Motorcyclists are 30 times more likely to die and five times more likely to be injured when compared mile for mile to passenger car occupants.1 Motorcycle helmets have been shown to prevent nearly 40 percent of fatal injuries and 13 percent of nonfatal serious injuries.1–3 However, as many as one-third of motorcycle riders still do not wear helmets, with a larger percentage riding unhelmeted in states without universal helmet laws.3 The effects of motorcycle helmet legislation on helmet use, patient injuries, and outcomes have been demonstrated.2–9 However, few to no data are available evaluating the effects of motorcycle helmet laws on craniomaxillofacial trauma.
Complex facial injuries are common among motorcycle trauma patients and are over twice as likely in unhelmeted patients.10–12 Although most facial injuries are not immediately life threatening, patients sustaining complex facial injuries have been shown to have poorer health outcomes and greater injury-related disability preventing employment.13
The National Highway Safety Act was signed into law in 1966 mandating that all states enact specific safety standards to continue receiving federal highway funding. Included in the legislation was the requirement for universal motorcycle helmet laws. In 1976, Congress amended the act, allowing states more flexibility in the implementation of helmet regulations.9 On April 13, 2012, the state of Michigan repealed their universal helmet law in favor of a partial law.
Several studies have shown an increased incidence of craniomaxillofacial injuries in unhelmeted riders, but none have shown the correlation between weakened motorcycle helmet laws and increased craniomaxillofacial injuries.10–12
Dramatic decreases in helmet use have been described following helmet law repeal.2,3,8,14 This study confirms these findings, showing a greater than two-fold increase in unhelmeted motorcycle trauma patients. Moreover, our data identify a substantial increased risk of craniomaxillofacial injuries in unhelmeted patients, providing a likely cause for the increase in facial injuries after the repeal. This finding is well documented in the literature.10–12 The risk for alcohol intoxication acting as a confounder remains a concern. We did note a higher blood alcohol content in unhelmeted patients compared with helmeted riders. However, no difference was seen when comparing patients presenting before and after the universal helmet law was rescinded. Furthermore, other large series have found an increase in injuries in unhelmeted patients even after controlling for multiple confounding variables, such as alcohol and drug use.12,15