# NTSB LAX08LA168: Mkii Lancair Legacy 2000, N199L, Bend, OR, June 9, 2008 - Type: NTSB accident investigation - Classification: Accident · No injuries · Limited investigation · Final report - Date: June 8, 2008, 17:09 local (Jun 9, 2008, 00:09 UTC) - Place: Bend, OR - Coordinates: 44.094444, -121.200279 - Nearby events: https://openairdocs.org/map.md?lat=44.0944&lon=-121.2003&mi=10 - Phase of flight: [Enroute](https://openairdocs.org/ntsb-phases/400) (OpenAirDocs' grouping) - Defining event: [Enroute-cruise: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340) - Highest injury: No injuries - Injuries: 2 uninjured - Status: Completed, report March 3, 2010 - Report: Approved by Office Director - Parties: Federal Aviation Administration, TCM - NTSB case key (mKey): 68191 - NTSB case page: https://web.ntsb.gov/investigations/?ntsbnumber=LAX08LA168 - NTSB report (PDF, downloads): https://data.ntsb.gov/carol-repgen/api/Aviation/ReportMain/GenerateNewestReport/68191/pdf - NTSB docket: https://data.ntsb.gov/Docket?ProjectID=68191 - Page: https://openairdocs.org/ntsb/LAX08LA168 ## Probable cause A total loss of engine power due to the fatigue failure of the Number 3 cylinder connecting rod. ## Findings NTSB's coded findings; those marked are part of the probable cause. - [Engine (reciprocating): recip engine power section](https://openairdocs.org/ntsb-findings/01058520): Aircraft › Aircraft power plant · Fatigue/wear/corrosion (probable cause); cases with it: [Mkii LANCAIR 2000, 1 case](https://openairdocs.org/ntsb-findings/01058520/cases.md?model=05607N5), [All aircraft, 233 cases](https://openairdocs.org/ntsb-findings/01058520/cases.md) ## Sequence of events The events NTSB coded, in order, by phase of flight. The defining event best describes what happened. - [Enroute-cruise: Powerplant sys/comp malf/fail](https://openairdocs.org/ntsb-events/340) (defining event); cases with it: [Mkii LANCAIR 2000, 1 case](https://openairdocs.org/ntsb-events/340/sequence.md?model=05607N5), [All aircraft, 820 cases](https://openairdocs.org/ntsb-events/340/sequence.md) - [Enroute-cruise: Loss of engine power (total)](https://openairdocs.org/ntsb-events/341); cases with it: [Mkii LANCAIR 2000, 1 case](https://openairdocs.org/ntsb-events/341/sequence.md?model=05607N5), [All aircraft, 3,820 cases](https://openairdocs.org/ntsb-events/341/sequence.md) - [Landing-landing roll: Off-field or emergency landing](https://openairdocs.org/ntsb-events/440); cases with it: [Mkii LANCAIR 2000, 1 case](https://openairdocs.org/ntsb-events/440/sequence.md?model=05607N5), [All aircraft, 3,365 cases](https://openairdocs.org/ntsb-events/440/sequence.md) - [Landing-landing roll: Runway excursion](https://openairdocs.org/ntsb-events/300); cases with it: [Mkii LANCAIR 2000, 1 case](https://openairdocs.org/ntsb-events/300/sequence.md?model=05607N5), [All aircraft, 3,643 cases](https://openairdocs.org/ntsb-events/300/sequence.md) ## Analysis While at 9,000 feet, the engine lost oil pressure, suddenly oversped (3,560 rpm), and lost power. The pilot made a dead-stick approach to a nearby runway. During the landing flare the airplane's main landing gear impacted a trench and sheared off just short of the runway. The airplane slid down the runway on its nose gear, main mount struts, and tail. The airplane then veered off to the right and departed the runway. Examination of the engine revealed a 4- to 5-inch diameter hole in the top of the engine case above the No. 3 cylinder. Further examination revealed that the No. 3 connecting rod of the engine had failed due to fatigue just below the wrist pin. The loose end of the connecting rod produced metal shavings that obstructed the oil pickup tube as the crankshaft continued to rotate. The blocked tube led to oil starvation, propeller overspeed, and catastrophic engine failure. Material Laboratory testing revealed that the connecting rod fatigue fracture was located in a decarburized region of the rod. The engine manufacturer could not identify the connecting rod as a component supplied by them. ## Factual narrative On June 8, 2008, at 1709 Pacific daylight time, a MKII Corporation Lancair Legacy 2000, N199L, experienced a loss of engine power and the pilot executed a forced landing to Bend Municipal Airport, Bend, Oregon. Lancair International Incorporated operated the airplane under the provisions of Title 14 Code of Federal Regulations Part 91. The airline transport pilot and single passenger were not injured, and the airplane was substantially damaged. Visual meteorological conditions prevailed, and no flight plan had been filed. The flight originated at Marysville, California, about 1400. The pilot reported to the Safety Board investigator that while cruising at 9,000 feet, the engine suddenly oversped and quit. The failure was accompanied by a loud noise, heavy vibration, and smoke. The pilot immediately secured the engine, turned the fuel selector to off, and diverted to the nearest airport. He attempted to restart the engine but shut it down after observing heavy smoke. He made a dead stick approach to runway 34 at Bend Municipal Airport. During the landing flare the airplane's main landing gear impacted a trench and sheared off just short of the runway. The airplane slid down the runway on its nose gear, main mount struts, and tail. The airplane then veered off to the right and departed the runway. Examination of the engine revealed a 4- to 5-inch diameter hole in the top of the engine case above the number 3 cylinder. The engine logbook documented that the experimental Continental IO-550-FI-EXP was installed on the airplane November 12, 2006, with a time since overhaul (TSOH) of 0.0 hours. On August 1, 2007, the engine was reinstalled on the airplane after it had been overhauled by AvWorks Custom Engines & Components, and designated IO-550-L2-X, serial number 0813. An annual inspection was performed on June 1, 2008, at TSOH of 236 hours. The airplane was equipped with an Electronics International MVP-50P Flight Data Recorder. Engine data indicated a drop in oil pressure at 1606:00, followed by sudden engine rpm rise from 2,520 to 3,560, at 1606:14. On June 16, 2008, the engine was examined at the Lancair facility, Bend, by a Federal Aviation Administration inspector and a technical representative of Teledyne Continental Motors (TCM). The crankcase was missing a portion of the material above the number two, three, and four cylinder deck areas. The internal surfaces of the cylinder bays all exhibited mechanical related damage. Metal shavings were identified obstructing the oil pickup tube and screen. Following the inspection, the engine was shipped to the TCM factory, Mobile, Alabama, for further examination under the supervision of the Safety Board investigator-in-charge (IIC). On December 2, 2008, the engine was laid out and examined by investigators at the TCM Factory. Two halves of the number 3 cylinder connecting rod exhibited fracture signatures consistent with fatigue, and were sent to the Safety Board Materials Laboratory for detailed examination. The Materials Laboratory determined that the fracture surfaces on the crank shaft portion of the number 3 connecting rod sustained mechanical damage consistent with continued crankshaft rotation after the fracture. The wrist pin portion of the connecting rod was protected by the piston skirts, and the fracture surface was preserved. Stereomicroscope examination of the fracture surfaces indicated that the number 3 connecting rod failed due to tensile or single-sided bending fatigue. Numerous ratchet marks indicated that multiple fatigue cracks initiated at the surfaces of both rails of the I beam before growing together and independently progressing into the I beam cross sections. The two fatigue cracks covered about 60 percent of the connecting rod cross section, before the section failed due to mechanical over stress. Micrograph images of the rail surfaces in the immediate vicinity of the fatigue initiation points on the number 3 connecting rod rails indicated no grinding marks or unusual surface features. The roughness in the region appeared to be consistent with a shot peened surface, consistent with TCM specifications. A metallurgical section through the fatigue region of the connecting rod was examined. Metallographic analysis indicated that scale was embedded in the surface of the connecting rod to a depth of approximately 0.001-inch. Metallographic analysis also indicated that the surface of the connecting rod, in the vicinity of the fatigue fracture initiation site, had about 0.015-inch of total decarburization. Discussions with a representative from TCM revealed the connecting rod surface should not have any embedded scale in critical areas and should have no more than about 0.002-inch of decarburization. Representatives from TCM did not recognize the markings on the number 3 connecting rod and could not positively identify it as a TCM supplied part. The entire Materials Laboratory Factual Report is located in the official docket of this accident investigation. ## Aircraft - Registration: [N199L](https://openairdocs.org/aircraft/N199L), registered now, S/N 2000-001, built 2000 (OpenAirDocs) - Reported make and model: MKII Corporation Lancair Legacy 2000 - Registry model: [Mkii LANCAIR 2000](https://openairdocs.org/model/mkii-lancair-2000) (registry code 05607N5) (OpenAirDocs) - Registry engine: [Continental IO-550-N](https://openairdocs.org/engine/continental-io-550-n) (registry code 17215, reciprocating) (OpenAirDocs) - Category: Airplane - Serial number: 2000-001 - Airframe hours: 1510 - Engines: Continental IO-550 reciprocating - Damage: Substantial damage - Flight: Business, Part 91 - Operator: Lancair International Inc - Registered owner: Lancair International Inc - Airworthiness certificate: Standard, Utility; Special, Experimental (Special) - Last inspection: Condition, June 1, 2008 - Departed: KMYV, Marysville, CA - Destination: KRDM, Redmond, OR - Airport: KBDN, Bend Municipal Airport, runway 34, 5,005 × 75 ft, asphalt ## Flight crew As NTSB recorded them. NTSB leaves out names. - Pilot; age 68; injuries: none; flight engineer, military, flight instructor, airline transport; airplane ratings: single-engine land, multi-engine land; instrument ratings: airplane; medical: class 3, with waivers/limitations; last flight review March 10, 2007; seat: left; flight hours: 22,000 total, 300 in this make and model, 17,000 as pilot in command, 59 in the last 90 days, 16 in the last 30 days, 3 in the last 24 hours ## Weather - Conditions: Visual (VMC), Day - Wind: 330° at 11 knots - Visibility: 10 statute miles - Lowest ceiling: none - Temperature: 72 °F, dew point 27 °F - Altimeter: 30.04 inHg - Observed at: KRDM ## FAA reports on this event (1) The FAA's own accident and incident reports, matched to the aircraft by N-number and date (OpenAirDocs). - [Accident 20080608834459A](https://openairdocs.org/incident/20080608834459A), Jun 8, 2008: Bend, OR, Substantial damage. On jun 8, 2008, approximately 1730 local, the pilot of an experimental aircraft (N199L) experienced a catastrophic engine failure approximately 10 mile south… ## Docket (9 files) The files NTSB released with the investigation on November 18, 2009, on NTSB's docket system: https://data.ntsb.gov/Docket?ProjectID=68191. 11.1 MB in all. - Pilot/Operator Aircraft Accident Report, NTSB Form 6120.1 (item 1, .PDF, 664 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320625&FileExtension=.PDF&FileName=Pilot%2FOperator%20Aircraft%20Accident%20Report,%20NTSB%20Form%206120.1-Redacted.PDF - Pilot Record of Conversation (item 2, .PDF, 11 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320626&FileExtension=.PDF&FileName=Pilot%20Record%20of%20Conversation-Redacted.PDF - Materials Laboratory 15 - Factual Report (item 3, .PDF, 1.3 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320631&FileExtension=.PDF&FileName=Materials%20Laboratory%2015%20-%20Factual%20Report-Master.PDF - Photo 1 - On scene left side of airplane (item 4, .PDF, 3.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320627&FileExtension=.PDF&FileName=Photo%201%20-%20On%20scene%20left%20side%20of%20airplane-Master.PDF - Photo 2 - Engine (item 5, .PDF, 3.5 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320628&FileExtension=.PDF&FileName=Photo%202%20-%20Engine-Master.PDF - Statement of Party Representatives to NTSB Investigation (item 6, .PDF, 56 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320629&FileExtension=.PDF&FileName=Statement%20of%20Party%20Representatives%20to%20NTSB%20Investigation-Redacted.PDF - TCM Engine Release (item 7, .PDF, 64 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320630&FileExtension=.PDF&FileName=TCM%20Engine%20Release-Redacted.PDF - Engine Logbook (item 8, .PDF, 1.2 MB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320633&FileExtension=.PDF&FileName=Engine%20Logbook-Redacted.PDF - Engine Performance Data (item 9, .PDF, 894 KB): https://data.ntsb.gov/Docket/Document/docBLOB?ID=40320859&FileExtension=.PDF&FileName=Engine%20Performance%20Data-Master.PDF From the NTSB's public API. Aircraft are matched to registry aircraft by N-number and event date, checked against the reported serial number, make and model; the registry's history has gaps, so older matches can be wrong. Compare the reported make and model. --- OpenAirDocs.org is an independent research project of [Contrail Labs](https://contraillabs.com/). It is not affiliated with the FAA or the NTSB. Source documents are U.S. government works in the public domain.