Most Common Abdominal Organ Injury in Pediatric Handlebar Bicycle Trauma
The spleen is definitively the most common abdominal organ injured in pediatric handlebar bicycle trauma, accounting for 25-30% of all pediatric blunt abdominal injuries. 1, 2
Epidemiology and Mechanism
Bicycle handlebar injuries specifically target the spleen due to the mechanism of direct impact to the left upper quadrant, where the spleen is anatomically positioned. 2, 3
The spleen remains the most frequently injured solid organ across all mechanisms of pediatric blunt abdominal trauma, including motor vehicle accidents, falls, sports injuries, and bicycle-related trauma. 1, 4, 5
Handlebar injuries are explicitly recognized as a distinct mechanism for splenic trauma in pediatric populations, with the World Society of Emergency Surgery guidelines specifically mentioning bicycle injuries as a common cause. 1
Why the Spleen is Most Vulnerable
The elastic pediatric rib cage transmits force directly into the abdominal compartment rather than absorbing it, making the spleen particularly susceptible to injury from handlebar impact. 1
The left upper quadrant location of the spleen makes it the primary target when a child impacts a bicycle handlebar during a fall or collision. 2, 3
Clinical Recognition
Upper abdominal pain and tenderness after handlebar injury most commonly indicates splenic injury, though children may maintain hemodynamic stability despite significant trauma due to their physiologic reserve. 2
The presence of ecchymosis over the upper abdomen, particularly in the left upper quadrant, should immediately raise suspicion for splenic injury. 3
Critical Diagnostic Considerations
FAST examination has limited sensitivity (56-79%) in pediatric patients and an inconclusive or negative FAST does not rule out splenic injury. 2
Contrast-enhanced CT scan is the gold standard with 97% sensitivity and should be performed in hemodynamically stable children with handlebar injuries and abdominal tenderness. 2
Longer hospital admission should be considered specifically for bicycle handlebar injuries due to the risk of delayed complications. 1
Other Organs (Less Common)
While the spleen is most common, handlebar injuries can also cause:
- Liver trauma (second most common solid organ injury overall in pediatric blunt trauma) 5, 6
- Bowel perforation 7
- Pancreatic injuries 7, 6
- Kidney lacerations 8
However, these occur significantly less frequently than splenic injury in the handlebar mechanism. 1, 4, 5
Management Implications
Non-operative management is successful in 95-100% of pediatric splenic injuries when managed in appropriate facilities with 24/7 surgical capability. 1, 2
The Eastern Association for the Surgery of Trauma recommends non-operative management for all hemodynamically stable children with splenic trauma regardless of injury grade. 1