Wheel-spoke injuries in a resource-limited setting: A Retrospective observational study in District General Hospital Kilinochchi, Sri Lanka

Abstract

Background: Wheel-spoke injuries are a common mechanism of trauma in low- and middle-income countries, especially affecting children. These injuries although common, are easily preventable. These injuries mainly occur while travelling as a pillion rider on bicycles or motorbikes. The injuries can range from minor abrasions to degloving injuries and fractures, potentially resulting in significant tissue damage.
Aim: To evaluate the injury pattern, management strategies and outcomes of wheel-spoke injuries with the aim of understanding effective preventive measures in a District General Hospital in Northern Sri Lanka.
Methods: A retrospective observational study was conducted at District General Hospital Kilinochchi. Records of patients who presented with wheel-spoke injuries from June 2024 to April 2026 were traced and reviewed. Data collected were the demographics, mechanism of injury, type of injury and its severity, management undergone and its outcome. Descriptive statistics were used to summarize the data and comparative analyses were performed to assess the differences between the groups.
Results: Mean age was 5.7 years. Females comprised of 59.1%. Severe injuries accounted for 9.3%. Surgical intervention required in 38.6%.
On Comparative analysis,
• Severity vs Surgery: p < 0.001
• Delayed presentation vs severity: p = 0.041
• Delayed presentation vs surgery: p = 0.048
• Delayed presentation vs complications: p = 0.032
Conclusion: Wheel-spoke injuries are preventable, but common and significant mechanism of injury found in certain communities. Delayed presentation significantly worsens the injury severity, need for surgical intervention and complication rates. Therefore, early presentation could be considered a critical modifiable factor in the management of patients with wheel-spoke injuries.