Bicycle-Related Injuries of the Upper Extremity

Document Type : RESEARCH PAPER


1 Department of Orthopaedic Surgery National University Hospital, Singapore

2 Department of Orthopaedic Surgery, National University Hospital, Singapore

3 Yong Loo Lin School of Medicine, National University of Singapore, Singapore


Background: In recent years, the increasing popularity of cycling for commuting and leisure has led to a
corresponding increase in bicycle-related injuries. However, there is a lack of extensive analysis of bicycle-related
injuries to the upper limb in the literature.
Methods: A retrospective review of all patients with conventional bicycle-related injuries of the upper limb was
performed. Data on demographics, mechanisms of injury, region of injury, fracture type, management type, and
length of hospital stay were extracted and analyzed.
Results: A total of 177 of 733(24%) patients with bicycle-related upper limb injuries were identified. The most common
mechanism of injury was a collision with another vehicle (60%). Frequently affected regions were the shoulder
(48%), hand (19%), and wrist (19%). Eighty-eight (50%) patients sustained bony injuries, while the remainder (50%)
had isolated soft tissue injuries. Fifty-three (30%) patients required a mean of 3.9 days of hospitalization, whereas
13 (25%) patients required high dependency or intensive care unit treatment. Surgical interventions were required
in 47 (27%) patients.
Conclusion: Bicycle-related injuries to the upper limb are common and result in significant morbidity. The most
common regions affected are the shoulder, wrist, and hand. Most of the injuries were caused by collisions with other
vehicles. A third of affected patients required hospitalization, and a quar ter required surgical intervention.
Level of evidence: III


Main Subjects

1. Where we ride: analysis of bicycling in American
cities. report on 2013 American Community Survey
data by the league of american bicyclists. Available
report_2014_forweb_edit.pdf. Accessed, 2014.
2. Pucher J, Buehler R. Walking and Cycling for Healthy
Cities. Journal of the Transportation Research Board.
2008; 58-65.
3. Singapore sees cycling boom amid COVID-19, with
increased ridership and bicycle sales. Available at:
631621. Accessed 25 Aug, 2020.
4. JUSTIN ONG . The Big Read: Road wars — will the
conflict between drivers and cyclists ever end?
Available at:
and-cyclists-ever-end. Accessed 9 January,
5. Oja P, Vuori I, Paronen O. Daily walking and cycling
to work: their utility as health-enhancing physical
activity. Patient Educ Couns. 1998;33:S87-94. doi:
6. Oja P, Titze S, Bauman A, et al. Health benefits Sports. 2011;21(4):496-509. doi: 10.1111/j.1600-
7. Mehan TJ, Gardner R, Smith GA, McKenzie LB. Bicyclerelated
injuries among children and adolescents in the
United States. Clin Pediatr (Phila). 2009;48(2):166-
73. doi: 10.1177/0009922808324952.
8. Wee JH, Park JH, Park KN, Choi SP. A comparative
study of bike lane injuries. J Trauma Acute
Care Surg. 2012;72(2):448-53. doi: 10.1097/
9. Lloyd R, Tucker A, Archbold P, Eames N. The changing
face of serious bicycle injuries from a UK Regional
Trauma Centre. Journal of Science and Cycling.
10. Thompson MJ RF. Bicycle-related injuries. Am Fam
Physician. 2001;63(10):2007-14...
11. L Peter, CC Hong, P Daniel, R Aoyama, D Murphy, WS
Kuan. Bicycle-Related Injuries in Paediatric Patients.
Annals of the Academy of Medicine, Singapore.
12. MR. S. Bicycling injuries. Curr Sports Med Rep.
2013;12(5):337-45. doi: 10.1249/JSR.0b013e318
13. Goldstein Y, Dolkart O, Kaufman E,et al. Bicycle-
Related Shoulder Injuries: Etiology and the Need for
Protective Gear. Isr Med Assoc J. 2016;18(1):23-6..
14. Gustilo RB, Anderson JT. Prevention of infection
in the treatment of one thousand and twentyfive
open fractures of long bones: retrospective
and prospective analyses. J Bone Joint Surg Am.
15. Chen WS, Dunn RY, Chen AJ, Linakis JG. Epidemiology
of nonfatal bicycle injuries presenting to United
States emergency departments, 2001–2008.
Academic emergency medicine. 2013;20(6):570-5.
doi: 10.1111/acem.12146.
16. The Straits Times. Parliament: About 2,600 food
delivery riders apply to switch from e-scooters to
e-bikes. Available at:
Accessed November 2022.
17. King CC, Liu M, Patel S, Goo TT, Lim WW, Toh HC.
Injury patterns associated with personal mobility
devices and electric bicycles: an analysis from an
acute general hospital in Singapore. Singapore Med
J. 2020;61(2):96. doi: 10.11622/smedj.2019084.
18. Liew YK, Wee CP, Pek JH. New peril on our roads:
a retrospective study of electric scooter-related
injuries. Singapore Med J. 2020;61(2):92. doi:
19. Toh Ting Wei. 417 road accidents involving cyclists
and e-bike users last year, slight drop from 2018.
Available at:
Accessed 9 January,2021
20. Reynolds CC, Harris MA, Teschke K, Cripton
PA, Winters M. The impact of transportation
infrastructure on bicycling injuries and crashes: a
review of the literature. Environ Health. 2009;8(1):1-
9. doi: 10.1186/1476-069X-8-47.
21. Lusk AC, Furth PG, Morency P, Miranda-Moreno
LF, Willett WC, Dennerlein JT. Risk of injury for
bicycling on cycle tracks versus in the street. Inj Prev.
2011;17(2):131-5. doi: 10.1136/ip.2010.028696.
22. Loo BP, Tsui KL. Bicycle crash casualties in a highly
motorized city. Accid Anal Prev. 2010;42(6):1902-7.
doi: 10.1016/j.aap.2010.05.011.
23. Burkhart TA, Andrews DM. The effectiveness
of wrist guards for reducing wrist and elbow
accelerations resulting from simulated forward falls.
J Appl Biomech. 2010;26(3):281-9. doi: 10.1123/
24. Hagel B, Pless IB, Goulet C. The effect of wrist guard
use on upper-extremity injuries in snowboarders.
Am J Epidemiol. 2005;162(2):149-56. doi: 10.1093/
25. Kendall M, Post A, Rousseau P, Hoshizaki T. The effect
of shoulder pad design on reducing peak resultant
linear and rotational acceleration in shoulderto-
head impacts. InMechanism of concussion in
sports 2014. ASTM International. DOI:10.1520/
26. Richards D, Ivarsson BJ, Scher I, Hoover R, Rodowicz
K, Cripton P. Ice hockey shoulder pad design and the
effect on head response during shoulder-to-head
impacts. Sports Biomech. 2016;15(4):385-96. doi:
27. Harris DA, Spears IR. The effect of rugby shoulder
padding on peak impact force attenuation. Br J
Sports Med. 2010;44(3):200-3. doi: 10.1136/
28. Pain MT, Tsui F, Cove S. In vivo determination
of the effect of shoulder pads on tackling forces
in rugby. J Sports Sci. 2008;26(8):855-62. doi:
29. Robinson LS, Brown T, O’Brien L. Profile and cost of
sport and exercise-related hand and wrist injuries
with Emergency Department presentation J Sci Med
Sport. 2020;23:683-689.
30. Robinson LS, Sarkies M, Brown T, O’Brien L. Direct,
indirect and intangible costs of acute hand and wrist
injuries: A systematic review. Injury. 2016;47:2614-
31. Robinson LS, Brown T, O’Brien L. Cost, profile,
and postoperative resource use for surgically
managed acute hand and wrist injuries with
emergency department presentation J Hand Th
er.2020;S0894-1130:30006-30005. https://doi.
32. Rosberg HE, Carlsson KS, Dahlin LB. Prospective
study of patients with injuries to the hand and
forearm: costs, function, and general health. Scand
J Plast Reconstr Surg Hand Surg. 2005;39(6):360-9.
33. Goh SS, Leong XY, Cheng JY, Teo LT. Electronic Bicycles
and Scooters: Convenience at the Expense of Danger?
Ann Acad Med Singapore. 2019;48(4):125-8.
34. K Beckwith VJ, K Kalaiselvan, S Ganapathy. Bicycle injuries among the paediatric population at an
emergency department in Singapore Singapore Med
J. 2019;60:343–346. doi: 10.11622/smedj.2019009
35. Tan WT CJ, Foo JM. A 5-year profile of trauma
admissions to the surgical intensive care unit
of a tertiary hospital in Singapore.Ann Acad
Med Singapore. 2010;39:363-367. https://doi.
Volume 10, Issue 12
December 2022
Pages 1030-1036
  • Receive Date: 29 June 2021
  • Revise Date: 03 June 2022
  • Accept Date: 14 June 2022
  • First Publish Date: 02 November 2022