The next device is coming, and so are the fractures

At a Glance 

• Micromobility devices produce predictable fracture surges. 
• Hoverboards and e-scooters drive high rates of operative injuries. 
• Orthopaedic surgeons can help shape safety standards before the next device arrives. 

Estimated read time: 5 minutes 

The trauma cases arrived before anyone was ready for them. In 2015, hoverboard-related injuries rose by an average of 208% over each of the four preceding years, and pediatric wrist fractures climbed more than 4,000% compared with 2014. Within a single holiday season, a self-balancing device with no handlebars, no brakes, and no safety standard from the Consumer Product Safety Commission (CPSC) had reached millions of children. Emergency departments in Philadelphia, Boston, San Diego, and Miami independently logged the same injury in the same age group through the same mechanism: a distal radius fracture in an 11-year-old who fell onto an outstretched hand. Looking back, the orthopaedic consequences should have been anticipated. 

Two years later, the pattern repeated in adults. When Bird launched dockless rental e-scooters in Santa Monica in September 2017, the model spread across U.S. cities within months, arriving ahead of the lanes, rules, enforcement, and public education needed to support it. The injury data followed almost immediately. Two Salt Lake City emergency departments went from eight scooter-related visits before launch to 50 in the equivalent period afterward. Two Southern California emergency departments logged 249 e-scooter injuries in the first year, nearly a third of them fractures. 

We write as orthopaedic teams have studied both surges. To us, the pattern looks like a recurring and predictable cycle, one that orthopaedic surgeons are well positioned to interrupt earlier than anyone else. 

The fractures are the story
Much of the public conversation about these devices has centered on helmets and head injuries. That focus, while understandable, has obscured what orthopaedic surgeons actually see most: fractures, frequently operative ones. 

For hoverboards, the injuries were remarkably consistent. Across multiple pediatric series, the distal radius was the dominant injury, accounting for roughly 43% of fractures in one cohort and more than half of all fracture locations in a 12-center study. The mechanism is physics, not carelessness. A device without handlebars or any fall-arrest feature leaves the upper extremity as the only point of contact with the ground, and skeletally immature bone fails at the wrist. A subset of children sustained an injury few anticipated: finger entrapment between the wheel and wheel well, producing phalanx and Seymour fractures that required nail-bed repair. Across these studies, virtually no injured child was wearing protective gear of any kind. 

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• Orthopaedic Injuries After Introduction of Electric Scooters to Denver, Colorado (JAAOS) 

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E-scooters brought a heavier injury profile to a mostly adult population. Falls produce the familiar fall-onto-an-outstretched-hand pattern (distal radius, radial head, and ulnar styloid injuries), but collisions with curbs and vehicles load the tibia and ankle through axial and rotational forces. At a Level I trauma center in Manhattan, the most common presentations were ankle, tibial shaft, tibial plateau, and radial head fractures. The details matter to anyone planning a case: a substantial share of spiral tibial shaft and ankle fractures involved the posterior malleolus, and most tibial plateau fractures showed posterior comminution. These are not the simple, low-energy patterns the devices’ casual image suggests. 

The operative burden confirms it. A Turkish series found that 48% of e-scooter fractures required surgery, versus 9% of all other fractures at the same institution. Two UCLA trauma centers treated 73 operative patients in the first two years, including open and hip fractures usually associated with high-energy trauma. A 2025 analysis in the Journal of the AAOS Global Research & Reviews®, comparing e-scooters, e-bikes, bicycles, and motorcycles at a Level I trauma center, reinforced that these micromobility crashes produce trauma center-level orthopaedic injuries rather than the minor spills their image implies. Treating them as routine commuter mishaps risks underestimating their extent, and that is a clinical message before it is a policy one. 

A burden hospitals did not choose
The institutional footprint is hard to overstate. E-scooter riders present to the emergency department at nearly four times the rate per mile traveled compared with cyclists. At Auckland City Hospital in New Zealand, 180 patients arrived in the four months after rental scooters launched; a third required admission or transfer, and more than 20% needed surgery. Canadian surveillance documented an 18% annual rise in scooter and hoverboard injuries over five years. Hospitals near high-use corridors carry this load (imaging, consultation, admission, operative time, and follow-up) for devices they had no role in introducing. 

This is where the data is routinely lost. When an e-scooter or hoverboard injury is coded simply as a “fall” or a generic transport event, its true contribution to operative workload disappears from the record. We cannot make the case for safer design and regulation with data we are not capturing. 

What orthopaedic surgeons should do
Orthopaedic trauma surgeons detect new injury trends before policy does. That proximity confers both perspective and a responsibility to act on it. We see three concrete steps. 

First, engage the CPSC early. When a novel mobility device enters the consumer market, particularly a pediatric one, orthopaedic input on injury mechanism should inform safety standards before the device reaches scale, not years afterward. The fracture mechanics are predictable enough that we can often forecast the injury pattern from the design alone. 

Second, fix the documentation. Mechanism-specific coding in trauma registries would let hospitals quantify these injuries, plan resources, and enter policy conversations with credible numbers rather than impressions. 

Third, advocate for protective equipment standards on the evidence we actually have. The biomechanical case for wrist guards against fall-related distal radius fractures is strong and is supported by transferable data from skateboarding and inline skating. We should also be candid: No prospective trial has yet shown that protective equipment reduces injury severity for these specific devices. That honesty strengthens our credibility when we advocate. 

These devices are not going away and eliminating them is not the goal. But the cycle of rapid adoption, a recognizable fracture surge, and regulation that arrives only after the injuries do is now well documented across two devices, three countries, and nearly a decade. The mechanics predict the mechanism; the mechanism predicts the fracture. The only variable still unresolved is whether the orthopaedic community engages the next consumer mobility device before it fills our clinics, or after. That is the gap worth closing. 

Melina Khorrami is an incoming second-year medical student at Touro University California College of Osteopathic Medicine, where she serves as president of the Student American Osteopathic Academy of Orthopedics (SAOAO) chapter, president of the American Osteopathic Academy of Sports Medicine (AOASM) chapter, and president of the Orthopedic Surgery Journal Club. 

Ali Rezazadeh Shirazi is an incoming third-year medical student and Clinical Anatomy Fellow at Kansas City University College of Osteopathic Medicine, where he assists in cadaveric lab instruction, lectures, and small-group teaching, while completing an anatomical and surgical research project. 

Saumith Menon graduated from Washington University in St. Louis in 2025 and is an incoming first-year medical student at Albert Einstein College of Medicine. 

Muhammad-Amin Munshi is a research scholar at Washington University Department of Orthopaedic Surgery.  

Neset Tang, MD, is a pediatric orthopaedic surgery fellow in the Department of Orthopaedic Surgery at Washington University in St. Louis and a co-supervising investigator on this work. 

Pooya Hosseinzadeh, MD, FAAOS, is a pediatric orthopaedic surgeon in the Department of Orthopaedic Surgery at Washington University in St. Louis, whose clinical interests include the operative and nonoperative treatment of musculoskeletal conditions in children with cerebral palsy and other neuromuscular disorders, congenital and developmental foot abnormalities, including clubfoot, hip dysplasia, lower extremity deformities, and pediatric trauma. He served as the senior supervising investigator on this work. 

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