Background photo by Franc
ATGATT. It stands for All The Gear, All The Time and is a war cry made by safety-conscious motorcyclists as they tackle a dangerous world on two wheels. But, do you really need to protect all your body parts all the time? Which body parts will you most likely injure in a motorcycle crash? The Center for Disease Control, World Health Organization, National Highway Traffic Safety Administration and Association For The Advancement Of Automotive Medicine has the answers you need. What can they tell us about motorcycle safety?
The CDC studied the 1,222,000 people who were treated in U.S. emergency rooms for non-fatal, motorcycle-related injuries between 2001 and 2008, then recorded their injuries by location on the body.
The CDC found that 30% of all non-fatal motorcycle injuries happen to the legs and feet
Photo by Elvert Barnes
Surprisingly, the largest percentage of injuries occurred to the leg and foot area — 30 percent of all non-fatal motorcycle injuries were recorded on the lower extremities.
The CDC found that 22% of most common motorcycle crash injuries occurred to the head and neck
Photo by Sarah Nichols
Next most-common were head and neck injuries, making up 22 percent of the total. Those were closely followed by “upper trunk” (i.e. chest, shoulder and back) wounds, then arms and hands, then “lower trunk” (i.e. hips and pelvis).
What the CDC information doesn’t tell us is how severe those injuries were or whether or not they were influenced by the wearing of appropriate safety gear.
Enter the AAAM study. While it set out to determine differences in injuries between young and old riders, it also tracked injuries related to helmet use. It tracked all injured motorcycle operators in the state of Maryland from 1998 to 2002, using both hospital discharge records and police reports. It also goes a little deeper than the CDC report, breaking injury locations down into nine areas — head, chest, abdomen, spine, neck, face, upper extremity, lower extremity, and external skin — and ranks them according to severity.
Distribution of Injury Severity Score (ISS) By Age and Helmet Use
As you can see in this graph, helmeted riders were shown to have a greater number of less severe injuries and a smaller number of more severe injuries.
Distribution of Injured Anatomic Region by Age Group
This graph shows the distribution of injuries and correlates with the CDC data showing that lower extremities represented the most common injury location. This table is not controlled for helmet use, unfortunately. Maryland is a helmet law state, so we can assume a high rate of helmet use though and the relatively low rate of injuries to the head, face and neck reflects that.
Injured Anatomic Region By Age and Helmet Use
But that’s what is tracked in this table, which shows the location of the most severe injury experienced by a given rider, tracking them across helmet use. What’s interesting here is that, while younger riders do show a greater occurrence of that most severe head, neck and face injuries among those who weren’t wearing helmets, the trend among older riders is the reverse. Lower extremities again make up a majority, even when we consider that these are the locations of only the single most severe injury on the rider’s body.
Rate ratios and 95% confidence intervals (CI) for death by body region among hospitalized motorcyclists
This table tracks the location of the injuries that resulted in death. Keep in mind, these were the deaths that occurred at the hospital, not at the accident site. Causes of death there were not reported in this study, but likely do include considerable instances of head trauma. Regardless, deaths-at-hospital were most commonly caused by thorax injuries, closely follow by head, then abdomen.
So far, this is good data. The CDC gives us the big picture of injury locations to riders nationwide, then the AAAM shows that data is not greatly influenced by helmet use. Let’s go more granular into the specific injuries with the information provided by the WHO.
In this study, motorcycle accident victims who wound up in the Jinnah Postgraduate Medical Centre in Karachi, Pakistan were surveyed to determine the precise nature of their injuries. Those with head injuries requiring neuro-surgery were excluded, as were those with only soft tissue damage, who didn’t break any bones.
Their data correlates with that of the CDC and AAAM, showing that the majority of injuries (in this case broken bones) occur to the lower limbs.
As you can see, the Tibia and Fibula are the most commonly broken bones in the lower extremity, followed by the Femur. In the upper body, it’s the wrist bones — the Radius and Ulna — which are the most commonly broken, followed by the Humerus.
In fact, the Tib and Fib represent such common injuries that the WHO report concludes: “In this study, the Tibia was found to be at greatest risk in motorbike accidents, probably due to its superficiality and exposed position while riding a motorbike. Protective measures need to be taken for the prevention of injuries and disability associated with lower limb involvement in motorbike accidents and leg protectors may help in this regard.”
But what about fatal injuries? The NHTSA provides that data, tracking available death certificate information for 8,539 fatal motorcycle crashes between 2000, 2001 and 2002.
Among Fatally Injured Motorcycle Riders
As you’d expect, the instances of head injuries causing a fatality are shown to be lower among helmeted rider than among those that go without.
One Injury-Related Record Axis Was Coded, 2000-2002
This table shows injury locations when only one injury was reported in a fatal crash. The head is the most common single area of fatal injury among both helmeted and unhelmeted riders, but does make up a greater proportion for unhelmeted riders.
Motorcyclists by Their Helmet Use, 2000-2002
How many injuries are caused by multiple, as opposed to single injuries? It turns out not that many and is roughly the same across helmeted and unhelmeted riders.
Injury-Related Record Axis, 2000-2002
This table tracks fatalities as the result of injuries in two locations. Again, the head is overwhelmingly fatal, more so for unhelmeted riders.
What We Don’t Know
The same problem that we had in What Can Fatality Rates Tell Us About Motorcycle Safety again exists here. Helmet use is only reported as a “yes” or “no,” but in the real world, a great difference exists between even DOT-certified, street legal helmets. A crash in a $700 Schuberth will not have the same results as a crash in a $25 half-helmet. On top of that, no other safety gear is statistically accounted for. We routinely watch as motorcycle racers walk away from 200 mph+ crashes while wearing head-to-toe protection; crashing in board shorts and flip-flops will have very different results.
What We Can Learn
To me, the most surprising data point is the prominence of leg and foot injuries. Among the small portion of motorcycle riders who actually take advantage of safety gear, these are the least likely areas to be equipped with real protection. Is this data a reflection of that fact or is it simply indicative of just how exposed our feet and legs are? Regardless, seriously protective boots, pants and armor are widely available and, anecdotally, are extremely effective at preventing foot and leg injuries.
At the same time, we can see that injuries to the lower extremities are unlikely to result in death. Overwhelmingly, according to the NHTSA, that is caused by a head injury, regardless of helmet use. That highlights the importance of wearing a quality, full-face helmet that’s less than five years old and fits properly; the glue used to bond layers of the EPS absorption material deteriorates beyond that time and poorly-fitting helmets can come loose in an impact, potentially failing to provide any protection or, worse, exacerbating injuries.
Injuries to the upper body are also common, but easily preventable. Virtually all motorcycle specific jackets incorporate shoulder armor, while protection for the back and chest is an easy add-on.
Next up are arm and hand injuries — those Radius and Ulna breaks. I’ve experienced more than my fair share of those, despite always wearing quality protection spanning my hands and arms. What I’ve learned that is effective, at least in some crashes that typically result in these injuries, are palm sliders. Those prevent your hands from “grabbing” the road, thereby turning direct impacts that would otherwise send forces straight up your arms into shearing forces that don’t break bones.
Hips and pelvic bones are pretty strong — reflected in the infrequency of their breaks — and also hard to protect against. That doesn’t mean you can’t do so, just that a full riding suit may be required, one that incorporates substantial armor around the hips, coccyx and pelvis. Padded under shorts — which will not fit under jeans — provide similar protection.
I guess what the real takeaway here is that major, life-altering injuries can occur anywhere on your body. But, it is easy to reduce the severity of them with quality, protective motorcycle gear. Hopefully this information helps you make the kind of decisions that could save your life, or at least your ankles.