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Extremity fractures associated with ATVs and dirt bikes: a 10-year national epidemiologic study



Morbidity and mortality of all-terrain vehicles and dirt bikes have been studied, as well as the association of helmet use and head injury.


The purpose of this study is to compare and contrast the patterns of extremity fractures associated with ATVs and dirt bikes. We believe there will be unique and potentially preventable injury patterns associated with dirt bikes and three-wheeled ATVs due to the poor stability of these vehicles.

Study design

Descriptive epidemiology study.


The National Electronic Injury Surveillance System (NEISS) was used to acquire data for extremity fractures related to ATV (three wheels, four wheels, and number of wheels undefined) and dirt bike use from 2007 to 2012. Nationwide estimation of injury incidence was determined using NEISS weight calculations.


The database yielded an estimate of 229,362 extremity fractures from 2007 to 2012. The incidence rates of extremity fractures associated with ATV and dirt bike use were 3.87 and 6.85 per 1000 participant-years. The largest proportion of all fractures occurred in the shoulder (27.2%), followed by the wrist and lower leg (13.8 and 12.4%, respectively). There were no differences in the distribution of the location of fractures among four-wheeled or unspecified ATVs. However, three-wheeled ATVs and dirt bikes had much larger proportion of lower leg, foot, and ankle fractures compared to the other vehicle types.


While upper extremity fractures were the most commonly observed in this database, three-wheeled ATVs and dirt bikes showed increased proportions of lower extremity fractures. Several organizations have previously advocated for better regulation of the sale and use of these specific vehicles due to increased risks. These findings help illustrate some of the specific risks associated with these commonly used vehicles.

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Correspondence to V. J. Sabesan.

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Conflict of interest

Daniel J. Lombardo MD declares that he has no conflict of interest. Timothy Jelsema MD declares that he has no conflict of interest. Andrew Gambone MD declares that he has no conflict of interest. Martin Weisman MD declares that he has no conflict of interest. Graysen Petersen-Fitts MD declares that he has no conflict of interest. James D. Whaley MD declares that he has no conflict of interest. Vani J. Sabesan MD declares that she has no conflict of interest. The funding is for work outside of the submitted manuscript.


Dr. Sabesan has received grant funding from Exactech, Inc.; Pacira Pharmaceuticals, Inc; Orthopaedic Research and Education Foundation.

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This article does not contain any studies with human participants performed by any of the authors.

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Lombardo, D.J., Jelsema, T., Gambone, A. et al. Extremity fractures associated with ATVs and dirt bikes: a 10-year national epidemiologic study. Musculoskelet Surg 101, 145–151 (2017).

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