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Incident Report
Open Medial Sub Talar Dislocation
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Date of Incident
Friday, 10/28/05 ~ 2:30 pm
Weather
A bit punchy as the earlier low cloudbase thinned and lifted. The day was
starting to mellow, but it still had some texture. Mild flow from the SE
at the impact site.
Site
The Skyport in the Santa Barbara mountains is off Gibraltar Road at just under
3,000 ft msl. There are 2 sister launches; the Skyport on the left below
the road, and the Eliminator on the right off the road. The launch sits on
the front side of a knob. The road climbs uphill around the knob from the
left east side.
Pilot
A seasoned P4 pilot with extensive experience top landing in general, with
numerous (~50?) top landings at this site..
Equipment
UP Trango canopy, medium, loaded toward the heavy end of the placard.
Light weight leather hiking boots. Modern Edel harness with normal back
protection. Weathered ProTec plastic helmet, no chin strap. Flight
suit over jeans and jacket. Basic Flytec Vario. Compass. Radio inop,
cell phone. Water & power bars.
The pilot had been in the air about 4 hours total, and about 3 hours since his last top landing elsewhere along the range. He had been pressing all day, pushing up and down the range low, connecting on low last chance points numerous times. Although he hadn't flown in 7 weeks, his confidence was high as the day aged. He had returned to the launch area and wanted to top land. His motivation for landing was a pressing bladder and fatigue. His options were to fly out and land in the main LZ next to his car, effectively ending the day. Try and top land near the Skyport in conditions that would be difficult and hazardous. Try and get to the Alternator, a more open top landing spot about 800 feet higher and several miles away.
Despite the pilots confidence in handling the glider and reading conditions, his confidence in executing a successful top landing at the Skyport in the air at hand was low. The best approach is typically to start back in the canyon and fly south up the road for an uphill road landing on the east side of the knob behind launch. Slowing the glider some increases accuracy and reduces retained energy. When the wind is from the SE, the uphill approach is problematic due to ridge lift on the edge of the road, so it's hard to get the glider to settle. Thermal activity compounds the problem, potentially making it even more lifty, depending on the cycle. If the air is punchy, then the usable speed range is reduced because you don't want to risk stalling the wing (potentially catastrophic, although the pilot had inadvertently stalled a wing attempting the same approach in punchy conditions on a previous occasion), so you can't get too deep in the breaks to reduce glide. Going around to the other side of the knob can get you out of the ridge lift, but the approach is downhill.
The pilot opted to attempt the approach, but not force it initially. The first try wasn't even close, with the glider climbing the whole way. The pilot made another attempt from further back in the canyon, hoping for a lighter cycle, and got closer, but still sailed of the end of the touchdown area. The pilot made a couple of attempts on the west side. Again, the first one was way high. On the second attempt, the pilot was in a good grove, into the wind, low, with the glider slow over the road, but the downhill was too much and the glider floated. If he got deeper in the breaks he might have gotten it to settle, but the air had too much punch to risk getting too slow.
At this point the pilots intuition told him skip the Skyport go for the Alternator or throw in the towel and head to Parma. The pressing bladder was making a case for getting on the ground soon. Going to the Alternator was uncertain. The altitudes were limited and the pilot wasn't sure if he could get there. If he couldn't, then it might be awhile before he could relieve his bladder. The pilot wanted more air, so going to the main LZ seemed like the least attractive option.
The pilot opted to make one last approach, starting further back and lower. Flying the glider at trim speed to reduce the sink rate. Despite extensive experience with approach variations for the intended road landing, the pilot didn't have experience approaching at trim speed. Early in the approach, the pilot realized it wasn't realistic to follow the winding road at the higher speed, but it did seem that he wouldn't overshoot. Rather than simply following the road, he lined up for a short section that projected out. His glide path looked favorable. The landing wouldn't be pretty. Slowing down some, but intending to run it on at speed without a flare.
Unfortunately the touchdown spot was going to be in a one lane section where a slide had eroded part of the road, with the road starting a mild curve into the hill (to the right). A bicycle rider was killed by an asphalt truck at the same location a short time later while she was training for triathlon competition. About 20 yards out, the pilot perceived he was going to miss the road by a few feet and land on the slide area. This wasn't appealing. For a moment, the pilot still had the option to abort left, but opted to commit and give it some input to the right. The glider pendulated more to the right than desired. There was a rocky outcropping that projected out from the hill toward the road. Impact was eminent.
The ground speed was fast for touchdown, maybe 12 to 15 mph. The jagged rocks looked like they could do some damage. The pilot got his feet up with the intention of taking the impact mostly with the thick bottom part of the back protector, but not wanting to break his back, he also needed to absorb some of the impact with his legs... but there was no clear footing.
The impact didn't seem too hard, but the pilot heard a snapping sound. The realization that he might have brokeen an ankle flashed through his mind in slow motion. After settling, he looked down at his ankle. Even though he realized he might have broken something, he thought it would be intact. He wasn't prepared to see his right boot angled to the right and his bone protruding out the left side. He didn't understand the injury at the time, but it was obviously not good. He screamed and cursed in anger and frustration.
Speculative Contributing Cause
The pilot was sitting on the edge of the road on the east side of the knob. Bob Anderson was setting up at the Eliminator, the HG launch on the SW side of the knob. The distance was short, but the hill effectively blocked sound. The Pilot hollered repeatedly for help as loud as he could in the hope Bob would hear him, but he didn't. The pilot then dug his cell phone out from his gear. He thought it was in his belly pack, and emptied the contents on the road when he couldn't find the phone. He eventually found the phone in his top shirt pocket and called 911.
Fortunately, Tammy Burcar, a local HG instructor with first aid training was across the canyon at a view turnout reading in the afternoon sun. She observed the approach attempts and heard the cries for help. Climbers across the canyon also heard the desperation and mobilized.
Tammy arrived about 5 minutes after impact, and the climbers showed up about 5 minutes after Tammy in their car. The pilot flagged down Tammy's car, not knowing who it was, and was relieve to see that he would be in capable hands. The pilot asked Tammy take the phone and she talked to the 911 dispatcher. It was decided not to wait for an ambulance and head to the hospital ASAP in the back of Tammy's car.
Tammy cleared the back seat and put some news print down to catch some of the blood. Despite the large amount of initial blood, the flow was not as bad as expected. Later enlightenment indicated the bleeding reduction was because the inside artery had been severed, rolling up and self sealing.
With the 3 assistance (Tammy plus the 2 hikers), the pilot was able to wiggle into the back seat via the right rear door. Tammy made good time getting down the bumpy road (from about 2900 feet) with an optimum balance of speed and bump avoidance. Hospital arrival was about an hour after impact.
The pilot was starting to go into shock. Shaking uncontrollably. Tammy summoned the troops and a crew came out to assist. Backed out the left door onto a gurney.
The trauma crew prioritized the injury and brought a whole team into the treatment arena. Writing this 5 months later, so I forgot most of the names, but they were all very compassionate and effective. They cut off all the clothing. The staff was initially referring to the injury as an Open Tib Fib Fracture, but later modified the diagnosis to an Open Medial Sub Talar Dislocation. The large Talus bone (ankle bone) had torn through and was sticking completely out the inside of the leg. The tear in the leg was about half the circumference, and the foot was dangling off to the right.
The attending physician directed the task. They got some morphine into the patient about 20 to 30 minutes after arrival. The morphine took the edge off and reduced the uncontrollable shaking. Had to request someone hold the foot because it was flopping around with each convolution and each pulse was accompanied by associated pain. A couple of sets of x-rays form a portable machine plus cleaning with a pressure washer spray gun.
About an hour after arrival, the staff put the patient into conscious sedation (didn't remember a thing) to reduce the injury (pop the bone back in). They had numerous assistants for the task, and discussed the game plan ahead of time. Upon waking from sedation, the pain was significantly reduced. Went for a cat scan and almost fell asleep in the tube.
The on call orthopedic surgeon, Doctor Eric Shepherd arrived sometime later and reviewed the data. He opted to get into surgery ASAP to clean and evaluate. 1st surgery that night (Friday) about 7 pm. The bone fragments in the joint were removed, but there are still floating fragments outside the joint. 2nd surgery on Sunday morning to repair the soft tissue and secure the fibula with a screw.
Follow up doctor appointments and therapy during the first several months, but haven't been back for a medical review since early 2006 (as off 1010)
The Talus (ankle bone) had torn through and was protruding completely out the inside of the leg. The tear in the leg was about half the circumference, and the foot was displaced outboard. Being a large bone, the talus can't tear completely out of the leg without causing extensive soft tissue damage.
No immediate injuries other than the ankle, not even a scratch or a bruise.
Speculation on Cause of Injuries
The injury is rare, but is sometimes seen in basketball and car accidents. With both feet out to absorb the impact, the right foot contacted first on an angled bolder and took the load. The angle of the rock twisted the foot badly outboard and the bone structure above it dislocated and drove out the side of the leg.
The boots worn were casual leather hiking boots. A more robust boot may have prevented or reduced the injury.
Initial discomfort was associated with poor circulation and swelling. With extensive damage to the vascular system, blood would easily pool in the foot, especially with the foot lowered. The nerve damage initially reduced the sensation by 80%, which may have aided in reducing the perceived pain. Once weigh bearing began, the circulation began to improve.
Strategies are subjective. Doctor Shepherd was concerned about an unstable joint and recommended keeping the injury immobile for an extended period resulting in a stiff ankle. A shorter immobility would result in more range of motion, but he theorized it was better to work on loosing a stiff ankle than deal with an unstable joint.
Non weight bearing for 7 weeks. Weight bearing applied over several weeks for extended durations in a boot cast. Off crutches completely at about 10 weeks, and out of the boot cast completely shortly there after. Able to carry full weight up on the ball of the foot at 5 months for limited durations after warm up stretching.
There is some concern about avascular necrosis (the bone dying) due to loss of blood supply, but the odds of survival are favorable.
Most of the feeling has returned to the foot. Not evenly, but 75 to 80% overall at 5 months out. At 2 years out, 95% of the feeling has returned
In therapy (5 months out). Hope to be able to run again. Making progress, but every step has some degree of discomfort and pain.
A full recovery is not expected. Medical studies indicate all subjects
with similar injuries have some degree of continuing pain and discomfort, and
most eventually have the sub talar / calcaneus joint fused. (2006)
(2010) Improvement peaked about a year or 2 after the incident, and 4 years out
is about the same. Circulation, inflammation, and lack of structure
continue to be the primary considerations. Sitting for extended periods at
a computer or on an airplane results in pooling which takes a while to work out,
so walking is difficult and painful after sitting. Moderate use yields the
most comfort, but too much use results in inflammation which may take a couple
of days to recover from. Can do a limpy jog for 10 meters when loosened
up, but the activity will require subsequent recovery from the resultant inflammation.
The pilot expects to fly again, hopefully at an advanced level, but will need
to throttle back due to inability to rebound from a hard impact or tackle a long
hike across difficult terrain. (2006).
(2010) The pilots was physically able to fly again about a year after the injury, but due
to other demands of time and family, did not get airborne again until about 4½
years after the injury. [3/27/10
Skyport to painted Cave to Parma]
Most of the lessons were learned on prior occasions, and were reinforced rather than learned:
The pilot acknowledges all those who provided varied support, and special thanks to Tammy Burcar for her effective performance during the first critical hour.
Submitted by
The Pilot
Tom Truax
on 4/2/06
Review and update on 3/27/10
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