Journal of Plastic, Reconstructive & Aesthetic Surgery (2013) 66, 1801e1802

CASE REPORT

The perils of spinning class: An open anklefracture following a spinning exercisesession

Daniel P. Butler*, Francis P. Henry, Shadi Ghali

Department of Plastic and Reconstructive Surgery, The Royal Free Hospital, Pond Street,London NW3 2QG, UK

Received 11 April 2013; accepted 5 May 2013

KEYWORDSOpen ankle fracture;Free-flapreconstruction;Trauma;Spinning class

* Corresponding author. Departmentive Surgery, The Royal Free HospitalStreet, London NW3 2QG, UK.

E-mail address: dan.butler@doctor

1748-6815/$-seefrontmatterª2013Brihttp://dx.doi.org/10.1016/j.bjps.2013.0

Summary Spinning is an increasingly popular form of cycle-based exercise. The workouts areoften of high-intensity and participants are intermittently encouraged to achieve a high crank-set-cadence rate. We report a unique case of an open ankle fracture requiring free flapcoverage, which highlights the potential perils of spinning class.ª 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published byElsevier Ltd. All rights reserved.

Case report

A previously fit and healthy 55-year-old female presentedto the Emergency Department after catching her left track-suit trouser leg in the pedal mechanism of her stationaryexercise bike while attending a ‘spinning’ class for the firsttime. She sustained an open left bimalleolar Weber A anklefracture with a 10 cm transverse laceration overlying theanteromedial aspect of her ankle (Figure 1).

Operative debridement and definitive bone fixation wascarried out at 48 h. A single plane non-circumferential type

t of Plastic and Reconstruc-, 20 St James Avenue, Pond

s.org.uk (D.P. Butler).

tishAssociationofPlastic,Reconstruc5.036

II degloving injury of the skin extending from the medial tolateral malleolus was identified.1 The resulting post-debridement wound measured 8 � 10 cm and exposed themedial malleolar fracture site as well as tibialis anteriorand extensor hallucis longus tendons. The medial malleolarfracture was reduced and internally fixated using twomedullary screws and a negative-pressure dressing wasapplied to the wound.

Further debridement was carried out at 96 h to assess forany further demarcation of devitalized skin/soft tissue.Seven days post-injury, the wound was covered with a freegracilis muscle flap harvested from the left thigh and anas-tamosed end-to-side to the posterior tibial vessels proximalto the zone of injury. A split thickness skin graft harvestedfrom the left thigh was used to cover the gracilis flap.

The patient had an unremarkable post-operative courseand was discharged six days after the free flap procedure.

tiveandAestheticSurgeons.PublishedbyElsevierLtd.All rightsreserved.

Figure 1 Pre-soft tissue debridement revealing the tibialisanterior and extensor hallucis longus tendon in the wound bed.

1802 D.P. Butler et al.

At the three-month follow-up, the fracture was shown tohave united, the wound had successfully healed and thepatient was fully mobilising (Figure 2).

Discussion

This case report describes a case of a significant openfracture occurring whilst exercising on a stationary exercisebike. The authors are unaware of any previous reports ofthis unique injury.

Spinning exercise classes are increasing in popularityamongst all age groups. Participants are on stationary ex-ercise bike in a fitness suite and are led by an instructor.The class is designed to enhance the individual’s cardio-vascular fitness and, therefore, a high-intensity workout isundertaken. During the workout, participants are inter-mittently encouraged to increase the intensity of the ses-sion by adopting a higher crank-set cadence rate, orstanding up from the seated cycling position. It was during ahigh-tempo period that our patient caught her left trouserleg in the pedal mechanism of her exercise-bike causing herto fall abruptly.

Previous reports on the risks of spinning exercise classesinclude a case of bilateral compartment syndrome of the

Figure 2 The appearance of the ankle at follow-up as anoutpatient.

thigh2 and cases of rhabdomyolysis.3 Case series of paedi-atric digit amputations secondary to becoming caught inthe chain/sprocket mechanism on home exercise bikeshave also been reported.4

Most open lower limb trauma occurs following high en-ergy injuries, such as road traffic accidents. A combinationof soft tissue avulsion and degloving can result in extensiveskin loss which, when combined with an underlying frac-ture, can necessitate free flap coverage.5 It is evident fromour case that the high-intensity workout associated withspinning classes can generate sufficient force to result inhigh-energy lower limb trauma if the subject falls from thebike. The sequence of events resulting in the open anklefracture occurring in this case began with the trouser legbecoming caught in the pedal mechanism. The highcadence and rotational energy within the pedal mechanismat this time was sufficient to result in a bimalleolar anklefracture and significant degloving of the lower leg.

Conclusion

This unique case of a significant open lower limb fractureoccurring whilst using a static exercise bike highlights thepotential for significant injuries to occur during high-intensity spinning class workouts. Participants should beencouraged to avoid wearing lose trousers whilst under-taking spinning sessions to minimise the risk of the legbecoming caught on the pedal mechanism during periods ofhigh-crank-set cadence.

Conflict of interests

Nil.

Funding

Nil.

Acknowledgements

Nil.

References

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3. Montero J, Lovesio C, Godoy MV, Ruiz G. Rhabdomyolisiscaused by spinning in nine patients. Medicina (B Aires) 2009;69(1 Pt 2):153e6.

4. Lehrer MS, Bozentka DJ, Partington MT, Lee B, Osterman AL.Pediatric hand injuries due to exercise bicycles. J Trauma1997;43(1):100e2.

5. Khan U, Smithan P, Pearse M, Nanchahal J. Management ofsevere open ankle injuries. Plast Reconstr Surg 2007;119(2):578e89.