10.13 Bicycle Spoke Injury
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agk's Library of Common Simple Emergencies

Presentation
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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:
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- 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:
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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 dressings, 
elevation and early followup.

Illustration
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img/cse1013.gif 

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