Orthopedic trauma in bicycling -Part 1

Today's interest in cycling is not limited to the professional realm but also encompasses recreational activities. During the Covid era and social distancing, cycling became and continues to be a means of exercise and stress relief for both young and old.

This fact brings to attention the injuries (both minor and major) that the sport of cycling poses on the roads of large urban centers, as well as mountain biking on the rural roads and trails of our country.

In general, cycling injuries are categorized as acute and chronic (from overuse syndromes or post-traumatic conditions). A combination of the above is usually the case . Additionally, some injuries may be related to mechanical issues, equipment failures (such as size, adjustments of the bike itself, inappropriate footwear, etc.).

The majority of cycling injuries could be prevented if safety rules regarding the selection of the proper equipment, its maintenance, appropriate training techniques, and the behavior of the cyclist on the road are followed. Special attention should be given to riding within urban areas, where the behavior of both cyclists and other drivers is the key difference between exercising safely and the risk of an imminent accident.

Trauma to soft tissue and skin.

The simplest injury that can occur from a bike fall is a scrape. This can range from a minor scratch to a loss of full thickness of the skin in the affected area, requiring more care than just a simple antiseptic. The same can happen with a laceration (a cut in the skin), depending on the location where it occurs (limbs, face) and the extent of the injury (how deep or how large it is).

Moving on to more serious injuries, we may encounter a muscle strain or contusion from direct impact during a fall or collision. Such an injury can manifest as a bruise, a superficial hematoma, or a deeper tissue injury, depending on the severity of the force applied to the affected soft tissue.

The usual treatment for soft tissue contusions from direct impact involves the well-known R.I.C.E. method: rest, ice, compression, and elevation of the affected limb, followed by a few days of rest. This is then followed by stretching exercises and increasing the range of motion of the involved joints. The return to sports will depend on the size and depth of the injury, which are related to the force exerted on the tissue at the time of the injury.

Bone and joint injury.

Fractures of the upper limbs are extremely common among cyclists, although this does not mean that lower limb injuries are not also considered. Treatment can range from conservative immobilization in a suitable splint to sometimes technically demanding surgeries for the best possible outcome.

The upper limbs are more exposed to injuries because cyclists use them to break falls and avoid collisions with moving or stationary objects in their path.

The most common injury places are the hands, wrists, collarbone, and elbow

The hands are often the first part of the body to break a fall to the ground. This puts the metacarpals at immediate risk, which can also be crushed by other cyclists, pedestrians, or bikes that may be involved in a collision.

The wrist is equally exposed as the palm, and it is not uncommon for a cyclist to sustain a fracture in the carpal bones (such as the scaphoid or lunate) or at the distal end of the radius, which is part of the wrist joint, after a fall.

The olecranon is another area that can fracture. It is part of the ulna and contributes to the elbow joint. It comes into contact with the ground when the bicycle loses traction and slips to the side, making the elbow the first point of contact with the ground, thereby breaking the fall of the cyclist.

A clavicle fracture is another common injury in cycling. It occurs when the cyclist extends their upper limb to break their fall. The force from the fall that the body experiences upon the hand's contact with the ground is transmitted from the hand to the wrist, then to the forearm, to the humerus, and ultimately to the mechanically weaker clavicle, where it is absorbed.

With the same mechanism, the force of a fall or collision can cause a dislocation, most commonly at the shoulder joint in cycling, although this can also occur in other joints

Regarding the joints, depending on the force applied and the movement of the joint at the time of the injury (flexion, extension, lateral movement, and rotation), the surrounding soft tissue envelope can experience strain or rupture of structures such as ligaments, tendons, and bursae.

In conclusion, acute injuries in a cyclist's life are common and range from minor injuries that do not require special care to serious conditions that necessitate surgery and long-term rehabilitation. An orthopedic specialist will assess the injury and provide the appropriate treatment intervention aimed at achieving the best possible and quickest recovery.