Research Letters

Subcapsular liver haematomas caused by bar ends in mountain-bike crashes

Although early cardiopulmonary resuscitation (CPR) is associated with increased survival of sudden cardiac arrest victims, it may also result in miscellaneous injuries.

A 25-year-old inebriated man rescued from drowning in a swimming pool was apnoeic and pulseless after being pulled out of the water. Successful CPR was provided by untrained bystanders, including abdominal thrusts thought to remove water from the airways and chest compressions to provide haemodynamic support. As the patient progressively improved during his subsequent hospital stay, he complained of right upper abdominal and thoracic pain. A computed tomographic scan showed a 11 cm subcapsular haematoma contiguous to the right hepatic lobe. A favourable outcome was obtained after conservative, non-operative treatment.

Subcapsular haematoma of the liver is a potentially life threatening complication that warrants consideration in survivors of cardiac arrest who have received closed chest compression and/or abdominal thrusts.

El ejercicio físico no comporta ningún efecto desfavorable para el hígado, aunque ocasionalmente puede ser causa de un síndrome de golpe de calor en corredores de larga distancia si no beben suficientemente. La práctica del deporte no tiene efectos nocivos para el hígado, excepto cuando se siguen conductas de riesgo, como consumir anabolizantes, compartir jeringuillas o viajar a países endémicos de hepatitis sin estar vacunados. En los pacientes con enfermedades hepáticas agudas o crónicas puede autorizarse la actividad física o el deporte que no cause una fatiga excesiva.

Physical exercise does not have harmful effects on liver, yet it can be an occasional cause of heat stroke in long-distance runners if they do not drink enough. Practicing sports does not have harmful liver effects as long as some risk behaviors are avoided such as consumption of anabolizers, sharing syringes or traveling to hepatitis endemic countries without being vaccinated. In patients with acute or chronic liver diseases, physical activity or practicing sports can be allowed as long as these do not lead to an excessive fatigue.

Background: Mountain biking, one of the most popular sports in recent years with more than 10 million riders, is implicated more and more in severe bike accidents with complicated injuries. In addition to head injuries, which are common and account for most of the fatalities, we have observed an increase in liver trauma over the years.

Method: Approximately 19 000 bike associated accidents were reported in 1998 in Austria. A total of 52 patients were admitted to our trauma ward between 1995 and 1997 with mountain-bike associated injuries. Of the 52, eight presented with subcapsular hematoma of the liver sustained by falling while riding. In all patients, nonoperative management was successful. These injuries were associated with a special form of bar-ends used on the mountain-bikes. After a broad response from the industry, facilitated by many articles in newspapers, life-style magazines, radio and television stations, this type of bar end has nearly vanished from the market.

Results: As a result, in 1998, only one case of liver injury was observed, and from 1999 to August 2000, no such injuries have been reported thus far.

Street and mountain bicycling are popular recreational activities and prevalent modes of transportation with the potential for severe injury. The purpose of this investigation was to compare the incidence, risk factors and injury patterns among adults with severe street versus mountain bicycling injuries.

We conducted a retrospective cohort study using the Southern Alberta Trauma Database of all adults who were severely injured (injury severity score [ISS] ≥ 12) while street or mountain bicycling between Apr. 1, 1995, and Mar. 31, 2009.

Among 11 772 severely injured patients, 258 (2.2%) were injured (mean ISS 17, hospital stay 6 d, mortality 7%) while street (n = 209) or mountain bicycling (n = 49). Street cyclists were often injured after being struck by a motor vehicle, whereas mountain bikers were frequently injured after faulty jump attempts, bike tricks and falls (cliffs, roadsides, embankments). Mountain cyclists were admitted more often on weekends than weekdays (61.2% v. 45.0%, p = 0.040). Injury patterns were similar for both cohorts (all p > 0.05), with trauma to the head (67.4%), extremities (38.4%), chest (34.1%), face (26.0%) and abdomen (10.1%) being common. Spinal injuries, however, were more frequent among mountain cyclists (65.3% v. 41.1%, p = 0.003). Surgical intervention was required in 33.3% of patients (9.7% open reduction internal fixation, 7.8% spinal fixation, 7.0% craniotomy, 5.8% facial repair and 2.7% laparotomy).

With the exception of spine injuries, severely injured cyclists display similar patterns of injury and comparable outcomes, regardless of style (street v. mountain). Helmets and thoracic protection should be advocated for injury prevention.

Le vélo de ville et le vélo de montagne sont des activités récréatives et des modes de transport populaires très utilisés, qui comportent un risque de blessures graves. Le but de la présente étude était de comparer l’incidence des blessures, les facteurs de risque et les types de blessures les plus fréquents chez les adultes victimes d’accidents impliquant l’utilisation de la bicyclette en ville et hors-piste.

Nous avons procédé à une étude de cohorte rétrospective à partir de la base de données de traumatologie du Sud de l’Alberta, en regroupant tous les adultes qui ont été victimes d’une blessure grave (indice de gravité de la blessure [IGB] ≤ 12), alors qu’ils circulaient à vélo en ville ou hors-piste entre le 1^er avril 1995 et le 31 mars 2009.

Parmi les 11 772 patients blessés gravement, 258 (2,2 %) l’ont été (IGB moyen 17, séjour hospitalier 6 jours, mortalité 7 %) alors qu’ils circulaient à bicyclette en ville (n = 209) ou hors-piste (n = 49). Les cyclistes qui roulent en ville sont souvent victimes de collision avec des automobiles, tandis que les adeptes du vélo de montagne se blessent souvent lors de tentatives de sauts ou d’acrobaties infructueuses et de chutes (escarpements, accotements, talus). Les adeptes du vélo de montagne ont été plus souvent admis les fins de semaine que les jours de semaine (61,2 % c. 45,0 %, p = 0,040). Les types de blessures étaient similaires dans les 2 groupes (tous p > 0,05), les traumatismes crâniens (67,4 %), les blessures aux extrémités (38,4 %), à la poitrine (34,1 %), au visage (26,0 %) et à l’abdomen (10,1 %) ayant été les plus fréquents. Les lésions médullaires ont toutefois été plus fréquentes chez les adeptes du vélo de montagne (65,3 % c. 41,1 %, p = 0,003). Une intervention chirurgicale a été nécessaire chez 33,3 % des patients (9,7 % pour fixation interne par réduction chirurgicale, 7,8 % pour une fixation du rachis, 7,0 % pour une craniotomie, 5,8 % pour réparation faciale et 2,7 % pour laparotomie).

À l’exception des blessures à la colonne vertébrale, les cyclistes gravement blessés présentent des types de blessures similaires et des résultats comparables, indépendamment du type de vélo qu’ils pratiquent (ville c. montagne). Il faut promouvoir le port de casques et de plastrons de protection pour prévenir les blessures.