Bicycle handlebar injuries in children: Is “ring sign,” an indicator of intra‑abdominal organ injuries?

  • J Deepak
  • K L Aravind
  • Gowri Shankar
  • M Narendrababu


Background: Children are vulnerable to a wide range of bicycle-related traumatic injuries. Bicycle handlebar injuries often cause
diagnostic dilemma and delay in diagnosis due to trivial nature of the incident. Objectives: To study the bicycle handlebar injuries
in children and their management. Materials and Methods: A retrospective review of all the children with blunt abdominal injuries
secondary to bicycle handlebar injuries at our institution, between April 2011 and March 2015 was done. The patient medical records
were examined, and all the data pertaining to the demographic information, clinical history, hematological investigations, imaging
studies, operative technique, post-operative recovery and complications, and duration of hospitalization were obtained. Results: During
the study period of 48-month, 26 children with blunt abdominal injuries were treated at our institution. Among these patients, 7 children
had bicycle handlebar abdominal injuries. All 7 patients were male. Mean age of the patients was 9.6 years (range 5-12 years). The
average time gap between trauma and presentation to our institution was 46 h (range 22-96 h). All the 7 children had circular patterned
abrasion of the bicycle handlebar over the abdominal wall. Mean duration of hospital stay was 16.1 (range: 9-28) days, and the average
duration of follow-up was 35.6 months (range 7-55 months). Conclusion: “Ring sign” indicates a higher probability of associated intraabdominal
injury, and these children should be thoroughly evaluated and managed with close observation, repeated clinical examination,
appropriate imaging studies, and surgical or endoscopic intervention as required.

Keywords: Bicycle handlebar injury, Ring sign, Blunt abdominal trauma, Traumatic pancreatitis
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How to Cite
Deepak J, Aravind K, Shankar G, Narendrababu M. Bicycle handlebar injuries in children: Is “ring sign,” an indicator of intra‑abdominal organ injuries?. Indian Journal of Child Health [Internet]. 29Nov.2017 [cited 18Jan.2020];2(4):204-9. Available from:
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