Table of Contents  
CASE REPORT
Year : 2022  |  Volume : 9  |  Issue : 4  |  Page : 319-321

Kite string injury: An unusual cause of extensive ankle trauma with vascular injury


Departments of Vascular and Endovascular Surgery, Yashoda Hospitals, Hyderabad, Telangana, India

Date of Submission12-Jan-2022
Date of Acceptance21-Feb-2022
Date of Web Publication8-Nov-2022

Correspondence Address:
Devender Singh
Departments of Vascular and Endovascular Surgery, Yashoda Hospitals, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijves.ijves_4_22

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  Abstract 


Vascular injuries due to kite string are uncommon but are associated with significant morbidities and mortality. We report a case of 45 years female sustaining kite string injury to her ankle resulting in neurovascular injuries and total transection of the tendoachilles. The aim of the article is to highlight this rare injury, its mechanism and the importance of awareness which can prevent this to a large extent.

Keywords: Kite string, manja, tendoachilles, vascular injury


How to cite this article:
Singh D, Aryala S. Kite string injury: An unusual cause of extensive ankle trauma with vascular injury. Indian J Vasc Endovasc Surg 2022;9:319-21

How to cite this URL:
Singh D, Aryala S. Kite string injury: An unusual cause of extensive ankle trauma with vascular injury. Indian J Vasc Endovasc Surg [serial online] 2022 [cited 2022 Nov 28];9:319-21. Available from: https://www.indjvascsurg.org/text.asp?2022/9/4/319/360544




  Introduction Top


Kite string leading to vascular injuries is an uncommon cause and only seen in limited parts of the world. Kite flying is a popular sport in Indian subcontinents and is celebrated on the eve of winter festivals in January and on August 15 in India. Over the years, these celebrations have now turned into competitions. Children and young adults compete against each other with an objective of bringing down kites of their competitors and being the last kite flying. To win or cut the kite of another person, people use dangerous methods to make their string strong, such as coating it with glass and glue (also known as manja); this will make the string razor sharp and cut the other person's kite. These days people frequently use chemical or Chinese manja, which is based on nonbiodegradable synthetic fibers. As a result, incidences of injuries resulting from kite strings are on the rise, not only among flyers but also unsuspecting passers-by, especially when flown in populated areas. Deep injuries to major vessels can lead to grievous injuries and sometime fatal.

Kite string injury resulting in total transection of an artery, nerve, and tendoachilles is extremely rare has not been reported in the literature to the best of our knowledge.


  Case Report Top


A 45-year-old female presented to the emergency department with a lacerated wound around the right ankle. The mechanism of injury was narrated as a kite string (manja) getting entangled around her ankle while she was walking on the side of the road, unaware of any thread. She had profuse bleeding and was taken to the hospital, where first aid was given with ligation of bleeding vessels and later shifted to us in view of extensive ankle injuries.

Local examination revealed a clean-cut transverse lacerated wound of 8 cm x 3 cm involving posterior, medial, and lateral aspects of the right ankle. A close examination confirmed a complete tear of the tendoachilles, posterior tibial artery, and posterior tibial nerve with both its cut ends visible through the wound [Figure 1], [Figure 2], [Figure 3], [Figure 4]. Her foot was warm, with palpable dorsalis pedis pulsation. Standard radiographs of the ankle did not reveal any bony abnormality. She was planned for the repair of her ankle with the help of a plastic surgeon.
Figure 1: Deep laceration around the right ankle

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Figure 2: Total transection of tendo achillis

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Figure 3: Total transection of the posterior tibial artery

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Figure 4: Total transection of the posterior tibial nerve

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Primary end-to-end repair done for the posterior tibial artery and nerve, as well as for tendoachilles. An above-knee cast with the knee in 30° of flexion and the ankle in gravity equinus was given for 6 weeks followed by gradual weight-bearing and range of motion exercises. The postoperative period was uneventful.


  Discussion Top


Kite flying in India is seen as a competitive sport and most commonly seen in January around the festival of Makar Sankranti. To win the competition, one tries to have a competitive edge by coating his/her kite's string with glass and starch known as manja. Recently, manja made of polypropylene thread (nylon) called “Chinese Manja” (because it was imported from China) became very popular due to its increased strength, which provided an edge to kite-flying competitors.

Various types of injuries occur while flying kites. It can cause primary impact injuries such as entanglement of thread around the neck leading to minor laceration over the face and neck, fatal neck injuries, or laceration of the hand due to handling of manja.[1] Secondary impact injuries occur which manja gets wrapped around the feet of a person leading to fall on the ground causing fracture of extremities or can cause pillion rider to fall from a moving two-wheeler leading to life-threatening injuries to head or torso.[2]

Only few cases of ankle injuries with the transaction of tendoachilles are reported in the literature due to kite string.[3] Ankle injuries with total transection of the posterior tibial artery, nerve, and tendoachilles are not reported so far.

The management of an incised wound caused by manja is similar to that of any other incised wound. A careful neurovascular examination is warranted because the depth and damage are maximum at the center and deeper injuries may be missed by an unsuspecting eye, which may see the wound as just a clean superficial laceration. Thorough and gentle lavage with normal saline is a must because the wound often contains fine glass particles that stick to the tissues as the thread sinks deeper while cutting.[4],[5] Usually, the neurovascular structures and tendoachilles are repaired end to end because of sharp cut by the string.

Although the injuries make headlines in local newspapers are grossly under reported in the literature. The present case is of an innocent-looking thread causing grievous injury to the ankle. In view of the high incidence of kite string injuries, the government should have legislation to prevent such injuries. Few suggestions include that flying kites should be permitted in only designated open playfields. Flying kites should be banned from areas near main roads and highways. There should be social awareness about such injuries secondary to kite flying and social counseling.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Prajapati C, Agrawal A, Atha R, Suri MP, Sachde JP, Shaikh MF. Study of kite string injuries in Western India. Int J Inj Contr Saf Promot 2017;24:136-9.  Back to cited text no. 1
    
2.
Borkar JL, Tumram NK, Ambade VN, Dixit PG. Fatal wounds by “Manja” to a motorbike rider in motion. J Forensic Sci 2015;60:1085-7.  Back to cited text no. 2
    
3.
Bagaria V. Achilles tendon rupture secondary to kite string (manja) injury: A rare etiology seen in two cases. J Foot Ankle Surg 2015;2:90-3.  Back to cited text no. 3
    
4.
Wankhede AG, Sariya DR. “Manja” – A dangerous thread. J Forensic Leg Med 2008;15:189-92.  Back to cited text no. 4
    
5.
Järvinen TA, Kannus P, Maffulli N, Khan KM. Achilles tendon disorders: Etiology and epidemiology. Foot Ankle Clin 2005;10:255-66.  Back to cited text no. 5
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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