Motorcyclist Down!

Text: James T. Parks • Photography: Dr. Hanson

Every time I see a motorcyclist spread-eagled on the pavement or hear about a fatal crash, I ask myself whether this pastime I love so much is worth the attendant risks. There's no doubt that safe riding skills can substantially reduce the probability of having accidents, but they can't eliminate the risks. This is where protective riding gear comes in: to reduce the severity of any injuries sustained in an accident. But how much protection does that gear really provide to riders?

Meet David H. Hanson, D.D.S., M.D., oral, maxillofacial and facial cosmetic surgeon and the co-founder of The Lincoln Park Institute for Oral and Cosmetic Surgery in Chicago, Illinois. Dr. Hanson has reconstructed many faces and skulls shattered in motorcycle accidents, but he is also a highly experienced motorcyclist, who regularly commutes 30 miles each way to work on his bike and tours cross-country with his wife for several weeks each summer.

Dr. Hanson's current ride is his beloved Harley-Davidson Screaming Eagle Road King. As both a motorcyclist and a physician, he has a special perspective on the injuries sustained by riders using - or not using - various types of protective gear. I spoke with him recently on this topic.

RoadRUNNER: When did you start riding motorcycles?

Dr. Hanson: I started out riding a dirt bike when I was 11 or 12, but my Dad was dead set against it, because my older brothers rode and all had been in accidents with cars.

RR: How have you been able to ride so extensively and avoid being in accidents?

Dr. Hanson: Educating yourself about safe riding techniques and practicing them is key. I've taken all of the Motorcycle Safety Foundation courses, regularly practice safe riding techniques, and ride frequently with more experienced motorcyclists who've helped me become an even safer rider.

RR: In a typical year, how many motorcyclists come to you for treatment?

Dr. Hanson: On average I treat about four per year that have had severe head trauma and skull fractures involving the face and jaw areas from a motorcycle accident.

RR: What happens in a motorcycle accident that causes head trauma and those facial injuries?

Dr. Hanson: My patients generally have either impacted the asphalt directly with their faces or, in the process of having their bodies rolled over and over during the accident, have had their faces fractured after the initial impact.

RR: At what stage of treating a motorcyclist's injuries do you get involved and what is the process for returning him or her to health?

Dr. Hanson: The first step in the process is for the trauma team, often including a neurosurgeon, to stabilize the motorcycle accident victim. Head trauma usually causes swelling of the brain, which can be fatal, so a neurosurgeon must first drill a hole in the skull to relieve the pressure in the skull. An ICP (intracranial pressure) monitor is subsequently placed on the patient to keep close watch on these critical pressures. All acute bleeding is controlled emergently. My work starts after a patient has been stabilized and some of the initial swelling has resolved. Motorcycle accident victims not wearing any type of head protection frequently don't make it out of the ER or later the ICU.

RR: Based on your medical experience, then, are you saying that wearing a helmet is often the difference between life and death for an accident victim?

Dr. Hanson: Yes, a motorcycle helmet is the single most important piece of protective gear that a rider can wear. Motorcycle helmet technology has come a long way in the last few decades. Today's helmets offer an amazing amount of rider protection from head trauma. Protecting the head is vital because most other injuries to a victim's body, short of massive body trauma caused by being T-boned or a very high speed crash, are usually survivable. Conversely, just the head trauma caused by falling off of a stationary motorcycle and banging your head on the pavement can make you a paraplegic, quadriplegic, or put you on a ventilator for the rest of your life. For many people that can be a fate worse than death.

RR: What happens next in the treatment process?

Dr. Hanson: For patients with multiple facial fractures, I usually start by giving them a tracheotomy, putting them on a ventilator, and wiring the jaw shut. This is followed by insertion of a feeding tube into the stomach. After swelling subsides, I start reassembling bones in the face and jaw. The various broken bones and skull fragments are pieced together like a jigsaw puzzle and secured by titanium plates; missing teeth are replaced months later with dental implants. Patient recovery lasts for weeks, if not months or years, and often involves physical and occupational therapy to restore mobility and coordination. It tears at your heart to see the impact of all of this on the victim and his or her family.

RR: Have you ever lost a patient after you start their treatment regimen?

Dr. Hanson: Only once that I can recall, because, again, accident victims have been stabilized before I take them to the operating room.

RR: How effective is motorcycle protective gear, other than helmets, in preventing or lessening injuries in an accident?
Dr. Hanson: Motorcycle accident victims, who were not wearing clothing to protect the torso, legs, feet and hands, will have severe road rash and often multiple broken bones. Although fractures can still occur with protective clothing, they are usually much less severe with it than without it.

RR: Have you ever treated a motorcyclist who was wearing a full-face helmet?

Dr. Hanson: No, I can't recall ever having treated facial or jaw injuries of any accident victim who was wearing a full-face helmet. Severe neck injuries can still occur, however, depending on how the rider falls and makes contact with the pavement or other objects.

RR: Any final safety advice you would like to offer motorcyclists?

Dr. Hanson: Enjoy the ride, but always follow safe riding strategies, take an advanced rider safety course every few years and, by all means, wear your motorcycle protective gear - particularly the helmet - because even the most experienced, safety-minded rider can fall victim to a freak accident.