Case Report:
Femur Fracture in a 31 y/o Female Kitesurfer
Michael S Tcheyan, MD
HPI: 31 y.o. Female with no significant past medical history presented to the Emergency Department with right lower extremity pain and deformity after a kitesurfing accident. The patient was launching her kite at a known kitesurfing spot in Rhode Island, when a gust of wind picked her up and launched her in the air until she collided with a parked car near the launch area. She subsequently was able to grab onto the roof rack of the car and fully release her kite. The kite subsequently became ensnared in high-voltage power lines.
She denied any head strike, loss of consciousness or neck pain. She was unable to ambulate after the accident. EMS was called and noted a palpable right femur deformity without wound or laceration. She was placed in a traction splint and transferred to a Level 1 trauma center.
PMHX: None
Meds: None
Physical Exam:
Blood Pressure: 112/72 Pulse: 80 Temp: 97.7 ºF RR 19 O2 99%
Abdomen: Soft, nontender
Pelvis: Stable
Right Lower Extremity: Skin intact, swelling and tenderness about the thigh, Sensation intact to light touch. Strength and motor intact, 2+ Dorsalis Pedis and Posterior Tibialis pulses, toes warm and well perfused.
Fig 1:
Diagnosis:
4 cm right displaced femur fracture
Non-displaced R. femoral neck fracture (seen on 3D reconstruction fine cuts of CT hip)
Hospital Course:
Orthopedics Trauma service was consulted in the emergency department. The patient was placed in proximal tibial traction in the emergency department. She was admitted to the orthopedics service and on Hospital Day 1 underwent fixation of the R. femoral neck and R. distal femur fracture with long intramedullary rod and proximal interlocking screw hardware. On Post-Operative Day (POD) #1 she began working with physical therapy, and was placed on aspirin for Deep vein thrombosis (DVT) prophylaxis. She was discharged on POD #2. Patient was advised to delay her flight back to Tahiti to prevent immobility and possible DVT formation.
Discussion:
Severe kitesurfing injuries, as seen in this case, tend to result from high-energy impact on land rather than in the water. In a prospective study in 2004 examining 234 kitesurfers with 124 self-reported injuries, the most common injury sites were foot and ankle (28%), skull (14%), chest (13%), and knee (13%). Based on their classification system, 3% of the injuries reported in the study were classified as severe, meaning that the injury resulted in the patient being absent from kitesurfing for at least 6 weeks, as was the case in our patient with a femur fracture. It is notable that in the cohort of 234 kitesurfers studied over six months, there was a fatal injury from polytrauma including a liver laceration.[1] The study found an overall injury rate of 7/1000 hours, and that 56% of those injuries were due to inability to detach the kite from the harness. They noted a lower injury rate among athletes using a quick-release kite system (4.8/1000 hrs), as compared to those who did not (7.6/1,000 hrs).
In 2020, another prospective study on kitesurfing injury was published in the Netherlands[2]. Those authors reported an injury rate of 10.5/1000 hours of kitesurfing and noted that even though the safety features of kitesurfing equipment had advanced since 2004, the injury rate unexpectedly increased. They commented that this could be due to the increased accessibility of the sport to participants who are less familiar with watersports as the injury rates decreased among more experienced kiters. In our patient’s case though she was an experienced kiter, she was kitesurfing in a spot at an unfamiliar location. They also found that all the fractures in their study occurred in very shallow water, or on land, as in the case we present. In comparison to other sports, the rate of injury in kitesurfing was higher than in windsurfing (5.2/1000 hours), but lower than other action sports including motocross, soccer, and American football.
In conclusion, while kitesurfing equipment has been made safer over the last 15 years, the injury rate does not appear to have decreased. A femur fracture is a serious injury, and fortunately our patient did not suffer any other traumatic injuries and was relatively close to a Level 1 Trauma center with an on-call orthopedist. Due to the nature of high-speed collisions in kitesurfing, severe polytrauma is a major risk. As equipment progresses, it is imperative that the community continue to evaluate safety, particularly with regards to entering and exiting the water. Given the high-energy nature of injuries, strong consideration should be given to use of helmets and impact vests.
Citations:
1 Nickel C, Zernial O, Musahl V, Hansen U, Zantop T, Petersen W. A prospective study of kitesurfing injuries. Am J Sports Med. 2004 Jun;32(4):921-7. doi: 10.1177/0363546503262162. PMID: 15150038.
2 Van Bergen CJ, Weber RI, Kraal T, Kerkhoffs GM, Haverkamp D. Kitesurf injury trauma evaluation study: A prospective cohort study evaluating kitesurf injuries. World J Orthop. 2020;11(4):243-251. Published 2020 Apr 18. doi:10.5312/wjo.v11.i4.243
Email: miketcheyan@gmail.com