The AAOS and the Orthopaedic Trauma Association addressed the impact of ATV injuries in a public service ad, “Over the river and through the woods, to the trauma center we go.” Reprints are available for free at


Published 6/1/2012
Peter Pollack

Motocross, ATV Popularity Leads to Rise in Pediatric Injuries

Riders and parents need education on safety and concussion symptoms

“Our home region of Rochester, Minn., is blessed with a number of motocross tracks,” began Anthony A. Stans, MD, speaking to members of the Pediatric Orthopaedic Society of North America (POSNA). “I suspect many in the audience also live near one. This motorcycle racing sport is growing in popularity, and children as young as 4 years old are competing.”

Dr. Stans discussed the topic of pediatric injuries due to motocross and all-terrain vehicles (ATVs) during the 2012 POSNA Specialty Day program. He explained that an expanding culture has sprung up around such sports, leading to an increase in injuries—especially head and orthopaedic trauma injuries. To support his claims, he presented the results of a 7-year study that looked at motocross injuries sustained by patients younger than age 18 who were seen at a single hospital emergency department.

“We identified 363 injuries in 297 patients; the average age of the patients was 14 years old,” said Dr. Stans. “Half of the patients were admitted to the hospital; one third of all patients required some form of surgical treatment; and of those patients, 90 percent had orthopaedic injuries.

“Looking at injuries by type,” he continued, “fractures accounted for approximately 70 percent of injuries. Many of these were long-bone fractures, so the forearm, the clavicle, the tibial shaft, the femoral shaft, and the humerus were all highly involved and frequently seen in motocross patients.”

Riding with concussion
Head injuries were the next most common injury type found in his study.

“All but one of the patients who had head injuries were wearing helmets,” he explained. “The message we took from this was that, although we don’t know how severe their injuries would have been had they not been wearing a helmet, wearing a helmet was not completely protective in terms of avoiding head injury.”

In ongoing research led by Amy L. McIntosh, MD—one of Dr. Stans’ colleagues—the team collected completed surveys from 139 motocross riders. The surveys were taken at the beginning, middle, and end of the 2010 motocross season. According to Dr. Stans, preliminary data from the surveys suggest that 50 percent of the riders experienced symptoms of concussion. However, only 40 percent of those patients sought medical attention for their symptoms, and 30 percent of symptomatic participants stated that they continued to compete on the same day.

“This is quite concerning to us,” said Dr. Stans. “We have noticed a couple of statistically significant associations: patients who had sponsorship support were more likely to have a head injury, and riders who characterized their own riding as aggressive were more likely to have a head injury. One hopeful point we found is that patients who received assistance from a salesperson when getting fitted for a helmet appeared to have a reduced likelihood of concussion.”

Bigger and faster
In addition to motocross, Dr. Stans said that ATV use has also contributed to the number of patients who are seen in the ED for similar injuries. He explained that, although three-wheel style ATVs were banned in 1988, overall ATV sales continue to increase. In addition, newer model machines are often larger and more powerful than older designs, resulting in an upswing in rollover accidents and a corresponding increase in severe injuries.

“One study that drew from a national database found that 4,500 patients were admitted to the hospital because of ATV-related accidents during 2006,” said Dr. Stans. “Spinal injuries occurred in 8 percent of patients, and pelvic fractures were a commonly associated injury. The research team found that, between 1997 and 2006, the overall injury rate from ATV accidents increased by 240 percent, and the spine injury rate increased by almost 500 percent.”

Dr. Stans said that he and his colleagues have found it valuable to work with the local motor sports organizations and to encourage parents and other leaders to view riders less as recreational users and consider them as more serious “road sport athletes.”

“Keep in mind that the machines are getting bigger and faster, and we’re seeing a lot of orthopaedic, head, and abdominal trauma as a result. Protective equipment can’t prevent all fractures, but our data suggest that proper-fitting helmets can reduce the magnitude of head injuries. Riders younger than 16 years of age should always be supervised. And it’s important to educate riders and their parents on the signs and symptoms of concussion.

“We probably began our work with more of an adversarial relationship with the parents, but it’s evolved into what I might term a suspicious partnership,” he continued. “We’re trying to work alongside them and I think that will help reduce injuries related to these activities.”

Disclosure information: Dr. Stans reports no conflicts.

Peter Pollack is a staff writer for AAOS Now. He can be reached at

Additional Resources:
ATVs: Injuries are part of the terrain 

PressReady 2007 AAOS ATV PSA

ATV and Motocross Sports ? High Velocity Toys Merit Caution

2010 Annual Meeting Information Podium Presentations - AAOS

2010 Annual Meeting Information Podium Presentations - AAOS

All-Terrain Vehicle Safety - OrthoInfo - AAOS 

Adult-Sized ATVs Are Not Safe for Kids; Statistics Startling

All-Terrain Vehicles Position Statement – AAOS

Ringing the bell on concussion management

AAOS supports new concussion statement

Sports Concussion - OrthoInfo - AAOS