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A Displaced Paediatric Metaphyseal Fracture Of A Distal Tibia And Fibula Sustained During Parkour - A Potentially Dangerous Recreation From France.

*C McLean, J Oakshott, P Patel, R Heywood, M Darbyshire and J Pike

*Department of Trauma & Orthopaedics, Frimley Park MDHU, Frimley, Surrey, UK

Address for Correspondence
Department of Trauma & Orthopaedics, Frimley Park MDHU, Frimley, Surrey, UK


J.Orthopaedics 2005;2(3)e4

Case report

A thirteen year old adolescent presented to our accident and emergency department with a closed, displaced fracture of his metaphyseal distal tibia and fibula.  He had fallen from a height of approximately two metres.  He had been attempting to jump over a gap between two walls onto a ledge on an urban building.  Following a sprint run-up he cleared the gap but overshot the ledge and fell onto his extended left leg in heel strike.  He was taken to hospital and referred to the on call orthopaedic surgeons approximately two hours after his injury with a deformed left leg.  At that stage he had diminished sensation to light touch on the dorsum of his foot and his dorsalis pedis pulse was weaker compared with the right side.  His fracture was reduced emergently in the accident and emergency department under sedation in order to alleviate his neurovascular compromise and he was placed into a split above knee plaster of Paris cast.  His neurovascular compromise was relieved immediately and he remained well overnight.  A formal manipulation under anaesthesia was performed the next day, when he was appropriately starved and a satisfactory reduction was achieved.  The reduction was not anatomic as the extent of the impaction of the anterior aspect of the distal fragment was such that fracture was unstable readily angulating into both varus or valgus.  The best stability was achieved with the distal fragment translated approximately twenty percent laterally, in this configuration the fracture remained anatomically reduced on the lateral film and there was no angular or rotational deformity.  An above knee plaster of Paris cast was applied with the ankle fully plantar-flexed in order to control the recurvatum deformity.  He was discharged two days later for follow-up in his local fracture clinic.




Fractures of the metaphyseal distal tibia and fibula are not common fractures in children being only the third most common long bone to fracture.  According to Rockwood ankle fractures, including the metaphyseal distal tibia, account for 4.4% of all paediatric fractures.  These fractures are often greenstick.  In contrast our patient’s fracture was one hundred percent displaced as a result of the comparatively violent mechanism of injury he sustained.  The violence of his injury accounted for his initial deformity, subsequent impaction of the anterior aspect of his distal fragment and consequential non-anatomic reduction.  Nevertheless adequate stability was achieved without the need for percutaneous pins.  Our patient’s skeleton is close to maturity and in keeping with his adolescent status his fracture had a combination of adult and paediatric features.  He was a high school student participating in an unorganised physical activity – this combination is associated with a high incidence of sport related injury [5].  His fracture occurred in the lower limb as opposed to the upper limb.  Upper limb injuries are more typical for children as they have a tendency to fall head first and land on their upper limbs or skulls [2,3].  The injury risk factor for Parkour is unknown Chambers defined this concept in a study of six American sports in 1979.  He studied the risk factors that contributed to fractures and dislocations during athletic events.  The injury risk factor was a function of the number of injuries, number of participants, duration of the participation and the duration of the sporting season [1].  Our patient had been attempting to perform an acrobatic leap as part of a Parkour activity.  Parkour may also be known, as the art of movement, free-running, or obstacle coursing is an activity invented in the Paris’ suburbs by David Belle and Sebastien Foucan.  Parkour consists of finding new and potentially dangerous ways to traverse the city landscape.  The activity is a way of using obstacles in one’s path in order to perform jumps and acrobatics.  It involves the scaling of walls, roof-running and leaping from building to building.  In essence it can be thought of as an extreme sport that combines aspects of free hand rock climbing with gymnastics in an urban setting.  Enthusiasts of the activity may refer to themselves as Parkouristes or traceurs.  Some Parkour enthusiasts claim that the activity is not just a recreation rather it is a form of art or even akin to an eastern philosophy requiring discipline, self-improvement and interdependence.  Parkour beginners are encouraged to start with the basic manoeuvres, in groups, avoiding high walls and with the use of protective equipment.  Information regarding Parkour is readily available on the internet, a search using the google search-engine revealed over 73,000 matches.  Our patient was new to Parkour, having gained his first exposure to it two days before his injury in a television documentary he had watched.  As such he was performing a difficult jump, on an unfamiliar obstacle – he was on a visit to our hospital’s locality – without the use of any protective equipment and without any previous Parkour training.  The phenomenon of children participating in dangerous television inspired activity is well known.  Children who watch television depicting physical risk taking are more likely to take physical risks themselves [4]. Whilst there are no other reports of injuries sustained during Parkour mentioned in the medical literature, it is surely only a question of time before a substantial number of case series are described.  Consequently traumatologists should familiarise themselves with Parkour and its risks and advise those wishing to participate in the activity of the inherent dangers associated with the recreation and means by which these may be reduced.



1) Chambers R.  Orthopaedic Injuries in Athletes Ages 6 to 17: Comparison of Injuries Occurring in Six Sports.  American Journal Sports Medicine 7: 195, 1979.
2) Hanlon C, and Estes W.  Fractures in Childhood—A Statistical Analysis.  American Journal of Surgery 87: 312, 1954.
3) Iqbal Q.  Long-Bone Fractures Among Children in Malaysia.  International Surgery 59: 410, 1975.
4) Potts R, Doppler M, Hernandez M.  Effects of television on physical risk taking in children.  Journal of Experimental Child Psychology 58: 321-331, 1994
5) Zaricznyj B, Shattuck L, Mast T, Robertson R, and D'Elia G.  Sports-Related Injuries in School-Aged Children.  American Journal Sports Medicine 8: 318, 1980.


 This is a peer reviewed paper 

Please cite as :


C McLean:A displaced paediatric metaphyseal fracture of a distal tibia and fibula sustained during Parkour a potentially dangerous recreation from France

J.Orthopaedics 2005;2(3)e4





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