“I have a love–hate relationship with motorcycles,” admitted Ronald W. Lindsey, MD, at the Association of Bone and Joint Surgeons 2012 annual meeting. “I’d like to think they’ve helped make me the surgeon that I am; at the same time, over the years I’ve had the chance to see how they’ve destroyed many of my patients and their families.”

In providing a “Modern Perspective on the Epidemiology and Patterns of Musculoskeletal Motorcycle Injuries,” Dr. Lindsey reviewed the epidemiology, helmet use, and injury patterns of motorcycle accident patients seen at a single Level I Trauma Center. His retrospective analysis of a prospectively collected injury database included all motorcycle injuries for the 10-year period ending Aug. 31, 2008.

Each event was considered separately. Dr. Lindsey found that several patients had more than one trauma event during the 10-year period, and each was included as an individual event.

The research team reviewed several variables, including patient age, gender, and ethnicity; helmet use; Glasgow coma scale (GCS) when first seen; injury severity score (ISS); length of hospital stay (LOS); specific injury diagnosis; and mortality. They looked at the demographic distribution of outcome variables, the association between patient demographics and helmet use, and the association between helmet use and outcome variables.

White men at risk
There were 1,252 motorcycle trauma events recorded during the decade, primarily among White men (5:1 male:female ratio; 8:1:1 White:Black:Hispanic ethnic ratio). Of the 1,093 events in which helmet use could be determined, 648 patients (59.3 percent) were not wearing helmets. Patients ranged in age from 4 years to 83 years.

Nearly 1,700 fractures were sustained; fractures to the lower leg and foot (346), the lower arm and wrist (235), and the spine (203) accounted for most of the orthopaedic injuries sustained. More than a third (35.7 percent) of tibial/fibular fractures were open fractures; more than one in five (20.47 percent) of radial/ulnar fractures were open.

The most prevalent nonorthopaedic injuries included concussions, abdominal injuries, face fractures, skull fractures, and hemothorax/pneumothorax. Regardless of age, patients who did not use helmets had a significantly higher risk for head trauma, had more severe head trauma, and had higher mortality rates.

Compared to recent European studies, he noted, the incidence of skull and face fractures in the United States is much higher, possibly because European riders are more likely to wear a helmet.

“We thought our older patients were particularly interesting,” said Dr. Lindsey, “not because they had higher ISS scores, higher fracture risk, higher risk for thoracic injury, or higher mortality—all of which we would assume—but because this was the group that was least likely to use helmets.”

37 times more likely to die
Dr. Lindsey pointed out that, per vehicle mile travelled in 2007, motorcyclists were about 37 times more likely than passenger car occupants to die in a motor vehicle traffic crash and 9 times more likely to be injured.

“So, for all of you who maybe have loved ones who are thinking of purchasing a motorcycle, this is really for you,” he said. “Our conclusions are very basic: In the United States, motorcycles are bad—and helmets, even if that’s all you wear, are good.”

Dr. Lindsey’s coauthors included Sean Burns, MD (no information); Zbigniew Gugala, MD, PhD (ISRN Orthopedics); Carlos Jimenez, MD (no information); and William Mileski, MD (no information). Dr. Lindsey (Biedermann-Motech; Springer; Journal of Bone and Joint Surgery–American; Journal of Orthopaedic Trauma; Journal of Trauma) is professor and chair of the department of orthopaedic surgery & rehabilitation at the University of Texas Medical Branch in Galveston, Texas.

Mary Ann Porucznik is managing editor of AAOS Now. She can be reached at porucznik@aaos.org

Bottom Line

• This retrospective study looked at all motorcycle injuries treated at a single level 1 trauma center over a 10-year period.
• Motorcyclists who did not wear helmets had a significantly higher risk for head trauma, had more severe head trauma, and had higher mortality rates.
• The most prevalent musculoskeletal injuries were fractures, primarily of the extremities and the spine.
• Based on highway safety data, per vehicle mile travelled in 2007, motorcyclists were about 37 times more likely than passenger car occupants to die in a motor vehicle traffic crash and
  9 times more likely to be injured.

Additional Resources:

• AAOS Position Statement on Helmet Use by Motorcycle Drivers and Passengers, and Bicyclists
• Patient Education: Helmet Safety
• Motorcycle and bicycle helmet use laws