-specific analyses revealed these associations were greater for male youths aged 16 to 20 years (spinal cord injury: aOR, 3.81; 95% CI, 1.38-11.10, and dying in a hospital: aOR, 4.37; 95% CI, 1.19-21.02) than female youths aged 16 to 20 years. Conclusions and Relevance: In this cross-sectional study of patients hospitalized for ATV injuries in Canada, youths aged 16 to 20 years and adults aged 21 years and older were at an increased risk of death and severe injuries compared with youths younger than 16 years. The increased risk of death and severe injuries was most evident among male patients.

Injury Pattern and Outcomes Following All-Terrain Vehicle Accidents in Kentucky Children: A Retrospective Study.

PURPOSE: All-terrain vehicles (ATVs) pose a significant risk for morbidity and mortality amongst children. We hypothesize that current vague legislation regarding helmet use impacts injury patterns and outcomes in pediatric ATV accidents. METHODS: The institutional trauma registry was queried for pediatric patients involved in ATV accidents from 2006 to 2019. Patient demographics and helmet wearing status were identified in addition to patient outcomes, such as injury pattern, injury severity score, mortality, length of stay, and discharge disposition. These elements were analyzed for statistical significance. RESULTS: 720 patients presented during the study period, which were predominantly male (71%, n = 511) and less than 16 years old (76%, n = 543). Most patients were not wearing a helmet (82%, n = 589) at time of injury. Notably, there were 7 fatalities. A lack of helmet use is positively associated with head injury (42% vs 23%, P < .01), intracranial hemorrhage (15% vs 7%, P = .03), and associated with lower Glasgow Coma Scale (13.9 vs 14.4, P < .01). Children 16 years and older were least likely to wear a helmet and most likely to incur injuries. Patients over 16 years had longer lengths of stay, higher mortality, and higher need for rehabilitation. CONCLUSION: Not wearing a helmet is directly correlated with injury severity and concerning rates of head injury. Children 16 years and older are at greatest risk for injury, but younger children are still at risk. Stricter state laws regarding helmet use are necessary to reduce pediatric ATV-related injury burden. LEVEL OF EVIDENCE: level III retrospective comparative study.

Adult golf cart injuries: A rising hazard off the course.

OBJECTIVE: Golf carts are increasingly being used as a means of transportation for travel in neighborhoods, city areas, and unpaved surfaces. The catchment area of our regional trauma center has seen an increase in golf cart use for transportation. In fact, Georgia has recently changed legislation to support the growing need for more defined laws around golf cart use. This study aims to further evaluate injury and outcome patterns in the adult population of northeast Georgia. METHODS: We performed a retrospective review of adult golf cart injured patients from 2018 to 2022. We evaluated key demographics, such as age and gender, along with the length of stay, Glasgow Coma Scale (GCS), and Injury Severity Score (ISS). Outcomes included the injury type. RESULTS: The results showed that orthopedic injuries were the most common (n = 24). Most patients were in the driver's seat (76%). Ejection from the golf cart was common (82%). Geriatric patients, 65 and older, had an increased length of stay compared to patients under the age of 65 (10 vs 3.9 days). CONCLUSION: Based on these results, future work includes injury prevention, increased awareness of injury patterns in prehospital and hospital settings, and communities updating their ordinances.

A New Source of Mutilating Hand Injuries: The Side-by-Side Utility Terrain Vehicle.

BACKGROUND: Rates of mutilating hand injuries are increasing from accidents caused by all-terrain vehicles (ATVs) and the recently popularized side-by-side utility terrain vehicles (UTVs). Increasing surgeon familiarity with upper extremity (UE) injury patterns, severity, and outcomes following ATV and UTV accidents may improve patient care and advocacy. METHODS: Retrospective comparisons of UE injury patterns, severity, hospital and intensive care unit (ICU) admission lengths, and number of operations were made between ATVs and UTVs. Findings were analyzed with Fisher exact tests, multivariate analysis of variance, analyses of variance with post hoc analyses, and multiple linear regressions. RESULTS: A total of 154 cases were identified for inclusion (ATV, n = 87; UTV, n = 67). Patient ages ranged from 4 to 89 years. The UTV group contained significantly more hand and finger injuries, and more of the fractures were open ( P = 0.005, P < 0.001, and P < 0.001, respectively). Riders of UTVs had nearly three times as many mutilating hand injuries and a nearly ninefold increase in amputations compared with ATV riders ( P < 0.001 and P < 0.001, respectively). On average, the UTV group spent 2.5 additional days in the hospital, 0.91 additional days in an ICU, and had 1.3 additional operations ( P = 0.001, P = 0.007, and P < 0.001, respectively). Vehicle type was the only variable significantly correlated with days in the hospital, ICU, and number of UE operations ( P = 0.002, P = 0.008, and P < 0.001, respectively). CONCLUSIONS: Hand surgeons are in a unique position to serve as forerunners for increasing public awareness of off-road vehicle risks and promoting rider safety. Collaborating with manufacturers and emergency care providers and directing teaching initiatives may improve patient outcomes. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.

Ability of youth operators to reach agricultural all-terrain vehicles controls.

PROBLEM: Utility All-Terrain Vehicles (ATVs) are one major cause of youth injuries and fatalities on farms. Utility ATVs have heavy weights and fast speeds that require complex maneuvering. Youth's physical capabilities may not be sufficient to perform those complex maneuvers correctly. Therefore, it is hypothesized that most youth engage in ATV-related incidents because they ride vehicles unfit for them. There is a need to assess ATV-youth fit based on youth anthropometry. METHOD: This study focused on evaluating potential inconsistencies between the operational requirements of utility ATVs and the anthropometric measures of youth through virtual simulations. Virtual simulations were performed to assess 11 youth-ATV fit guidelines proposed by several ATV safety advocacy organizations (National 4-H council, CPSC, IPCH, and FReSH). In total, 17 utility ATVs along with male-and-female-youth of nine ages (8 to 16 years old) and three height percentiles (5th, 50th, and 95th) were evaluated. RESULTS: The results demonstrated a physical mismatch between ATVs' operational requirements and youth's anthropometry. For example, male-youth aged 16 of the 95th height percentile failed to pass at least 1 out of the 11 fit guidelines for 35 % of all vehicles evaluated. The results were even more concerning for females. Female youth 10 years old and younger (from all height percentiles) failed to pass at least one fit guideline for all ATVs evaluated. DISCUSSION: Youth are not recommended to ride utility ATVs. PRACTICAL APPLICATIONS: This study provides quantitative and systematic evidence to modify current ATV safety guidelines. Furthermore, youth occupational health professionals could use the present findings to prevent ATV-related incidents in agricultural settings.

What inhibits the progress of early-career women in Karachi? Studying the effects of socio-spatial mobility barriers on women's employment.

BACKGROUND: There is a widespread acceptance and shift towards sustainable, inclusive and smart mobility solutions around the world. However, in Karachi, poorly coordinated urban planning, lack of effective governance structure and investment in transport, has allowed the growth of an almost unregulated and ungovernable informal transport sector. Women are more severely affected by the poor service since men not only have more space allocated to them on public transport but also have the freedom to use alternative and cheaper private vehicles such as motorbikes and cycles. Poor representation of women in the transport sector further aggravates the situation. OBJECTIVE: The paper aims to highlight the gender-disaggregated effects of poor transport design, provision and lack of personal agency on mobility, for emphasising the social and cultural attitudes faced by female employees. It argues that not integrating the gender-based disadvantages faced by women into planning, reinforces their disadvantaged position and force them to take complex trips. METHODS: Scenario-based questions were designed for focus group discussion which covered not only the everyday mobility challenges but also their reactions to the potential solutions. For a gender-based comparative analysis, two separate focus group discussions were organised. RESULTS: Adopting a sector-based mapping approach of the issues discussed in the groups helped understand the complexity of female user experience at various levels, starting from planning or discussing the trips with families, to making modal choices. It also helped to tease out the impact of these issues on their employment opportunities as early-career women. CONCLUSION: The model proposed in this paper can help illustrate where changes can be made in the system considering the social aspects of transport.

Evaluation of human exposure to vibration in the hand-arm system during motorcycle riding activities.

BACKGROUND: The majority of Indians prefer to drive by two-wheeler. Hands are the most important interface between the rider and bike while riding a motorbike. The vibration is transferred to the physical structure by the handlebar as it travels. Long-term exposure to the vibrations may have an impact on various bodily structures. OBJECTIVE: To measure and analyse the human exposure to vibration in the hand-arm system while riding a motorcycle using a vibrometer. METHODS: The several types of bikes based on their cc's were evaluated in three different road conditions during this investigation (tar road, concrete road, and gravel road). The subjective and quantitative data of each participant were recorded. The RMS A(8) values were supported for every combination of motorcycles and road conditions, and vibration intensity was evaluated using a tri-axial vibrometer. RESULTS: The exposure limit value for daily vibration exposure is 5 m/s2 according to the UK Control of Vibration at Work Regulations 2005 standards.This study suggests that the bike with the least amount of vibration be used to prevent hand-arm vibration (HAV) syndrome. This study found that bike C had the least vibration across all three types of roads, which will benefit riders by reducing health issues as they ride. Therefore, it is further examined utilising the Taguchi method with various bike C age groups. Bike C with the lowest age had the least vibration when different bike C ages were compared, hence it was recommended for riding. CONCLUSION: The vibration level of each bike has a huge impact, which was measured using a tri-axial vibrometer. According to the results, bike C has the least vibration across three distinct types of roads and also provides riders with less health issues while riding bikes. As a result, a moped can drive in three different road circumstances with the least amount of vibration, delivering comfort and safety while lowering vibration levels.

Pediatric all-terrain vehicle (ATV) related head injury rates and patterns: A 10-year nationwide analysis.

INTRODUCTION: The use of all-terrain vehicles (ATVs) carries significant risk of permanent injury and death, disproportionately affecting children. These injuries commonly affect the head and are especially severe among children as they are often unhelmeted and more likely than adults to experience rollover injuries. Many studies examining patients with ATV-related injuries are single-center cohort studies, with few focusing specifically on head injuries. In the present study, we aimed to characterize the annual incidence of ATV-related head injuries between 2012 and 2021, classify and compare head injury types, and identify descriptive characteristics of ATV-related head injury victims. METHODS: Using the US Consumer Product Safety Commission's National Electronic Injury Surveillance System (NEISS) database, we queried all head injuries associated with operating or riding an ATV in children under 18 years-old from over 100 emergency departments (EDs). Patient information regarding age, race, sex, location of incident, diagnoses, and sequelae were analyzed. We also collected the estimated number of ATV-related head injuries from all US EDs using the NEISS algorithm provided by the database. RESULTS: Using the NEISS algorithm we identified 67,957 (95% CI: 43,608 - 92,305) total pediatric ATV-related head injuries between 2012 and 2021. The annual incidence of ATV-related head injury was similar throughout this study period except for a 20% increase during the COVID-19 pandemic period of 2019-2021 (2019: 6382 injuries, 2020: 6757 injuries, 2021: 7600 injuries). A subset of 1890 cases from approximately 100 EDs were then analyzed. Unspecified closed head injuries were the prevailing type of injury (38%, 900/1890), followed by concussions (27%, 510/1890). More severe injuries included intracranial hemorrhages in 91 children (3.8%, 91/1890). Injuries of all types were predominantly seen in 14-17 year-old's (780/1890, 41%) and in males (64.1%, 1211/1890). In addition, ATV-associated injuries were significantly more common in those coded as white (58.0%, 1096/1890) than any other racial group. ATV-associated accidents among children younger than 9 more commonly occurred at the home compared to accidents involving children older than 9 (57% vs. 32%, p < 0.0001). CONCLUSION: ATV-related head injuries cause a significant annual burden among children, with growing incidence in recent years. Further research may wish to explore potential benefits of helmet use and supervision of younger children in possible prevention of these accidents and their associated economic and non-economic costs.

Do All-terrain or Recreational Off-highway Vehicle Crashes Have a Higher Odds of Amputation?

BACKGROUND: Riding off-road vehicles is associated with the risk of injury to the extremities. There are two main types of four-wheel recreational off-road vehicles: quads or all-terrain vehicles (ATVs), which are essentially four-wheel off-road motorcycles, and recreational off-highway vehicles (ROVs), also colloquially referred to as utility terrain vehicles, which have side-by-side seating, higher maximum speeds, and a roll cage. There are multiple orthopaedic society position statements on ATVs, but none on ROVs. Perhaps this is because the injury patterns and differences between the two vehicles have not been elucidated. QUESTIONS/PURPOSES: (1) What patient, vehicle (ROVs versus ATVs), and injury factors are associated with amputation? (2) What are the anatomic location distributions of fractures and amputations by vehicle type? METHODS: Records of all patients in our hospital's billing system who had both a diagnostic code indicating an accident related to an off-road vehicle and one indicating an extremity or pelvic fracture between February 2014 and January 2020 were screened; this resulted in the identification of 328 patients with fractures resulting from off-road vehicle collisions. A total of 16% (51 of 328) of patients were excluded from the analysis because their injury did not involve either an ATV or an ROV; 277 patients were included in the final analysis. The following variables were collected: age at time of the injury, gender, BMI, vehicle type, Gustilo-Anderson type if applicable, amputation level if applicable, anatomic locations of injuries, ethanol level, and drug screen. ATV crashes accounted for 52% (145 of 277) of patients, and ROV crashes accounted for 48% (132 of 277). Patients from ATV crashes did not differ from those in ROV crashes in terms of mean age (24 ± 16 years versus 24 ± 13 years; p = 0.82), BMI (25 ± 7 kg/m 2 versus 26 ± 6 kg/m 2 ; p = 0.18), or gender (79% [114 of 145] men/boys versus 77% [102 of 132]; p = 0.79). Among patients who had a drug or ethanol screen, there was a higher percent of ATV riders who used marijuana (39% [19 of 49] versus 17% [7 of 42]; p = 0.04), but there were no differences in abnormal blood alcohol screen or abnormal nonmarijuana drug screen; however, these results were available in only about one-third of patients (99 of 277 for ethanol and 91 of 277 for drug screen). Statistical analysis was performed using logistic regression analysis for factors associated with amputation, with p values < 0.05 considered significant. RESULTS: After controlling for differences in demographic factors, the stepwise increase in Gustilo-Anderson grade of open fracture (OR 9.8 [95% CI 3.6 to 27.0]; p < 0.001) and ROV vehicle type (OR 15.7 [95% CI 3.6 to 68.5]; p < 0.001) were both associated with amputation. There was no increase in the odds of amputation associated with age (OR 1.0 [95% CI 0.9 to 1.1]; p = 0.81), gender (OR 1.4 [95% CI 0.3 to 5.8]; p = 0.68), or BMI (OR 1.1 [95% CI 0.9 to 1.2]; p = 0.37). The most frequent ATV fractures occurred in the forearm and wrist (22% [45 of 203]), whereas most ROV injuries occurred through the metacarpals (41% [107 of 262] of fractures and 58% [18 of 31] of amputations). CONCLUSION: ROV crashes are associated with a higher odds of amputation when compared with ATV crashes. Because most ROV injuries were in the forearm and below, this likely occurs when upper extremities are crushed and mangled under the roll cage in rollover ROV crashes. Because of this danger, we urge our orthopaedic societies to either update current ATV position statements to include ROVs or release separate statements on ROVs. LEVEL OF EVIDENCE: Level III, prognostic study.

A Systematic Review of Youth and All-Terrain Vehicles Safety in Agriculture.

All-terrain vehicle (ATV) incidents are one of the leading causes of injuries and fatalities among youth in the agricultural industry. It has been hypothesized that many youth-related ATV incidents occur because children ride ATVs that do not fit their capabilities and are not following basic safe riding practices. In addition, various ATV safety guidelines regarding youth (e.g., CPSC, ANSI/SVIA, ASI) are inconsistent and may not align with state or local laws. To the best of our knowledge, no comprehensive studies have compared the physical and mental requirements for riding ATVs and the youth's capabilities to ride ATVs safely. Consequently, there are no scientific-based recommendations for age limitation, physical and mental capabilities, and safety requirements for youth to ride ATVs safely. Thus, there is a need to review the available sources related to youth safety and ATVs in the agricultural industry, identify the research voids, and recommend modifications to current ATV guidelines. This study conducted a systematic review of available ATV-related studies, standards, guidelines, and laws to establish better-informed minimum age, physical and mental capabilities, and safety requirements for youths to ride ATVs on the farm.

Self-reported Quad Bike Use, Safety Behaviors, and Safety Awareness among Young Adults in U.S. and Canadian Agriculture.

The number of agricultural fatalities and injuries related to agricultural quad bike use has risen substantially in the last two decades. Safe engineering design features such as crush protection and roll bars have proven potential to lessen the burden of injury but have traditionally not been included in many quad bike safety training programs. The aim of this study was to survey more than 700 young adults working in U.S. and Canadian agriculture to examine self-reported quad bike safety behaviors and awareness of quad bike safety design engineering features. We found that U.S. males continue to be at higher risk for quad bike-rollover incidents when compared to other groups. Even when accounting for other factors such as age and country, we found that participants who reported youth occupational quad bike use (≤14 years old) were up to 200% more likely to allow extra riders and up to 489% more likely to not wear a helmet when compared to participants who reported beginning occupational quad bike use in adulthood. These findings support the Agricultural Youth Work Guideline (AYWG) for occupational quad bike use at age 16. Less than 20% of young adults working in agriculture were aware of safe design features such as wide frames, stability ratings, crush protection devices, and accessories made by the original equipment manufacturer. There is tremendous need to educate the future agricultural workforce about the importance of choosing quad bikes with safer design features.

Orthopaedic Injuries from All-Terrain Vehicles: An Epidemiological Account and Review of Legislation.

All-terrain vehicles (ATVs) are an ongoing source of orthopaedic trauma in the United States. The National Electronic Injury Surveillance System (NEISS) database was queried for ATV-related extremity trauma from 2010 to 2019. An estimated 31,979 ATV-related injuries present to emergency departments annually without significant variability between years. Patients were predominantly white (63.5%), male (72.2%), and aged 18 - 44 (49.9%). Injury sites frequently included the shoulder (24%), wrist (12.8%), and ankle (11.2%). Fractures were most common followed by strains and sprains. Only 15.5% of injuries occurred on public land. Alcohol use was rarely implicated. Orthopaedic surgeons should be aware that rates of ATV-related musculoskeletal injuries have not changed significantly over the last ten years despite legislative efforts to improve ATV safety. Additionally, safety laws are inconsistent across the US, and many apply to the use of ATVs on public land when a minority of injuries occur on non-public land. (Journal of Surgical Orthopaedic Advances 32(4):225-231, 2023).