FlarePath
Cases › CHI08IA022 · Part 121 airline

Airbus Industrie A320-211Northwest Airlines

Fargo, ND, USA · 2007-10-21·N331NW

0
fatal
0
serious
No injury
highest injury
Minor
damage

What happened

NTSB summary, verbatim

Shortly after departure, the flightcrew received a Brake and Steering Control Unit (BSCU) channel 2 fault message. Upon reaching 10,000 feet, the crew reset the BSCU per the cockpit operational manual (COM); however, the BSCU channel 2 fault returned and they could not turn off the auto brakes, nor could they change the brake setting from “Maximum.” The crew confirmed that they had “yellow” brake pressure (alternate brakes and parking brake), and believed that they would be landing with alternate brakes. Because turning the antiskid and nosewheel steering to the “Off” position would also turn off maximum braking, they discussed landing with the antiskid and nosewheel steering selected “Off” if necessary. When the crew extended the landing gear during the first approach, they received a landing gear shock absorber fault indication and the auto throttles and autopilot turned off. The crew then contacted air traffic control (ATC) and requested a climb to assess the situation. The captain stated that the landing gear remained down and the flaps were raised. The first officer continued to perform the procedures in the COM and contacted maintenance control to inform them of the landing gear shock absorber fault. The autopilot and auto throttles remained inoperative. The flight crew then requested and received vectors to final approach. The captain stated that they set the flaps to full and completed the landing checklist. He stated that they planned to keep the brake pressure low during the landing and continue the landing roll with manual braking until they came to a stop. They then intended to turn the nosewheel steering on and taxi to the gate. The captain stated they anticipated an uneventful landing and did not advise ATC of the situation. After landing, the crew felt a vibration when the nosewheel touched down and ATC informed them of flames near the nose gear. The airplane came to rest on the runway with the nose gear strut turned 90 degrees to the direction of landing. The lower half of both the nose gear tire and wheel assembly was ground away due to runway contact. The nose gear was the only part of the airplane that sustained damage. Postincident examination and testing of the nose landing gear systems revealed an unidentified and intermittent failure of an integrated circuit on the BSCU monitor board. This failure most likely resulted in frozen BSCU System 1 analog and discrete outputs. If the BSCU System 1 commands had frozen, the BSCU System 2 would have been able to detect the System 1 failure but would not have been able to take control. As a result of this incident, the aircraft and the nose gear manufacturers established a program intended to increase the reliability of the BSCU. Each issued a service bulletin for modification of the BSCU software and both the Federal Aviation Administration and European Aviation Safety Agency issued Airworthiness Directives that made compliance with the service bulletin mandatory.

Photographs

7the aircraft, and what the investigators found
Wreckage and site documentation · 7 photographs from the docket

Photographs are NTSB docket attachments — works of the US government, in the public domain. Captions are the Board’s own.

Probable cause

the Board's determination
The failure of the Brake and Steering Control Unit, which allowed the nose landing gear to turn to the 90-degree position.

Sequence of events

7 timed eventsfrom the FDR factual report · claude-fable-5-1 (in-session)
  1. about 19:11:50 CDTtakeoffp.2
    Takeoff from Minneapolis
  2. about 19:11:55 CDTinitial climbp.2
    Within about 5 seconds of takeoff, Autobrake Decel Lo/Med/Max, Autobrake Fault, Autobrake Off and the brake pedal and brake pressure parameters stopped registering valid data (BSCU/nose wheel steering system fault)
  3. 19:12-19:54 CDTcruisep.2
    Flight continued without apparent incident: climb to 24,000 ft, cruise and descent for approach
  4. 19:54:24-19:54:37 CDTapproachp.2
    Landing gear selected down; gear down and locked recorded at 19:54:37
  5. 19:54:57 CDTapproachp.2
    Nose gear weight-on-wheels transitioned from air to ground while airborne (nose gear turned 90 deg, proximity sensor state change)
  6. 19:55:28 CDTapproachp.2
    Autopilot 2, autothrottle and flight director switched from engaged to disengaged; master warning recorded
  7. 20:06:46 CDTlandingp.2
    Left and right main gear weight-on-wheels indicated ground - landing at Fargo with the nose gear at 90 degrees

NTSB analysis

from the final report

Shortly after departure, the flightcrew received a Brake and Steering Control Unit (BSCU) channel 2 fault message. Upon reaching 10,000 feet, the crew reset the BSCU per the cockpit operational manual (COM); however, the BSCU channel 2 fault returned and they could not turn off the auto brakes, nor could they change the brake setting from “Maximum.” The crew confirmed that they had “yellow” brake pressure (alternate brakes and parking brake), and believed that they would be landing with alternate brakes. Because turning the antiskid and nosewheel steering to the “Off” position would also turn off maximum braking, they discussed landing with the antiskid and nosewheel steering selected “Off” if necessary. When the crew extended the landing gear during the first approach, they received a landing gear shock absorber fault indication and the auto throttles and autopilot turned off. The crew then contacted air traffic control (ATC) and requested a climb to assess the situation. The captain stated that the landing gear remained down and the flaps were raised. The first officer continued to perform the procedures in the COM and contacted maintenance control to inform them of the landing gear shock absorber fault. The autopilot and auto throttles remained inoperative. The flight crew then requested and received vectors to final approach. The captain stated that they set the flaps to full and completed the landing checklist. He stated that they planned to keep the brake pressure low during the landing and continue the landing roll with manual braking until they came to a stop. They then intended to turn the nosewheel steering on and taxi to the gate. The captain stated they anticipated an uneventful landing and did not advise ATC of the situation. After landing, the crew felt a vibration when the nosewheel touched down and ATC informed them of flames near the nose gear. The airplane came to rest on the runway with the nose gear strut turned 90 degrees to the direction of landing. The lower half of both the nose gear tire and wheel assembly was ground away due to runway contact. The nose gear was the only part of the airplane that sustained damage. Postincident examination and testing of the nose landing gear systems revealed an unidentified and intermittent failure of an integrated circuit on the BSCU monitor board. This failure most likely resulted in frozen BSCU System 1 analog and discrete outputs. If the BSCU System 1 commands had frozen, the BSCU System 2 would have been able to detect the System 1 failure but would not have been able to take control. As a result of this incident, the aircraft and the nose gear manufacturers established a program intended to increase the reliability of the BSCU. Each issued a service bulletin for modification of the BSCU software and both the Federal Aviation Administration and European Aviation Safety Agency issued Airworthiness Directives that made compliance with the service bulletin mandatory.