If a child wearing a helmet strikes a fixed object on his or her bicycle and flies over the handlebars, you would MOST likely encounter:

• A. Skull fracture
• B. Chest wall contusion
• C. Fracture of the femur
• D. Compression injuries to the intra-abdominal organs

Answer: (D)

The key idea is how the injury mechanism in a bicycle crash with a rider going over the handlebars concentrates force on the abdomen. When the rider is pitched forward and over the handlebar, the abdomen can be directly compressed against the steering column or against the spine during impact. This “handlebar injury” pattern makes intra-abdominal organs vulnerable to crush injuries, such as blunt trauma to the pancreas, duodenum, stomach, liver, or spleen, even if the head is protected by a helmet. Helmets reduce head injuries but don’t prevent injuries to the abdomen, so abdominal compression injuries are more likely here than skull fractures or chest wall contusions. A femur fracture is possible in high-energy crashes, but the classic, most likely result from this mechanism is injury to the intra-abdominal organs from crushing forces. If such trauma is suspected, assess for abdominal signs and use imaging (like FAST or CT) to evaluate for intra-abdominal injury.