E-bikes are not just causing more injuries as they become more popular. They are also changing the nature of severe trauma observed in children. Researchers from Rady Children’s Hospital and UC San Diego presented preliminary findings at the Annual Meeting of American Academy of Orthopaedic Surgeo ns in New Orleans last week that show how the greater velocities involved in e-bike crashes appear able to cause a broader range of trauma than was the case when pedal power was more prevalent. Overall, investigators found that e-bikes have gradually become a much larger share of overall bicycle-related severe trauma at Rady Children’s, moving from just 2% of bicycle-related cases in 2017 to 64% in 2023. These cases were severe enough to require activation of the hospital’s trauma team. And that trend has only increased. An updated tracking system now used by Rady shows that the number of e-bike-related severe trauma that the hospital has observed increased further in 2024 and 2025. Researchers analyzed 338 severely traumatic bike injury cases seen by Rady doctors from 2017 through 2023 and observed that the average age was higher for those involved in e-bike crashes, with an average age of 12.6 years versus 10.7 years for pedal pushers. There were also distinct differences observed in the types of injuries sustained by these two groups. Dr. Rachel Mednick Thompson is an orthopaedic surgeon at Rady Children’s Hospital. (Rady Children’s Hospital) Dr. Rachel Mednick Thompson, the Rady orthopedic surgeon and the study’s lead author, noted that extremity injuries were significantly more common among e-bike riders. “We’re seeing all types of extremity injuries with e-bikes,” Thompson said. “And it’s not typically hands and feet; it’s more long bone injuries, you know, radius, ulna, humerus, femur, tibia.” Researchers calculated that e-bike riders were 2.4 times more likely to sustain an extremity injury than their peers riding pedal bikes. Researchers realized that those odds could be influenced by accidents in which a vehicle and a bicycle collide. After all, vehicles have significantly more mass and bring more force to bear than is the case when it’s just a bike involved. To try to better understand e-bikes’ role in extremity injury, they also ran the numbers after eliminating vehicles. “When we exclude the cars, you’re four times more likely to get an extremity injury on an e-bike,” Thompson said. Head injuries showed an opposite trend. Researchers found that pedal pushers were more than twice as likely as e-bike riders to sustain head injuries. That finding makes sense, given that researchers found that e-bike riders were three times more likely to wear helmets than their traditional bike riding peers. It is likely, Thompson noted, that parents who buy their kids e-bikes understand that they are capable of higher speeds, with some said to reach velocities approaching 30 miles per hour. There might also be a socioeconomic factor in play. Given that e-bikes can be significantly more expensive than traditional bikes, they first became popular among families with more disposable income. “We know that helmet use is tightly correlated with socioeconomic status, so it might be just that wealthier kids are getting e-bikes, and they also tend to be the kids who wear their helmets,” Thompson said. Why do e-bike riders appear to be sustaining more severely traumatic extremity injuries than pedal bike riders? People ride e-bikes in Pacific Beach on March 4, 2026 in San Diego, CA. (K.C. Alfred / The San Diego Union-Tribune) Though the data does not explain this difference entirely, the working hypothesis is that the greater velocity often involved with e-bikes plays a significant role. Higher speeds mean more force when an e-bike rider comes to a sudden stop. “It takes more high-energy trauma to break a femur as compared to an ankle, right?” Thompson said. Dr. Romeo Ignacio, Rady’s trauma director, has been active in advocating for greater restrictions on young children riding e-bikes capable of reaching the kinds of speeds that make severe traumatic injury more likely. There are several bills now in the Legislature that seek to rein in what many feel is now out of control. Just last week, state Sen. Catherine Blakespear, D-Encinitas, introduced Senate Bill 1167, legislation that seeks to prevent e-bike manufacturers and sellers from marketing their wares as e-bikes if they exceed 20 miles per hour or 750 watts of power. While Ignacio said he is not anti e-bike per se, it is nonetheless clear that more must be done to reduce the two-wheeled mayhem that pediatric medical specialists now face with greater frequency. “Where this used to be a once-a-week problem, it’s now every day that we keep seeing these injuries,” Ignacio said. A person rides an e-bike in Pacific Beach on March 4, 2026 in San Diego, CA. (K.C. Alfred / The San Diego Union-Tribune) As if to illustrate his point, San Diego provided fresh evidence of the risks involved. Early Thursday morning, San Diego police responded to an e-bike accident on Nautilus Street in La Jolla. A 14-year-old boy riding a “Ghostcat” e-bike was said to lose control of his ride at 8:22 a.m., sustaining severe traumatic injuries, including “intracranial hemorrhage, subdural hematoma, orbital fracture and multiple abrasions” that required an ambulance transport. ...read more read less