Handlebar sign: a bruise with underlying visceral injury

Abstract

A 14-year-old boy presented with a painful swelling topped by a bruise overlying the skin of the right inguinal region without peritonitis. This was the area of impact of bicycle handlebar while riding 6 days ago. On contrast-enhanced CT scan, we found a traumatic abdominal wall hernia (handlebar hernia) near the right deep ring without any solid organ, bowel or urinary bladder injury. Inguinal exploration revealed a defect in transversus abdominis and internal oblique muscle which was repaired and meshplasty was done.Delayed presentation and ignorance towards ‘handlebar sign’ is associated with visceral injury (haematoma/perforation) will incur the risk of rising morbidity and mortality. With CT scan we can assess the abdominal cavity to rule out associated visceral or vascular injury. Surgical repair for restoring disrupted anatomy with or without meshplasty is the preferred approach.

Comparison of two bicycle handlebar trauma cases

“…The impact force associated with such an injury can be considerable owing to the small cross-sectional area of a handlebar end, coupled with the rider’s weight and velocity 4. As the forces of momentum are involved, it is possible that patients with a higher body mass may be at a greater risk of receiving significant soft-tissue damage at comparatively lower speeds; however, many other variables are involved.…”

“…Recognition of the phenomenon coined as ‘motor-scooter handlebar syndrome’ was first reported in 19681; however, this injury mechanism is not exclusive to motorised vehicles with handlebars. Bicycle handlebars are a known cause of both visceral2–4 and vascular trauma 5–8. While rare in occurrence, most vascular traumas associated with this mechanism of injury involve the common femoral artery (CFA) or external iliac artery (EIA) 9.…”

An Unusual Mountain Biking Injury: Case Records of the Massachusetts General Hospital Wilderness Medicine Fellowship

“…Handlebar injuries can include pancreatic injuries, traumatic abdominal wall hernias, duodenal hematoma, splenic and liver injuries, renal injuries, and rarely, vascular injuries. [4][5][6][7][8][9] Handlebar injuries are less common in adults, presumably because of well-developed abdominal wall musculature as well as the reduced likelihood of riding recklessly, in comparison to children and adolescents. 10 At this point, the patient requires evacuation and further evaluation.…”