Hard to Handle: Penetrating Bicycle Handlebar Injuries in Children, 2005–2024

Introduction: Blunt bicycle handlebar injuries in children are well described; however, penetrating injuries caused by handlebar ends or brake levers remain poorly characterized. We sought to describe the epidemiology, injury patterns, and clinical outcomes of penetrating bicycle handlebar injuries in children using a national emergency department surveillance dataset. Methods: We conducted a retrospective cross-sectional study using National Electronic Injury Surveillance System data from 2005 to 2024 and identified bicycle handlebar injuries in pediatric patients (≤21 y). Using diagnosis codes for puncture wounds and foreign bodies and narrative keyword searches, cases of penetrating trauma were identified. Exclusion criteria included nonhandlebar, superficial, or ambiguous cases. Results: Among 12,939 handlebar-related bicycle injuries, 127 cases met criteria for penetrating handlebar injury (national estimate ∼3078 cases). Most penetrating injuries were puncture wounds (109/127, 85.8%), while 18/127 (14.2%) involved a retained foreign body. Penetrating injuries were concentrated in school-age children (5-14 y) and occurred most in the upper leg and abdomen. Compared with nonpenetrating handlebar injuries, penetrating injuries were associated with significantly higher hospitalization rates and remained independently associated with hospitalization after adjustment (adjusted odds ratio ∼6.30, 95% confidence interval 4.23-9.39, P < 0.001). Conclusions: Penetrating bicycle handlebar injuries, while rare, are associated with substantially increased hospitalization compared with nonpenetrating handlebar trauma. These findings support targeted prevention efforts in school-age children and highlight the importance of safer handlebar and brake lever design.