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Physical Activity for Health Research Centre (PAHRC)
Edinburgh Cyclists’
Tram Injuries
Prof Chris Oliver
@CyclingSurgeon CyclingSurgeon.Bike
Julian Maepel, Paul Stirling, C McCann, Sam Mackenzie, Tim White, Chris Oliver
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh
http://www.internationalfuturesforum.com/
Edinburgh Orthopaedic Trauma Unit
•Serves 800k in Lothian
•Per year
•A&E 120k+ RIE
•Trauma Orthopaedic
•7k inpatients
•6k operations
•42k outpatients
•> 1,000 hip fractures
•12 consultants
•Regional & military training
•National Trauma Centre
•Academic program
•International Trauma Symposium
http://www.ed.ac.uk/clinical-sciences/orthopaedics-trauma/clinical/trauma
Prof Chris Oliver
Section Editor Trauma:
•Multiple injury
•Skin Loss
•Burns
•Skeletal injury
•Conflict & Military
•Head injury
•Chest injury
•Abdominal injury
•Vascular injury
OUP
ISBN: 9780199665549
https://www.theguardian.com/environment/bike-blog/2013/jul/18/los-angeles-boston-united-states-rockies-bike-blog
Do 20mph speed limits reduce casualties and
increase cycling, walking, and liveability in the
general population?
•National Institute Health
Research –NIHR
•£890k grant
•Lead by
•Scottish Collaboration for Public
Health Research & Policy
•Physical Activity for Health
Research Centre, The University
of Edinburgh
•Centre for Public Health, Queen’s
University Belfast
•August 2020
•Prof Chris Oliver - Study
Steering Committee Member
http://www.isrctn.com/ISRCTN10200526
Some Cycling Safety Facts
•Life years gained due to the health & fitness
benefits of cycling in Britain outweigh life-years
lost through injuries by a factor of around 20:1
•2011-2015, one cyclist was killed on Britain’s
roads for every 29 million miles travelled by
cycle = 1,000 times around the world
•Unlikely to be killed cycling as walking
•UK has a good road safety record
•Cycle safety in is one of the poorest in Europe
Cycling UK (CTC)
http://www.parliament.scot/ResearchBriefingsAndFactsheets/S4/SB_14-30.pdf
http://www.parliament.scot/ResearchBriefingsAndFactsheets/S4/SB_14-30.pdf
All Cycling injuries in Lothian PreTram
Cycling accounted for 11% of sports fractures (n=104).
•Mountain Biking 73, Road 25, BMX 6
Mean Age: 31 years. 88% ♂: 12% ♀
Upper Limb 91%: Lower Limb 8%: Axial 1%.
Commonest Upper Limb Fractures:
Clavicle (22%), Distal Radius (14%), Metacarpal (12%)
Proximal Radius (12%), Finger Phalanx (10%).
Commonest Lower Limb / Axial Fractures:
Toe Phalanx (2%), Ankle (1%), Pelvis (1%).
Greg Robertson EOTU
Greg Robertson EOTU
Greg Robertson, Hilary Scott,
Chris Oliver
Br J Sports Med 2017
doi:10.1136/bjsports-2016-097445
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
Edinburgh Tram Inquiry
http://www.edinburghtraminquiry.org/
Retrospective review Tram related Injuries
•7 years
•41.4 years +/- 16 years
•24% weekends
•All to A&E in Lothian; RIE, SJH, WGH
•>1000 x-rays, 10 CT/MRI scans, blood tests
•156 soft tissue injuries
•64 fractures
•29 operations
•Mean length of hospital stay 1.7days
•Economic impact unknown
Mechanism of cycling tram injuries
•143 wheels caught in
tram track
•32 wheels slipped on
tram track
•1 collision with tram
•Forced by other vehicle
to change path and
forced towards tram
track
•Pedestrians
Anatomical region
Soft tissue injury
Fracture
Head injury
- minor
33
0
Head injury
- serious
0
1
Thorax
5
0
Abdomen
4
0
Clavicle
0
4
Acromioclavicular joint
4
0
Proximal Humerus
15
4
Humeral shaft
0
2
Elbow
15
18
Forearm
2
1
Wrist
26
11
Hand
10
7
Finger
5
8
Hip
9
2
Thigh
2
0
Knee
21
2
Leg
2
0
Ankle
2
1
Foot
1
2
Toe
0
1
Total
156
64
Tram related injuries Lothian Post Tram
Procedure
Number
Dynamic Hip Screw
1
Cannulated
Hip screws
1
Midfoot ORIF
1
Distal radius ORIF
6
Olecranon ORIF
2
Distal radius ex
-fix
1
Phalanx ORIF
1
Distal Humerus ORIF
1
Emergency Carpal Tunnel Decompression
1
Rotator cuff repair
1
Nasal fracture MUA
1
Wound suturing in ED
12
Total
29
Tram related injuries Lothian Post Tram
Hip fracture after tram cycling injury - Dynamic Hip Screw
Representative images
Tram Injury Cycling - Complex elbow injuries
Professor
Physical Activity for Health
Sit Less
Walk More
Which is Different
and Why?
MRI Cross Sectional Leg Scans
40-year-old triathlete
74-year-old sedentary man
70-year-old triathlete
Copyright © BMJ Publishing Group Ltd & British Association of Sport and Exercise Medicine. All rights reserved.
C Schiphorst, A Murray, P Kelly,
C Oliver, F Bull
Br J Sports Med
doi:10.1136/bjsports-2016-
096999
@PlayonPedals
7k preschool riding in Glasgow
World Health Organisation to develop Global
Action Plan to Promote Physical Activity
http://blogs.bmj.com/bjsm/2017/05/22/world-health-organisation-develop-global-action-plan-promote-physical-activity/
Cyclist blaming
What to do?
Policy change
Cycling Action Plan
New Active Travel
Infrastructure
Reverse engineer
Shims
http://www.internationalfuturesforum.com/
Physical Activity for Health Research Centre (PAHRC)
Edinburgh Cyclists’
Tram Injuries
Prof Chris Oliver
@CyclingSurgeon CyclingSurgeon.Bike
Julian Maepel, Paul Stirling, C McCann, Sam Mackenzie, Tim White, Chris Oliver
Edinburgh Orthopaedic Trauma Unit, Royal Infirmary of Edinburgh