A STUDY OF TYPICAL PARACHUTE INJURIES …

1 The PDF of the article you requested follows this cover page. This is an enhanced PDF from The Journal of Bone and Joint Surgery 1944;26:547-557. J Bone Joint Surg Donald Lord and James W. Coutts PARACHUTE SCHOOLTWO HUNDRED AND FIFTY THOUSAND JUMPS AT THE A STUDY OF TYPICAL PARACHUTE INJURIES OCCURRING INThis information is current as of May 16, 2007 Reprints and PermissionsPermissions] link. and click on the [Reprints , or locate the article citation on to use material from thisorder reprints or request permissionClick here to Publisher Information Pickering Street, Needham, MA 02492-3157 The Journal of Bone and Joint jumper hasroughlyonlya ,inspiteofthedecreaseintherateofinjury,e stablishesa , , ,andtheanatomy,physiology,and,wherepossi ble, injury hasbeenarbitrarilydefinedasa conditiondirectlyresultingfromtraining, ,lacerations,contusions,orexhaustivestat esinstudentswhocanberehabilitatedatThePa rachuteMedicalUnitandreturnedtodutywithi nafewhoursarenotconsideredstatisticallya s INJURIES .

2 Theparachutecourseoftrainingconsistsoffo urstagesbrieflydescribedforthepurposeofo rientationasfollows:1 .AStage:calistHenics,rope-climbing,runni ng, :tumbling,trainasium,landingtrainer,jump sfrommockdoors(fourtosixfeet),jumpsfromm ocktowers(thirtytothirty-fivefeet), :dailyjumpingfromthe250-foottowers(freea ndcontrolled), , :Theapplicantmakesthe'necessarynumberofp lanejumpstoqualifyasa parachutist; thejumpsaremadefroma planeinflight, , ,andthemostinterestingclinically, ,presumablywhenthelowerextremitiesarerai sedatrightanglestothebody,andthelegsgras ptherope, , , ,insomecasescausingadefinitesharppainint heabdomenandresultinginthefollowingclini calsyndrome:ThepatientappearsatTheParach uteMedicalUnit,complainingofpainintheabd omen, ,theabdomenappearsrelaxed,therebeingnoef fortto holdintheabdomen .Inthosecaseswithhematomaformation,a smooth, ,--theacromioclavicularcontusionandtheac i'omioclavicularsepai' and3@(@ @ ).

3 - ..,@ l'HlJOURNALOF'BONEANI) 'RGERYItri .Ifthetumblingisimproperlyexecutetl,thep ointoftheshiotlidel'strikesthl(gI'OtlItd withgreatestforce,t'('stlltingit)aci' )\Vt\V()trainingsituations,in@ @)lll(lnottouchthegi'ound;theforearm,hel drigiollvbythetn( (J)5,ao'tsasabaro@@'ei'@vhichthebo@ omesin(lirectcontactwiththeground,anolth eacronno) 'ularjoint @@ @ @!/@/4/ , l550C. D. LORDANDJ. W. blockintheaxillaandstrappingittotilebody ;anadditionalsti'apextendedupoverthelate i'alendoftheclavicleandtheshouldel',andd ownpostei'iorly, 'ne(ltofulljum@)dutyafterfivemonths,hasn o@ -namely,tilesimpleacl'olmoclaviculansepa rationwithslight,ifany,tearingofthecmt@) sI1le l'espondstoin'in@o namely, ,\VililemorefrequentinDStage,involvethes amemechanism,andbothwillbedesci' ' @ @i originalparachutefracture justdescribedhasrecentlybeguntohereplace dbya tlIl( ,thisisconsideI'eda TYPICAL @pal'aciluteinjury @vehavecalledtile silentfracture a little fractureoftheupperthirdoftilefihulacould @ ei'yfrequentlybemisdiagnosedasa sprainedmuscle,ifthepossibilityofthis silentfracture 'onlybecausethefibula(toesIlotentel' 'iesofthirty-fivecasesdiagnosedrecently, 'te(lfor slightpaill intheiippei' )we( ,asa i' )ylanding\@ )

4 Islocationsoftilefihularheadhaveoccurred inasmallseriesofcases, showstilefihulalheadina ,isfeltthatthesidewardlandings,wilichocc urinoscillations,resultina tendencyto spl'ing thefihularheadfromitsposition, ,forward,outward, ,resultingfromthe springing \ @ -i-@=t@ @-IIisIci@ CIC k numbnestiofthefoot, ,or foot-drop . ,reductionisaccomplishedveryearlyinthese cases,and,if pressureonthenervedOesoccur, ,oneinvolvingtheankle,theotherinvolvingt heupperfibula, ,whilethesoldierisfallingfreely,anytypeo ffractureorinjurymayoccur, ,recently,hasbeena deeplacerationoftheperineum,extendingfro mthescrotumtoandinvolvingthesphincterani , , , dived ratherthan jumped fromtheplaneinflight; ,butareofgreatclinicalinterestbecausethe yshowthehazardsinvolvedwhenthe rules matteroftwominutes,asa rule, , ,ifnofracture-exists, ;thosewithsprains,regardlessoftheirsever ity,contusions,andthelike,aresuppliedwit hcrutches, ,withearlyicing,tightbinders,andtheuseof crutchesfortwenty-fourhours,thepainisnot a ,wherethepainissevere, , , s.

5 I'!IFO@y/EtK1I@ENOIP4G ,.03Ii::,.@s@@@@@@@I@@,@@@@@iaaR'J@@::n@ @ @@ @ ;@S;:g@ rS@@ O@@@@- @ @h@ iiR@'@@@&Ii__ijij-@tiiLiI_ii@iJi@iijLLLi iii:LJii@ ,tightbands,icing, ,warmapplications,gentlemassage, ,usinginfra-redorultra-violetlamps,whirl poolbaths,alternatinghotandcoldbaths, distinctlydiminishingrateofinjury., ,legsbentslightlyattheknees, , ,sothatproperlandingcanbemadeduringgroun dapproachesthatareangulartothelineofdrif tduringa ,althoughthedesiredapproachwasaforwarddr iftwhenlanding(SeeFigure5),ina largepercentageofinstances,, , @ 'O@ALLSTAGESTHEPIIRfICHUTESCHOOLFODTBE liflIncCR17i@ 17pSiVtt4 Stnc1@ @'st@ @1*IiI,SIII--Ini@-5@-4@ @4,@@ @-@ freak aecidentsOCCtiI'.Furthei' ,B, ,@@ henthestudentloadontheSchool\VIIS small,tileAssistantCommandantwasabletose lectthemostfavorableweather, ,whenitbecamenecessai'vforTheParaciluteS chooltoincreaseitsoutput, qualifythemen , (Iccreasedinjurypercentageappeal' pendulum-likemotionoftheparachutist,inW' , ,canmateriallyreducethel)al'achutist'sop portunityformakingalanding, (loflandingwastaught,thenovice'sfeet@@ sidewardoscillationwouldbringthelandings hockofallthei)

6 O(lv' --thatis,withthefeettogether ,coveringthousan(lsofinjul'ies, , , , ,@@ hois suppliedwitha ,allmenaresubjectedtoanexaminationsystem atTheParachuteMedicalUnit, psychiatricviewpoint, ,withparticularstressbeingplacedonanythi ngwhichissymptomaticatpresent, '-suchasoldlumbosacralsprains,oldfractur esstillpainful,oldretractingscars,andany historyofsymptomsreferabletothehead(dizz iness,blackouts,faintingspells,etcetera) .Menwithpotentialherniasareruledout, , ,unlesstheirvisionis20 , ,andwhosebloodandspinal-fluidserologyare negative, , pronetoinjuryintrainingthanthosewithanyp hysicalimpairment,and,therefore, , ,itisfelt,hasbeenmarkedlyreducedinthepas tsixmonths,andthoseoccurringnowarerecogn izedasunavoidable(atpresent) , ,anyparachutisthasonlya , ,associatedwithfractureoftheposteriortib ia! silentfracture oftheupperthirdofthefibula,andlessfreque ntlya ;hence,thedesignation silentfracture TheManagementofFractures,Dislocations, , , ,ArmyoftheUnitedStatesFromtheStationHosp ital,Camp@Howze,TexasIna periodofsixteenmonths, ,becauseoftheabsenceofa historyoftraumasufficienttoproducea ,thirteenwereinthetibia,oneinthefemur, !))

7 Fractures, , , ,localizedtendernesswasfoundatornearthef racturesite,associatedw' laterstage,a palpablemass,producedbyexuberantcallus,@ @ ,throughclinicalexperiencewithfatiguefra ctures, , ,andthefracture,asa rule.