“In Texas and other places in the Southwest, there’s an abundance of open space available for riding motorbikes and all-terrain vehicles (ATVs)—leisure activities that can lead to devastating injuries in the pediatric population,” noted Ryan A. Rose, MD, a Dallas-based orthopaedic surgeon.

According to Dr. Rose, children injured while riding the two-wheeled motorbikes may have different injury characteristics than children injured while riding the four-wheeled ATVs.

When the investigators compared injury characteristics between the two groups, they found that motorbike accidents have a much higher rate of multiple orthopaedic injuries, while ATV accidents result in significantly more skull fractures. Dr. Rose presented the results of this study at the 2014 annual meeting of the Society of Military Orthopaedic Surgeons (SOMOS).

Studying laws and recommendations
When the researchers first began reviewing the literature on ATV and motorbike injuries in children, they found that Texas laws regarding off-road motorbike use are fairly limited.

“Laws call for things such as helmets, eye protection, and rider education, but no license is required,” said Dr. Rose. “Direct supervision is required if the operator is younger than 14 years of age.”

They also reviewed current guidelines and recommendations from several organizations regarding ATV and motorbike use in children.

“The American Academy of Pediatrics (AAP) recommends that children younger than 16 years should not ride ATVs or motorbikes because their motor coordination, strength, and judgment are not yet up to par,” noted Dr. Rose.

“But it’s not just the AAP,” he continues. “The AAOS, the Orthopaedic Trauma Association, and the Pediatric Orthopaedic Society of North America all recommend that, among other things, ATVs should never be driven by a child younger than 12 years, and that all ATV operators should be licensed and undergo a hands-on training course. In addition, the recommendations state that protective gear—including helmets, gloves, and heavy boots—should always be worn.”

Although the researchers found a fair amount of data on ATV-rider injuries in the pediatric and adult population, they could only identify one study on motorbike injuries in the pediatric population. No study, they found, had yet compared pediatric ATV injuries and pediatric motorbike injuries.

A retrospective review
The researchers sought to identify differences in musculoskeletal injury location and severity between pediatric ATV and motorbike riders. To do so, they conducted a retrospective review of all emergency department (ED) visits for ATV and motorbike injuries sustained in the pediatric population between 2005 and 2011 at a single pediatric Level 1 trauma center in Texas.

Investigators reviewed data on the following:

• characteristics of osseous musculoskeletal injuries and associated injuries
• protective equipment use
• Injury Severity Score (ISS)
• length of hospital stay (LOS)

The investigators collected data on 504 ED visits, including 334 patient visits (156 patients) for ATV injuries, and 170 patient visits (123 patients) for motorbike injuries. Children injured on ATVs had a mean age of 8.7 years (range, 1 year to 17 years), while children injured on motorbikes had a mean age of 10.2 years (range, 3 years to 16 years). Both groups were predominately male (67 percent of ATV patients, 83 percent of motorbike patients).

Protective equipment and injuries
Dr. Rose and his colleagues found that motorbike riders tended to be more likely to wear protective equipment. For example, 44 percent of motorbike riders wore a helmet, while only 14 percent of ATV riders did so.

“And yet,” noted Dr. Rose, “we found no differences in ISS, LOS, or the rate of head/visceral injury, despite a higher rate of protective equipment use among motorbike riders.

“In the motorbike population, nearly 72 percent of patients sustained musculoskeletal injury, compared to 46 percent in the ATV population,” said Dr. Rose. “We concluded that despite significantly greater use of protective equipment, children are more likely to sustain orthopaedic injuries while riding a motorbike than when on an ATV.”

Dr. Rose pointed out that 40 percent of motorbike riders sustained lower extremity injuries—primarily fractures of both the tibia and the fibula—compared to 24 percent of ATV riders. There were no statistically significant differences in the rate of spine injuries.

“As might be expected, motorbike riders had more multiple injuries of an orthopaedic nature, as well as more injuries of a nonorthopaedic nature,” stated Dr. Rose. “But we found it interesting that the skull fracture rate was statistically higher in the ATV population. This goes back to the fact that 44 percent of motorbike riders wore a helmet, while only 14 percent of ATV riders did.”

Dr. Rose acknowledged study limitations, such as the difficulty in assessing whether motorbike injuries occurred during off-road or on-road riding or whether they occurred at competitive events.

“In summary, despite significantly higher rates of protective equipment use, pediatric motorbike riders sustain a much higher percentage of injuries, specifically tibia/fibula fractures and lower extremity injuries, compared to ATV riders,” said Dr. Rose. He emphasized, however, that “ATV riders actually sustained a higher risk of skull fracture.”

Other key conclusions of this study, noted Dr. Rose, include the importance of parental oversight as it relates to ATV and motorbike use and the need for greater safety measures to be taken regarding use of these vehicles.

“In addition,” he said, “understanding the differences in injury patterns associated with ATV and motorbike trauma can help guide orthopaedic and ED providers as they assess patients for secondary injuries.”

Dr. Rose’s coauthors of “Pediatric Musculoskeletal Injuries Associated with Recreational Motorized Vehicle Use: Do More Wheels Mean a Safer Ride?” include Anthony Riccio, MD; Grant D. Hogue, MD; and Robert L. Wimberly, MD.

The authors’ disclosure information, including potential conflicts of interest, can be viewed at www.aaos.org/disclosure

Jennie McKee is a senior science writer for AAOS Now. She can be reached at mckee@aaos.org

Bottom Line

• This retrospective review aimed to identify differences in musculoskeletal injury location and severity between pediatric ATV and motorbike riders.
• Investigators reviewed data on 504 ED encounters for ATV and motorbike injuries at a single pediatric Level 1 trauma center in Texas between 2005 and 2011.
• The researchers found that children injured while riding motorbikes have a much higher rate of multiple orthopaedic injuries, while those injured in ATVs sustain significantly more skull fractures.
• A greater understanding of the differences in injury patterns associated with ATV and motorbike trauma may help guide orthopaedists and ED providers as they assess patients for secondary injuries.