Dutch Study Marks Recent Increase in Orbital Fractures from e-Bike Accidents

Riding an e-bike currently does not require a helmet or a driver’s license. The study team emphasized that proper education on basic protective equipment is not, but should be, common practice. Photo: Vander Films/unsplash.com. Click image to enlarge. Common causes of orbital fractures are traffic accidents, assault, falls and sports. In the Netherlands, where bike riding is woven into the cultural fabric more so than in most other countries, the number of traffic accidents as well as the use of electronic bicycles (e-bikes) has increased. As a result, researchers recently investigated changes in the etiology of orbital fractures, especially the role of e-bikes and population aging. They determined bicycle accidents caused most orbital fractures in the country in recent years. The highest increase in orbital fractures due to e-bikes was in patients aged between 50 and 75 years. The team noted that their findings contrasted with other investigations, where orbital fractures were most common in young adults, and the prevalence of orbital fractures decreased with age.In this retrospective cohort study, the researchers reviewed medical records of patients presenting with periorbital trauma in the period 2011 to 2022 to identify patients with orbital fracture. From 1,099 patient records, they found 495 patients with orbital fracture.The study found the most common causes to be bicycle accidents (36%) and falls (31%), followed by assault (13%), scooter accidents (8%), car accidents (3%) and other (10%), while other publications report assault and falls to be major causes and bicycle accidents only to be a minor cause.Among the patients with orbital fracture caused by (electric) bicycle, there were two patients with orbital compartment syndrome, two with eyelid laceration and no patients with globe injury other than contusion. Two patients died as a result of the trauma, two patients needed craniotomy because of subdural hematoma and one patient suffered from an epidural hematoma.Because most fractures (75%) were multiple and included the zygoma, fixation surgery was performed in 25% of patients. At the time of presentation, 25% of patients had ocular motility problems, which persisted in 8.2% of all fracture patients at one-week follow-up. Diplopia was a presenting feature in 12.3% of these cases, which persisted at last follow-up in only 0.6%. There were no patients who were without diplopia or ocular motility problems at presentation or in the first week but did develop complaints later or have persistent complaints at last follow-up.The high percentage of bicycle accidents here underlines the risk for e-bike riders compared to motorcycle and car users. “Although the patient cohorts might be different in other parts of the world, the popularity of e-bikes is increasing in many countries, making the possible consequences of bicycle accidents relevant for everyone,” the researchers wrote in their paper, which was published in Orbit.Click here for the journal source. van der Meeren SW, Brand LS, Zamanipoor Najafabadi A, et al. Changes in the etiology of orbital fractures over 2011-2022: the role of age and electric bicycles. Orbit. June 18, 2025. [Epub ahead of print].