Gybing, windsurfing and SP diastasis

Windsurfing - gybing

​Windsurfing is usually associated with ankle and lower limb sprains and fractures, mainly due to falls off the board with the foot being still hooked under the strap. However, we had a different pattern of injury for a windsurfer who presented to the minors area of Derriford with severe pelvic pain.

This was an otherwise fit and well 53 year old gentleman who was attempting to do a gybe (a maneuverer where the sail is swung from one direction to the other, allowing the wind to hit it from the opposite side). However , due to gusty wind, he lost control , and with his front leg (right leg) still hooked to the strap , his back leg (left leg) unhooked from the strap and went into abduction , practically into a split , before falling into the water.

He managed to make it to the shore, get out of his wetsuit, and drive to the emergency department where described severe pain over the suprapubic area. His observations were all within normal range and with analgesia , he managed to mobilise and fully weight bear from wheelchair to bed , although with severe pain.

Examination showed tenderness over the symphysis pubis and the left side of the groin. The abdomen was soft otherwise and there were no other evident injuries. Lower limb examination was normal but range of movement of the left hip was restricted by pain in the left side of the groin. ​

​An X-ray of the pelvis showed evidence of pelvic diastasis, and the left sacroiliac joint was suspicious for a potential fracture. After discussing with the orthopaedic team, a CT pelvis was obtained which confirmed pelvic diastasis with no associated fractures. There was also a 10*6*11 cm pelvic haematoma anterior to and compressing the urinary bladder. Both sacroiliac joints appeared normal, with an incidental cystic lesion noted lateral to the left sacroiliac joint. 

​The patient was admitted under the orthopaedic team, where two days later, he underwent an open reduction and internal fixation of the pelvic diastasis with a left sacroiliac screw insertion.

This presentation was particularly interesting to consider the possibility of ligamentous disruption to the symphysis pubic with abduction injuries.

N Bothma on behalf of Ahmed Abdelhadi (ED ST1)