Long-term consequences of PTW crashes: insights from European in-depth data

OBJECTIVES: Powered-Two-Wheeler (PTW) riders are disproportionately vulnerable to severe injuries and long-term health consequences following road traffic crashes. This study investigates typical crash scenarios, injury patterns, influencing factors and injury-specific mechanisms associated with long-term outcomes for PTW riders, impacting their quality of life. METHODS: Three in-depth crash databases are analyzed: VOIESUR (France), GIDAS (Germany), and RAIDS (Great Britain), covering 4,424 crashes involving at least one PTW, regardless of the model year or rider's experience. Variables included collision configuration, maneuvers, collision speeds, motorcycle type, protective equipment, injury severity following AIS 2015 and predicted functional capacity index (pFCI). The aim was not to compare countries, but rather to compile a broad and relevant sample. RESULTS: Frontal collisions were the most frequent crash configuration (between 57% and 67% according to the databases), typically occurring at junctions when the PTW is going straight on the main road, and the opponent vehicle - mostly a car - is trying to turn across the PTW, from the main road to a secondary road. PTW collision speeds range from 20 to 40 km/h, while opponents are often nearly stationary, with collision speeds under 10 km/h. Overall, the most frequent injuries are rated AIS1 to AIS3, from superficial skin injuries to open radius fractures and joint injuries. Lower extremities are the most affected body region, contributing about a third of the injuries, followed by upper extremities. Frequent injuries with long-term consequences (pFCI ≤ 4) include tibia, fibula, ulna, and severe radius fractures, as well as pelvic ring fractures. Injury-causing parts are found to be primarily the PTW handlebar, the front structure of the oncoming vehicle, and the road surface. The influence of PTW types reflects differences in usage and speed ranges: sports and conventional motorcycles are used on highways and rural areas, while scooters are mostly used in cities. This has consequences for speeds and the severity of injuries: sport and conventional motorcycles are associated with higher MAIS levels and more severe long-term consequences compared to scooters. Protective equipment analysis showed absence or improper use of a helmet correlated with higher head injury severity. CONCLUSIONS: PTW crashes, especially frontal impacts at intersections, result in injuries with predicted long-term consequences, predominantly affecting lower and upper extremities. The head remains relatively safe, since the appropriate use of helmet is now well established in these three countries. Injury mechanisms often involve direct contact with vehicle structures, the PTW itself or the vehicle's opponent, and the road. Severity varies by PTW type: heavier motorcycles are associated with higher injury risk. These findings are important to consider to improve prevention, targeted interventions, patient care, to reduce the deterioration in quality of life and the impact of long-term consequences.