Bicycle Spoke Injury

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10.13 Bicycle Spoke Injury

Presentation

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 hours.
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 necessary.

What not to do:

Do not assume that because the x rays are negative you are merely dealing with a simple abrasion.

Discussion:

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 followup.

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