Tram system related cycling injuries



Understanding of tram-system related cycling injuries (TSRCI) is poor. The aim of this study was to report the spectrum of injuries, demographics and social deprivation status of patients. Secondary aims included assessment of accident circumstances, effects of TSRCI on patients’ confidence cycling, together with time off work and cycling.


A retrospective review of patients presenting to emergency services across all hospitals in Edinburgh and West Lothian with tram related injuries between May 2009 and April 2016 was undertaken. Medical records and imagining were analysed and patients were contacted by telephone.


191 cyclists (119 males, 72 females) were identified. 63 patients sustained one or more fractures or dislocations. Upper limb fractures/dislocations occurred in 55, lower limb fractures in 8 and facial fractures in 2. Most patients demonstrated low levels of socioeconomic deprivation. In 142 cases, the wheel was caught in tram-tracks, while in 32 it slid on tracks. The latter occurred more commonly in wet conditions (p = 0.028). 151 patients answered detailed questionnaires. Ninety-eight were commuting. 112 patients intended to cross tramlines and 65 accidents occurred at a junction. Eighty patients reported traffic pressures contributed to their accident. 120 stated that their confidence was affected and 24 did not resume cycling. Female gender (p < 0.001) and presence of a fracture/dislocation (p = 0.012) were independent predictors of negative effects on confidence. Patients sustaining a fracture/dislocation spent more time off work (median 5 days vs 1, p < 0.001) and cycling (median 57 days vs 21, p < 0.001).


TSRCI occur predominantly in young to middle-aged adults with low levels of socioeconomic deprivation, most commonly when bicycle wheels get caught in tram-tracks. They result in various injuries, frequently affecting the upper limb. Traffic pressures are commonly implicated. Most patients report negative effects on confidence and a sizeable minority do not resume cycling. TSRCI can result in significant loss of working and cycling days.

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Change history

  • 21 February 2018

    The author would like to correct the errors in the publication of the original article. The corrected details are given below for your reading.


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Corresponding author

Correspondence to J. F. Maempel.

Ethics declarations

Conflict of interest

J Maempel, S Mackenzie, P Stirling, C McCann and T White declare that they have no conflict of interest. Professor C Oliver was a member and councillor of the Cyclists Touring Club Lothian and Borders and also the chair of the Road Share Steering Group based in Edinburgh, Scotland. He no longer holds these positions.

Ethical approval

For this type of study formal consent is not required. The study was registered locally as an audit of service.

Informed consent

All patients contacted by telephone to answer questions regarding the circumstances of their incidents, effects on confidence, cycling and return to work were asked for informed consent to include their responses in the study prior to asking them any questions. 4 patients declined and did not, therefore, respond to the questions. The responses from the remaining patients who gave consent were included in the manuscript.

Additional information

The ​original ​version ​of ​this ​article ​was ​revised: The author would like to correct the errors in the first paragraph of the Methods section.

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Maempel, J.F., Mackenzie, S.P., Stirling, P.H.C. et al. Tram system related cycling injuries. Arch Orthop Trauma Surg 138, 643–650 (2018).

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  • Cyclist
  • Cycling
  • Tram
  • Tram-system
  • Streetcar
  • Light rail
  • Fractures
  • Injuries