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Peer-reviewedCC BY 4.0Journal of Clinical Medicine

Bicycle-Related Acetabular Fractures Are Associated with Anterior Column Involvement: A Multicenter Study with an Exploratory Analysis of Clipless Pedal Use

  • Bong-Ju Lee1,2
  • Hwan-Hee Lee3
  • Sung-Min Kim4
  • Pichayut Wattanapreechanon4,5
  • Se-Won Lee4
5 affiliations
  1. 1Department of Orthopedic Surgery, Daejeon Sun Hospital, Daejeon 34811, Republic of Korea
  2. 2Department of Orthopedic Surgery, Graduate School, The Catholic University of Korea, Seoul 06591, Republic of Korea
  3. 3Department of Orthopedic Surgery, Daejeon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Daejeon 34943, Republic of Korea
  4. 4Department of Orthopedic Surgery, Yeouido St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 10 63-ro, Yeongdeungpo-gu, Seoul 07345, Republic of Korea
  5. 5Department of Orthopedics, Faculty of Medicine Vajira Hospital, Navamindradhiraj University, 3 Thanon Khao, Wachira Phayaban, Dusit District, Bangkok 10300, Thailand
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Abstract

Background/Objectives: Cycling-related acetabular fractures have not been well described. We aimed to determine the proportion of acetabular fractures associated with bicycle accidents and to compare their fracture patterns with those caused by other mechanisms. Findings related to clipless pedal use were considered exploratory. Methods: Patients treated for an acetabular fracture between January 2010 and December 2023 were identified by ICD-10 codes from a university hospital network Clinical Data Warehouse. After exclusions, 378 patients with 385 fractures were classified according to the Judet–Letournel system. Fracture-pattern proportions were compared using Fisher’s exact test, and the association with anterior column involvement was examined with logistic regression adjusted for age and sex. Cleat-shoe status, obtained from medical records or telephone interviews, was analyzed descriptively. Results: Bicycle accidents were the mechanism of injury in 26 of 378 patients (6.9%). Compared with fractures caused by other mechanisms, bicycle-related fractures showed a higher proportion of pure anterior column fractures (38.5% versus 16.7%, p = 0.014) and anterior column involvement (65.4% versus 38.2%, p = 0.011). The association with anterior column involvement remained after adjustment for age and sex (adjusted odds ratio 3.02, 95% CI 1.31–6.98). Among 12 confirmed cleat-shoe users, 7 (58.3%) had a pure anterior column fracture, 10 (83.3%) had anterior column involvement, and 8 (66.7%) had extension into the acetabular roof. Conclusions: Bicycle-related acetabular fractures were associated with a higher proportion of anterior column involvement, and the association remained after adjustment for age and sex. Because bone quality and injury energy could not be adjusted for, this association should not be interpreted as causal. The anterior-dominant pattern among confirmed cleat-shoe users is exploratory and should not be interpreted causally.

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Cite

BibTeXRIS
BibTeX
@article{lee2026bicyclerelated,
  title = {{Bicycle-Related Acetabular Fractures Are Associated with Anterior Column Involvement: A Multicenter Study with an Exploratory Analysis of Clipless Pedal Use}},
  author = {Bong-Ju Lee and Hwan-Hee Lee and Sung-Min Kim and Pichayut Wattanapreechanon and Se-Won Lee},
  journal = {Journal of Clinical Medicine},
  year = {2026},
  month = oct,
  doi = {10.3390/jcm15207918},
  url = {https://www.mdpi.com/2077-0383/15/20/7918},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Bicycle-Related Acetabular Fractures Are Associated with Anterior Column Involvement: A Multicenter Study with an Exploratory Analysis of Clipless Pedal Use
AU  - Bong-Ju Lee
AU  - Hwan-Hee Lee
AU  - Sung-Min Kim
AU  - Pichayut Wattanapreechanon
AU  - Se-Won Lee
PY  - 2026
DA  - 2026/10/01
JO  - Journal of Clinical Medicine
DO  - 10.3390/jcm15207918
UR  - https://www.mdpi.com/2077-0383/15/20/7918
AB  - Background/Objectives: Cycling-related acetabular fractures have not been well described. We aimed to determine the proportion of acetabular fractures associated with bicycle accidents and to compare their fracture patterns with those caused by other mechanisms. Findings related to clipless pedal use were considered exploratory. Methods: Patients treated for an acetabular fracture between January 2010 and December 2023 were identified by ICD-10 codes from a university hospital network Clinical Data Warehouse. After exclusions, 378 patients with 385 fractures were classified according to the Judet–Letournel system. Fracture-pattern proportions were compared using Fisher’s exact test, and the association with anterior column involvement was examined with logistic regression adjusted for age and sex. Cleat-shoe status, obtained from medical records or telephone interviews, was analyzed descriptively. Results: Bicycle accidents were the mechanism of injury in 26 of 378 patients (6.9%). Compared with fractures caused by other mechanisms, bicycle-related fractures showed a higher proportion of pure anterior column fractures (38.5% versus 16.7%, p = 0.014) and anterior column involvement (65.4% versus 38.2%, p = 0.011). The association with anterior column involvement remained after adjustment for age and sex (adjusted odds ratio 3.02, 95% CI 1.31–6.98). Among 12 confirmed cleat-shoe users, 7 (58.3%) had a pure anterior column fracture, 10 (83.3%) had anterior column involvement, and 8 (66.7%) had extension into the acetabular roof. Conclusions: Bicycle-related acetabular fractures were associated with a higher proportion of anterior column involvement, and the association remained after adjustment for age and sex. Because bone quality and injury energy could not be adjusted for, this association should not be interpreted as causal. The anterior-dominant pattern among confirmed cleat-shoe users is exploratory and should not be interpreted causally.
SN  - 2077-0383
ER  -