Heel injuries caused by motorcycle spokes: experience in an orthopedic trauma service-case series.

INTRODUCTION: Motorcycles are a widely used mode of transportation in Colombia; however, they pose a particular risk of injury to child passengers, mainly due to the heel becoming entangled in the rear tire spokes. METHODS: A series of 45 cases treated at the Hospital Susana Lopez de Valencia in Popayán Colombia between 2020 and 2024 were retrospectively reviewed. Patients were classified into three severity levels based on skin, Achilles tendon, and bone involvement. Management included debridement, prophylactic antibiotics, negative pressure therapy, and coverage procedures (reverse sural fasciocutaneous and lateral supramalleolar flaps). Descriptive statistics were used. Categorical variables were expressed as n (%); continuous variables as mean (SD) or median [IQR]. The 95% CIs for proportions were calculated using the exact binomial method. Statistical analysis was performed using Stata software. RESULTS: The mean age was 10.9 years (range, 6–45), with 86.7% of patients being under 10 years old, and all were passengers. The lesion size ranged from 4 to 48 cm², with a mean of 27.2 cm². The right foot was the most commonly injured, accounting for 64.4% of cases. According to injury severity, the most common were GII (55.6%, CI 95%: 40.4–69.7) and GIII (28.9%, CI 95%: 17.2–44.2). Negative pressure therapy was used in 77.8% of cases (Grade II and III). The average hospital stay was 8 days for grade I injuries, 20.3 days for grade II injuries, and 23 days for grade III injuries. Three pre-coverage infections and three partial flap necrosis complications occurred. CONCLUSIONS: Heel injuries caused by motorcycle lightning are common, preventable, and primarily affect children. Treatment requires multiple surgical procedures and specialized coverage with regional flaps. Educational and preventive campaigns are needed to reduce their incidence.