A small child, riding on the back of a friend's bike, gets
his foot caught between the spinning spokes and the frame or
fender supports. The skin over the lateral or medial aspect
of the foot or ankle is crushed and abraded with underlying
soft tissue swelling
What to do:
Cleanse the area with a gentle scrub (SurClens, Betadine).
Provide any tetanus prophylaxis required, apply a
temporary dressing of povidone-iodine and normal saline, cover with a cold pack and elevate above the level of the heart.
Get radiographic studies to rule out any fracture.
Dress the wound with antibiotic ointment and a non-
adherent cover such as Adaptic gauze. Incorporate a bulky
compressive dressing consisting of gauze fluffs, Kerlex
and a mildly compressive ACE wrap.
Have the patient keep the foot strictly elevated over the
next 24 hours and schedule him for a wound check within 48
Inform the parents that the crushed skin is not a simple
abrasion and may not survive. They should understand that
a slow-healing sore might result or skin grafting might be
required, and therefore careful surgical followup is
What not to do:
Do not assume that because the x rays are negative you are
merely dealing with a simple abrasion.
Bicycle spoke injuries are similar to, but not as serious
as, wringer injuries. Fractures are not commonly associated
with these injuries but often there is severe soft tissue
injury. Consequences of his crush injury can be minimized by
the use of compression ressings, elevation and early