Electric bicycles (e-bikes) are faster and easier to pedal than traditional bikes, making them increasingly popular with teens and young adults. Along with a rise in popularity, physicians at CHOC are witnessing a surge in e-bike injuries.
Dr. John Schlechter, pediatric orthopedic surgeon specializing in sports medicine, arthroscopy, and fracture care for children and adolescents at CHOC, noticed another alarming pattern. Complex patella fractures that were once rare in children are becoming much more common among child and adolescent e-bike riders.
Dr. Schlechter’s current research into e-bike injuries highlights the pressing need to understand inherent dangers and unsafe riding habits.
“In some ways, this research project is a public service announcement,” he says. “A lot of us know this is going on, but we’re trying to put some numbers behind it to enlighten parents, children, and community activists about what we’re really seeing in the hospitals.”
Patella injuries on par with high-speed motor vehicle crashes
Children frequently experience minor injuries during bicycle accidents, but patella fractures are rare. When they occur, Dr. Schlechter notes that they are usually small avulsion fractures. However, patella fractures stemming from e-bike accidents are often far more severe.
“E-bike injuries just blow the kneecap apart because it’s that high-velocity, high-energy impact that we really don’t see in bicycle falls,” Dr. Schlechter says. “We’re putting implants in children that I’ve never seen put on a 13-year-old knee. These implants were reserved for adults with poor bone quality or who were in a high-speed motor vehicle accident.”
Treating severe patella fractures is more complex than applying a brace or a cast. Comminuted patella fractures require an open procedure with specialized stainless steel or titanium implants, or “star plates”. Due to the rarity of these injuries, these specialized implants may not be available at less-equipped children’s hospitals. Moreover, pediatric physicians must now reorient to treatment methods and begin conducting procedures traditionally only performed on adults.
“What we started seeing was more adult-like injuries with higher severity and multiple extremities injured instead of just an isolated injury,” Dr. Schlechter says. “We’re also now seeing multiple organ system involvement — neurological issues with abdominal issues with orthopedic issues — whereas a similar injury from a regular bicycle would result in a leg fracture. If you were to remove the injury mechanism, my theory is that you would remove these types of injuries and surgeries in children and adolescents.”
Understanding electric bicycles and adolescents’ riding habits
With regard to capabilities, some e-bikes are closer to motorcycles than toys.
“Initially, e-bikes were really made for pedal assist,” Dr. Schlechter says. “The original Class 1 pedal-assist e-bikes were made for the person who wants to exercise but might not have the coordination or muscle strength to get themselves up a hill.”
Currently, there are three classes of e-bikes:
- Class 1: Equipped with a pedal assist only; maximum speed of assistance is 20 miles per hour (mph)
- Class 2: Equipped with pedal assist and a throttle to allow riders to start and stop without pedaling; maximum speed of assistance is 20 mph
- Class 3: Equipped with pedal assist and can reach assistance speeds of up to 28 mph; some may include a throttle
Although e-bikes have been on the market for many years, easier access and affordability have led to a recent increase in popularity. Between 2019 and 2022, sales quadrupled, topping 1 million in a year.
Beyond popularity and easy accessibility, Dr. Schlechter notes that some industrious adolescents are circumventing safety speed limiters.
“With the internet being the way it is, kids figure out how to deregulate these bikes,” he says. “E-bikes can come with a governor to control how fast they go, but some people change that to make them even faster than they should be.”
What’s more, children and adolescents may make unsafe choices in riding habits, even if they aren’t normally e-bike users.
“Parents should be aware that although they’re sending their child out with a pedal bike and helmet, their child may still have a friend with an e-bike, and we’re seeing that they somehow attach their bicycle to the e-bike or become a passenger,” Dr. Schlechter says. “So now you have an adolescent riding an e-bike in the street, with a passenger, riding against cars, potentially without their helmet on — if that’s not a recipe for disaster, I don’t know what is.”
Timely intervention and crucial education
Although traditional bicycle accidents account for 50 times as many emergency room visits as e-bike injuries, there is a pressing need for greater awareness about safety risks. The U.S. Consumer Product Safety Commission acknowledges these dangers and recently provided advanced notice of proposed rulemaking to update regulations and standards and mitigate safety risks.
Meanwhile, counties across California are tightening age restrictions on e-bikes. Earlier this year, Marin County adopted a new law prohibiting children younger than 16 from operating a Class 2 electric bicycle. San Diego County also prohibits children under age 12 from riding Class 1 or 2 e-bikes. These regulations help spread awareness, and as Dr. Schlechter’s study will soon elucidate, very necessary.
Dr. Schechter’s research is ongoing, and early details show that when accidents do occur, injuries can be devastating. Once-rare pediatric orthopedic treatments are becoming more frequent as e-bike ridership booms, so the best intervention will be awareness.
His advice for parents is simple: “Children and adolescents should use an old-fashioned pedal bike. It’s good for their coordination, it helps build muscle and bone density, gets them outside, and they can still get to school. They just might have to leave a little bit earlier.”
Learn more about the innovative programs and specialized treatments being used for kids every day at the CHOC Orthopaedic Institute.
