Complex Pediatric Foot Injuries Secondary to Entrapment in Motorcycle Spokes: A Series of 56 Cases

Objectives: To describe the clinical presentation, severity, anatomical involvement, and initial management of pediatric foot and ankle injuries secondary to motorcycle wheel-spoke entrapment. Methods: A retrospective, observational, descriptive study was conducted on a consecutive series of pediatric patients with foot and ankle injuries caused by motorcycle wheel-spoke entrapment, treated at a referral trauma center between January 2023 and December 2025. Demographic characteristics, anatomical distribution according to the Zwipp zonal classification, injury severity based on the Zwipp score and Muzzammil classification, affected structures, treatment performed, number of surgical procedures, and length of hospital stay were analyzed. Results: Fifty-six patients were included. High-severity injuries (Zwipp score ≥5) were identified in 22 patients (39.3%), while type IIIB and IIIT injuries accounted for 84% of cases according to the Muzzammil classification. Bone exposure was documented in 30 patients (53.6%), and open fractures in 21 (37.5%). The tarsometatarsal region was the most frequently affected anatomical site. Management required a median of three surgical procedures (interquartile range (IQR), 2-3), and soft-tissue coverage using skin grafts and/or flaps was required in 18 patients (32.1%). Conclusions: Motorcycle wheel-spoke entrapment is associated with severe foot and ankle injuries in children, characterized by extensive soft-tissue damage, osseous and tendinous involvement, and the frequent need for multiple surgical procedures. This series provides a detailed characterization of the anatomical patterns, severity, and initial management of this uncommon but potentially devastating mechanism of pediatric trauma.