TITLE:
The African Child Provides Us with a New Mechanism for “Fall Astride Injury”: A Narrative Review
AUTHORS:
Frank Obeng, Mahamudu Ayamba Ali
KEYWORDS:
Fall-Astride Injury, Straddle Trauma, Pediatric Urethral Injury, Bulbar Urethra, Trauma Prevention, Africa
JOURNAL NAME:
Open Journal of Urology,
Vol.15 No.12,
December
22,
2025
ABSTRACT: Purpose: Fall-astride injuries are well recognized as a cause of anterior urethral trauma, typically following bicycle accidents, fence straddles, or bathtub slips. We aimed to describe a novel, culturally specific mechanism of pediatric fall-astride injury observed in a rural African setting (“the running stick mechanism”) and contextualize it within existing literature. We use the term “running‑stick mechanism” to describe an observed childhood play in Southeastern Ghana in which a child clasps a rigid stick between the thighs while running forward, positioning the perineum against a narrow, firm object. A trip or sudden deceleration can reproduce the classical fall‑astride impact on the bulbar urethra. Materials and Methods: Through non-participant observation in serendipity, and digital reconstruction, we documented children simulating bicycle riding by clasping a rigid stick between their thighs while running (“running-stick mechanism”). A systematic literature search was then conducted across 11 databases (PubMed, PMC, ScienceDirect, BMC Surgery, Wiley Online Library, AJOL, etc.) using the terms fall astride injury mechanisms and straddle trauma. Findings were synthesized narratively, with illustrative diagrams created for health education. Results: Despite identifying 22 relevant sources on straddle injuries, no prior report described the running-stick mechanism. Biomechanical analysis confirmed parallels with classic fall-astride trauma, particularly risk of bulbar urethral injury, hematoma, and potential stricture formation. Immediate caregiver education discouraged repetition of the behavior during 16-week follow-up. Visual illustrations were produced to support clinical and public health awareness. Conclusions: The “running-stick” play represents a previously undocumented but biomechanically valid mechanism of pediatric fall-astride injury. Its identification highlights the need for culturally informed surveillance, early caregiver education, and preventive strategies in low-resource settings. Recognition of such mechanisms may improve diagnostic suspicion and reduce the long-term burden of pediatric urethral trauma.