Fatal injuries in cyclists: analysis of the epidemiological and medico-legal aspects and of the protective role of the helmet in a post-mortem case record in the territory of milan from 1995 to 2010

Introduction : The involvement of the bicycle in traffic accidents is growing, especially in large urban conglomerates, such as, for instance, the Milanese one. The use of this form of transport is aimed for sports or recreational activities and its diffusion is due to logistic expediency. and ease of use. However, bicycle crashes are responsible for significant morbidity and mortality, due to simple falls and involvement of motor vehicles. In either event, the effect is often represented by head-brain injuries, which could be significatively reduced, if not even avoided, as reported by numerous studies, with the use of a suitable protective helmet. In Italy, despite the amendments to the legislative Decree of 30 April 1992, n° 285, introduced by the Law of 29 July 2010 n.120, the use of helmet is optional, as it is not mandatory even for children under 14. The purpose of this report is to demonstrate the efficacy of helmets, especially as regards lethal head-brain injuries. Materials and methods A retrospective study was performed using a post-mortem case record, collected between 1995 and 2005 at the Section of Legal Medicine of the University of Milan, relating to all cases of death due to road traumatism, with significant involvement of a bicycle. The analysis of the available necroscopic documents allowed to investigate the kind of the found lesions, the circumstances of the accident, and, if present, the protective efficacy of helmets. Results The number of cases was equal to 269 (1.6% of total), examined considering various parameters: sex (male in 81% of cases), age bracket (52% of cases between 60 and 79 years), survival (64%), seasonal trend of the events (oftener during spring and summer) and crash site (urban roads). The accidents happened in three ways: direct impact (231 cases), running down of the cyclist (31 cases), and impact followed by projection against obstacle (7 cases). The protective helmet was worn by only one victim. In most cases (84%), the pathological lethal found was head-brain injuries, related with non-use of helmet. Conclusions The high number of helmetless cyclists, who died from injuries sustained in the cephalic region, would require legislative implementation of proper measures of prevention, such as the obligation to wear helmet, required for all two-wheelers, and the creation of special cyclists-reserved lanes. This in order to reduce both the number of accidents and the frequency and severity of injuries suffered by road cyclist users