# Cyclist Injuries from Tram Track Incidents: A Retrospective 10-Year Analysis
## 4 Discussion
### Preventing Injury  
Given the overall high incidence rates, some of which continue to increase, several authors have discussed ways to prevent injury and prevent this mechanism of injury in particular. [PERSON] et al. [5] compared bicycle crashes directly involving tram tracks to crashes in other circumstances and found track crashes to be more common on highly frequented streets with parked cars and no bike infrastructure. In addition, [PERSON] et al. [5] discussed modifying standard tire width in order to prevent tire wedging and suggested separate lanes for public transportation and cyclists. The width of the tram tracks is around 37 mm in our city. Thicker tires might prevent wedging because they would not fit into the tracks while thinner tires could easily get into the tracks and lead to a fall. Moreover, thinner tires show less grip to the surface than thicker ones, which may potentially also be a reason for easier slippage inside the tracks. Bike helmets have repeatedly been mentioned as an effective measure to reduce incidence and severity of traumatic brain injuries [6; 7; 8; 9]. Although all cyclists are advised to wear a helmet to reduce the risk of brain injury, this is far from being widely implemented, and cyclists without helmets are still frequently seen. It should be noted that in Austria, there is no legal obligation to wear a bicycle helmet for persons over the age of twelve. In our cohort, helmet usage was reported only for one of the nine patients with a diagnosed traumatic brain injury. This might have been the real count, or the consequence of incomplete documentation of patient history or more difficult data collection in patients with traumatic brain injury and possibly impaired vigilance. Across the entire 10-year period, about one sixth (17%), even a quarter of the cases in some years, were related to the most common injury site in the inner city. Throughout this 10-year study period, the city government implemented several measurements to the most frequented traffic hubs to increase cyclists' safety. A taxi waiting area along a highly frequented road was removed at the most common injury site and replaced with a non-road bike lane in November 2018. Furthermore, so-called \"sharrows\" were introduced to indicate to cyclists the preferred bike lane in order to decrease the risk of accidents with suddenly opened car doors or entrapments between parked cars or pedestrian walkways. Figure 3 shows the separation of bike and tram routes at one main injury site. Besides physical protective equipment and separation of traffic with ideally dedicated bicycle lanes, public awareness of common injury mechanisms and hazards related to trans was reported to decrease the injury incidence [1; 10; 11; 12; 13; 14]. [PERSON] et al. [1] reported a sharp decrease in tram-system-related cycling injuries after a period of local media attention. Furthermore, the results of a literature review by [PERSON] et al. [2] suggest a rather paradox finding that a higher proportion of all journeys made by bicycle reduces the proportion of cyclist injuries caused by single-bicycle crashes. It might therefore also be concluded from these findings that traffic that is based a lot on bicycle routes, is frequently used, and adapted accordingly in terms of urban planning represents a more safe environment for cyclists. However, due to the chosen retrospective study design, no statement can be made about the absolute numbers of bicycle trips made in this study; these findings also indicate that regulatory measures taken by urban planners have relevant effects on the risk of injury to cyclists. The results of this study should furthermore be of high relevance to clinicians, traumatologists, orthopedic surgeons, and rescue workers who need to provide medical care to injured cyclists with appropriate injury mechanisms and corresponding injuries that warrant rapid treatment.