FTW92IA184

NTSB incident investigation · Boeing 737-222 · Oklahoma City, OK · July 15, 1992

Incident · No injuriesIncident investigationFinal report
Date
July 15, 1992, 16:15 local (21:15 UTC)
Place
Oklahoma City, OK
Injuries
88 uninjured
Damage
No damage
Phase of flight
Approach
Aircraft
N12235Boeing 737-222
Weather
Visual (VMC) · Day
Status
Completed · report June 30, 1993
Report
Approved by Office Director
Case key
18391

From the NTSB’s public API. By law, NTSB reports can’t be used as evidence in lawsuits over the incident.

On this page

Probable cause

Hydraulic fluid exhaustion due to the chafed 'a' system hydraulic line and the improper installation by unknown maintenance personnel of the 'b' system line.

Sequence of events

NTSB’s coding before 2008: each occurrence and phase of flight, and the causes and factors under it. The codes are defined in NTSB’s coding manual.

Airframe/component/system failure/malfunctionApproach - faf/outer marker to threshold (ifr)
Fluid,hydraulic - exhaustionCause
Hydraulic system,line - chafedCause
Hydraulic system,line - incorrectCause
Maintenance,installation - improperUnknownCause

Analysis

The airplane experienced a dual hydraulic system failure during final approach. The captain elected to go around and land at a nearby military airport that had longer runways. The landing was uneventful. Investigation revealed that a hole had been chafed through a return line in the 'a' hydraulic system at a bracket in the left wheel well area. It was also determined that an 'a' system and a 'b' system return line had been cross connected in the area of the no. 1 pylon. The cross connected lines allowed the 'b' system fluid to transfer into the 'a' system and vent overboard. Both hydraulic systems, indications and readings, and tests were normal until the hole was chafed through the 'a' system line. A maintenance record review could not determine at what point in time the lines had been reversed.

Aircraft

Registration
N12235
Reported as
Boeing 737-222
Category
Airplane
Serial number
19758
Airframe hours
41,106
Engine
P&W JT8D-9, 14,500 lbs thrust, turbo fan
Damage
No damage
Flight
Part 121
Operator
Continental Airlines, Inc.
Registered owner
Icci, Inc.
Airworthiness certificate
Standard, Transport
Last inspection
Continuous airworthiness · February 3, 1992 · 74 hours before
Departed
DEN · Denver, CO
Flight plan
IFR

Matched to the registry by N-number and the event date; the registry’s history has gaps, so older matches can be wrong. Compare the reported make and model.

Flight crew

As NTSB recorded them. NTSB leaves out names.

Role
Pilot
Age
44
Certificate
Airline transport
Airplane ratings
Single-engine land, Multi-engine land
Instrument ratings
Airplane
Medical
Class 1, Valid Medical--no waivers/lim.
Seat
Left
Flight hours
13,000 total · 800 in this make and model · 120 in the last 90 days · 40 in the last 30 days · 2 in the last 24 hours

Weather

Conditions
Visual (VMC) · Day
Visibility
10 statute miles
Lowest ceiling
None