Purpose: The injury occurs when a child passenger sits behind or in front of the rider; his leg gets caught in the rotating wheel’s spokes, and crushed against the frame. The study aimed at reviewing our experience in managing this common injury.

Patients and Methods: Between 2000–2005, 43 children were treated following bicycle spoke injury. All cases were thoroughly reviewed.

Results: Mean age was 5.1 years (range 1–15). Twenty-seven were up to 5 years. Thirty-seven were males, and 7 were females. The right leg was injured in 30 children, and the left in 13. Twenty one were seated behind the rider, and 6 in front of him. Most children were injured in the afternoon and between April and September. Twenty six injured the antero-medial aspect of the ankle and lateral calcaneal region. Twenty nine children had deep abrasions, 11 had abrasion with skin defect, and 3 had laceration. All children had edema and ecchymosis. Eighteen children had fractures. Greenstick fracture of the distal and fibula with anterior and varus angulation was observed in 6 cases. Hospital stay ranged 2–12 days. All fractures were treated non-operatively and healed uneventfully. Soft tissue injuries healed well largely by secondary intention within up to 9 weeks.

Conclusions: Bicycle spoke injury may lead to considerable morbidity and prolonged healing time. The mechanism of injury and management are discussed. The injury may be initially underestimated due to deceptively mild appearance. The prognosis is determined mainly by soft-tissue damage. Preventive measures include ergonomic changes like installing special carriers and spoke-guards.