[Legal and forensic medical aspects of falls from a height (II). Report on an extensive experience (125 cases)].
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Accidents↗
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Severity and outcome of falls in children.
Three hundred and five patients with falls over a period of 4 years were reviewed with the aim to determine the pattern, severity and outcome of childhood injuries from falls in our environment. The results showed that falls accounted for 25% of all childhood injuries. There were more male than female in ratio 2:1. The age ranges from 5 months-15 years with mean age of 6.15 years + or - 3.63. About 40% of the patients were preschool children. Home was the commonest site of falls in 55.3% followed by school in 38% of the patients. Falls from height accounted for 25% and at the ground level in 75% of the patients. Falls from stairs and storey buildings accounted for 68.3% of falls from height, whereas falls while playing on a ground level occurred in 83% of those whose falls were at ground level. Musculoskeletal injuries with fractures of bones were the commonest injuries sustained followed by head injuries. Fracture of lower limb bones accounted for 48% of all the bone injuries commonest bone being femur. The upper limb bones fractured occurred in 45.6%. There were two cases of skull fracture. Head injuries occurred in 6.2% of the patients and severe in 10% of the head injured patients. Other systemic injuries occurred rarely. Most of the injuries were trivial with Injury Severity Score ranges from 2-26. The mean Injury Severity Score was 2 in 235 patients (77%), 10.5 in 64 (21%), 12.5 in 4 (1.4%) and 21.5 in 2 patients(0.6%). Seventy-eight percent of the cases were treated as outpatient. Hospital stay ranges from 1-45 days with mean of 3.8 days. The hospital stay correlated very well with the Injury Severity Score. Wound Infection occurred in only 1.4% of the patients with mortality in 2 patients (0.6%) with Injury Severity Score of 17 and 26 respectively.
Accidental Falls↗
The investigation of fatal falls and jumps from heights in Maryland (1987-1992).
This study is a retrospective analysis of 139 cases of falls and/or jumps from heights, examined at the Office of the Chief Medical Examiner for the State of Maryland during the 6-year period from 1987 through 1992. A total of 56 individuals (40%) committed suicide by jumping from heights and 72 (52%) fell accidentally. Of the 72 accidental falls, 36 (50%) were work related. Two cases involved victims of homicide and the causes in nine cases remain undetermined. Of the 139 cases examined, 89 individuals (64%) fell or jumped from buildings, 29 (21%) from bridges, 15 (11%) from ladders, and 6 (4%) from trees or electric poles. Of the 29 individuals who fell or jumped from bridges, 14 went into water. Falls and jumps most often involved whites (78%) and males (82%). Their ages ranged from 4 to 83 years, with the majority in their 20s and 30s. Of the 124 people who fell or jumped from heights and landed on the ground, the head was the most frequently injured body region (70%), followed by the chest (66%), the abdomen (48%), extremities (28%), and the neck (19%). Of the 124 victims who landed on the ground, 63 sustained lethal injuries involving multiple organs. In contrast with ground impacts, water impact injuries were much less severe. Five of the 14 victims who jumped from bridges into water were relatively uninjured and died from drowning even though they jumped from heights of 100-200 feet (30-60 m).(ABSTRACT TRUNCATED AT 250 WORDS)
Accidental Falls↗
Homicide-suicide in Hong Kong, 1989-1998.
This study provides the first systematic research of homicide-suicide (HS) in a Chinese society. Data were drawn from the HK Homicide Monitoring Data-base computer file derived from investigation and death reports held by the HK Police Force and the Coroner's Court. During the 10-year study period, 56 events involving 133 deaths were identified. The majority of offenders were males (75%) and most victims were female (64%). The mean age of offenders and victims were 41.9 and 32.3 years, respectively. Spouses and lovers comprised the majority of victims (46.4%) followed by child victims (36%). Most HS events were motivated by separation or termination of marital or sexual relations (39%), economic reasons (25%) and other domestic disputes (20%). The most frequent modes of killing were strangulation/suffocation (26%), stabbing/chopping (24%), followed by gassing/poisoning (14%) and falling from height (14%). The commonest of suicide was falling from height (48%). It was followed by gassing/poisoning (22%) and strangulation/suffocation (13%). Depression (18.3%) was found to be the commonest mental disorder. Most offenders were from low-socio-economic background. Two-third were unemployed and 76.6% had 9 or less years of education. HS in HK were distinguished from those reported in the western literature in respect to the high relevance of economic factors, the absence of mercy killing between old couples, a higher percentage of pedicide-suicides and the infrequent use of firearms.
Adult↗
Suicides in the young people of Geneva, Switzerland, from 1993 to 2002.
Suicides in Geneva in those less than 25 years old, from 1993 to 2002, were reviewed. Scenes investigations, autopsy findings, toxicology results, and psychiatric history (when available) were examined. There were 65 cases. The average annual suicide rate was 11/100,000. Seventy-seven percent were male, and 23% were female. The youngest was 12 years old and most of the victims were 18 years old and over (89%). For men, the use of firearms was the most common method (38%), followed by fall from height (16%) and drowning (10%). For women, fall from height was the most frequent (40%), followed by firearms and medication overdoses (20% each), hanging (13%), and drowning (7%). Toxicological analysis was performed in 41% of the cases and showed that alcohol was present in 26% and other drugs in 67% of these cases. The most common drugs present were benzodiazepines, cannabis, and cocaine.
Adolescent↗
[Epidemiologic analysis of spinal injuries resulting from high falls].
A series of 1365 patients treated between 1965 and 1987 because of spine injury resulting from the fall from the height was analysed. A fall from the height may cause hyperflexion, axial loading or hyperextension type of injury. Hyperflexion injury occurs usually after fall from horsedrawn wagon, scaffold, roof or pillar. Axial loading injuries dominate in falls from the ladder, tree, suicidal jumps and falls from lower height. There is remarkable correlation among the height of the fall, degree of nervous system injury and results of management.
Accidental Falls↗
Quantitation of incident spinal fractures: comparison of visual detection with quantitative morphometry.
The value of quantitative morphometry in detection of new spinal fractures was assessed in serial radiographs from 83 patients with osteoporosis. From vertebral landmarks on lateral spine radiographs, a computer program allowed calculation of vertebral heights and area. By comparing vertebral dimensions in the two sets of films, incident spinal fractures could be quantitated based either on the minimum criteria of 15% reduction in vertebral height (CM2) or a fall in height and area of 20% and 10% (CM1). The results of quantitative morphometry were compared with those of the consensus and individual readings of visual detection by three experienced investigators in the same paired sets of spinal films. For incident new fractures, the visual consensus method (V-C) showed a very good agreement with individual visual detection (kappa of 0.794 to 0.916) as well as with CM1 (kappa of 0.821). However, there was a poor agreement between the results of consensus reading and of detection by CM2 (kappa of 0.341), due to excessive number of fractures identified by CM2, but not by the visual method. For incident recurrent fractures, there was a poor agreement between V-C and individual visual detection, and between V-C and quantitative morphometry (kappa of 0.306 to 0.496). It was due to severe compression fractures at baseline, which caused further changes in vertebral dimensions difficult to measure accurately by either visual or quantitative morphometry. Thus, if the visual detection of fractures by a consensus of experienced investigators is considered as the "gold standard," quantitative morphometry, based on minimum reduction in vertebral height of 20% accompanied by a minimum decline in area of 10%, provides an objective detection of incident new spinal fractures but not of recurrent fractures.
Aged↗
Halovest treatment in traumatic cervical spine injury.
This is a cross-sectional study on the use of halovest appliance in the Orthopaedic and Traumatology Department, Kuala Lumpur Hospital from June 1993 to September 1996. Fifty-three patients with cervical spine injuries were treated by halovest stabilization. Majority of cases was caused by motor-vehicle accident; others were fall from height at construction sites, fall at home, hit by falling object and assault. The injuries were Jefferson fracture of C1, odontoid fractures, hangman fractures, open spinous process fracture and fracture body of C2, and fracture, and fracture-dislocation of the lower cervical spines. Majority of patients had hospital stay less than 30 days. The use of the halovest ranges from 4 to 16 weeks and the healing rate was 96%. Two patients of lower cervical spine injury had redislocation and one of them was operated. There was one case of non-union of type II odontoid fracture and treated by posterior fusion. Other complications encountered during halovest treatment were minor. They were pin-site infection, pin-loosening, clamp loosening and neck pain or neck stiffness. This method of treatment enables patient to ambulate early and reduces hospital stay. We found that halovest is easy to apply, safe and tolerable to most of the patients.
Adolescent↗
Stepping responses made by elderly and young female adults to approach and accommodate known surface height changes.
Falls on stairs, kerbs and footpaths are a major cause of morbidity in older female adults. This investigation examined the stepping responses made by 48 elderly (mean age 67 years, S.D. 5.4 years) and 48 young (mean age 20 years, S.D. 2.4 years) healthy, community-dwelling adult females to approach and accommodate known surface height changes. The surface was designed to simulate an object like a kerb or step in the walking path. For ascent, the surface was 9 m long (height, 15 cm) with a 13 m ground-level approach. For descent, it was 15m long (height, 15 cm) with a 7 m ground-level departure. These tasks (particularly descent) perturbed the gait of the elderly more than the young. The elderly exerted more control or were more cautious. They made earlier and larger step adjustments (p<.05), primarily employed a short step crossing strategy (elderly, 60%; young, 19%), exhibited less footfall variability (p<.05), moved slower across the step (p<.001) and spent more time in double foot support while crossing the step. In descent, the elderly preferred to land on the forefoot (p<.001). In both conditions, the elderly placed the feet closer to the step and cleared it by a lesser margin. Step descent appears to be particularly hazardous for older females since foot clearances were small and foot placement was closer to the step.
Adult↗
[A fall from a great height onto tree branches].
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Accidental Falls↗
[Surgical treatment of traumatic disruption of the thoracic aorta due to fall from 6 meters height tree; report of a case].
Disruption of the thoracic aorta due to blunt chest trauma is highly lethal and requires emergent operative intervention. A successful operative treatment of traumatic disruption of the thoracic aorta is reported. A 44-year-old male was admitted to our hospital following a fall from 6 m height tree. Four hours after accident, chest X-ray film demonstrated mediastinal widening. Chest helical computed tomography (CT) scanning demonstrated mediastinal hematoma, left pleural effusion and partial descending aortic dissection. Aortic disruption was diagnosed, and surgery for the thoracic aorta was performed emergently. The 2/3 of circumferentia of the aorta was found to be disrupted in the length of 2 cm, and it was replaced with a vascular prosthesis under partial cardiopulmonary bypass. We conclude that the enhanced chest helical CT scanning is helpful for diagnosis and that if other organ injuries are not critical, the emergent surgery should be required.
Accidental Falls↗
Risk factors for severe injuries associated with falls from playground equipment.
A case control study design was used to determine the risk factors for severe injuries associated with falls from playground equipment. Children presenting to the Hospital for Sick Children in Toronto because of falls from playground equipment (1995-1996) were identified through daily review of admissions and emergency department visits. Cases were defined as children with a severe injury (AIS > or = 2), whereas, controls were children with a minor injury (AIS < 2). Data on age, sex, socioeconomic status, prior experience on the equipment, previous playground injury, type of equipment, height of fall, undersurface, nature of injury, body part involved, and disposition were collected via telephone interview, field trip measurement, and mailed questionnaire. A total of 126 children were studied--67 cases and 59 controls. There were no differences between the two groups on age, sex, socioeconomic status, prior exposure to the equipment, or previous playground injury. Extremity fractures predominated in the case group, while, facial lacerations predominated in the control group. The median height of fall for cases was 199 cm, compared with 160 cm for controls (P = 0.021). Cases were also more likely to have fallen from a height of > 150 cm (73%), compared with controls (54%), P = 0.027. The majority of cases (82%) and controls (86%) fell onto an impact absorbing undersurface (P = 0.540). The median depth of impact absorbing undersurface, however, for both case and control injuries was 3 cm--well below the recommended safety standards. Height of fall was an important risk factor for severe injury associated with falls from playground equipment. Above 150 cm, the risk of severe injury was increased 2-fold.
Accidental Falls↗
Prediction of upper extremity impact forces during falls on the outstretched hand.
Among the most common causes of upper extremity fracture is a fall on the outstretched hand. Yet few data exist on the biomechanical factors which affect injury risk during this event. In this study, we measured impact forces during low-height (0-5 cm), forward falls onto the outstretched hand, and found that these are governed by an initial high-frequency peak and a subsequent, lower-frequency oscillation. This behavior was well-simulated by a two-degree-of-freedom, lumped-parameter mathematical model. Increases in body mass caused greater increases in the peak magnitude of the low-frequency component (Fmax2) than the high-frequency component (Fmax1). However, increases in fall height more strongly influenced Fmax1, which exceeded Fmax2 for all but very low fall heights. Model predictions suggest that fall heights greater than 0.6 m carry significant risk for wrist fracture, since above this height, peak forces surpass the average fracture force of the distal radius. Finally, while the shoulder experiences lower peak force than the wrist (since Fmax1 is not transmitted proximally), it undergoes considerably greater deflection, and thereby absorbs the majority of impact energy during a fall.
Accidental Falls↗
[Isolated fractures of the atlas].
PURPOSE OF THE STUDY: To present the current tends in the diagnosis and management of isolated atlas fractures based on the retrospectively evaluated group of patients with this trauma. MATERIAL: In the period from 1995 to 2002, we treated 486 injuries to the cervical spine at our department. Out of these, 19 patients sustained an isolated fracture of the first cervical vertebra. This group consisted of 12 men and seven women; the average age was 46.6 years. Neurological findings in 18 patients were classified as Frankel E and, in one, as Frankel A. The causes of injury included a fall from height in five patient, a fall in the street in five pedestrians, a car accident in five patients, a dive into shallow water in three and a shooting injury in one patient. METHODS: We treated 16 patients conservatively, using a halo-vest in eight patients and a Philadelphia collar also in eight patients. In two patients with unstable atlas injury, we carried out C1-C2 transarticular stabilization according to Magerl. In the patient who had been shot, we removed the bullet transorally. RESULTS: All patients healed completely without signs of instability. One patient with postraumatic pentaplegia, who died within 24 h of surgery due to septic shock, had not been included in the follow-up. Two patients reported neck pain at rest, three after exercise and 13 were without any pain. The patient after C1-C2 transarticular stabilization had a significant restriction of the range of motion in the cervical spine; the rest of the patients were without limitation. None of the patients showed any deterioration of neurological findings during the treatment, nor was any post-traumatic atlantoaxial instability recorded after the therapy was completed. DISCUSSION: Isolated fractures of the atlas account for 1 to 2% of all spinal fractures. Many fractures may remain unnoticed and, therefore, it is important to X-ray patients with a symptomatic injury to the cervical spine in three standard projection planes (anteroposterior, lateral and transoral). When a fracture of the atlas is suspected, it is necessary to examine them by computed tomography to obtain a more accurate presentation of fracture lines. Views on the method of treating isolated fractures of the atlas, particularly unstable ones, are not consistent. CONCLUSIONS: Isolated fractures of the first cervical vertebra, in terms of therapy, are stable and unstable. Stable fractures heal within 8 to 12 weeks. A Philadelphia collar or halo-vest provide sufficient immobilization. Surgical stabilization or a halo-vest immobilization for a period of 12 weeks are recommended in unstable injuries that are characterized by the lateral mass displacement of more than 7 mm or extension of the space before the dens (predental space) by more than 3 mm, or in which magnetic resonance imaging demonstrated injury to the transverse ligament. After the halo-vest removal, it is necessary to perform functional examination of the cervical spine for detection of potential atlantoaxial instability.
Adolescent↗
[Treatment of femoral neck fractures with compressed screw and sartorius bone flap in youth or middle age].
OBJECTIVE: To study the application and the curative effect of compressed screw and sartorius bone flap in treating femoral neck fractures in youth or middle age. METHODS: From February 1996 to December 2004, 86 patients with femoral neck fracture were treated by open reduction compressed screw and sartorius bone flap, aging from 21 to 49 years. Fracture was caused by traffic accident in 35 cases, fall from height in 27 cases and fall in 24 cases. According to Garden classification, 23 cases were type II, 25 cases were type III, and 15 cases were type IV. We analyzed fracture healing and evaluate function by observation of the postoperative X-ray films. RESULTS: Of the 86 patients, 62 were followed up 6 months to 7 years (2 years and 5 months on average). According to Weijie's criterion for nonunion and necrosis of femoral head, nonunion occurred in 4 cases; the healing rate of fracture was 93.5%. In healed patients, necrosis of femoral head occurred in 7 cases (11.3%) after 3 years. The results of hip joint function evaluation were excellent in 44 cases, good in 8 cases, fair in 6 cases and poor in 4 cases; and the excellent and good rate was 83.9%. CONCLUSION: Compressed screw and sartorius bone flap was simple and effective for femoral neck fractures in youth or middle age.
Adult↗
Aetiological and epidemiological aspects of acute head injury in Malawi.
One hundred and four patients (88 males and 16 females) with acute head injuries admitted to the Queen Elizabeth Central Hospital, Blantyre from July 1st to December 31st 1995 were prospectively studied using a questionnaire. Forty seven (45.2%) of the injuries were caused by road traffic accidents, 42(40.4%) by assaults, nine (8.7%) resulted from falls from heights, two (1.9%) from occupational injuries and the remaining four (3.8%) were of miscellaneous origins. RTA associated head injuries involved 17 (36.2%) pedestrians; 14 (29.8%) vehicular passengers, 10 (21.3%) pedal cyclists; five (10.6%) drivers and one motor cyclist. Malawi males aged between 20 and 29 were mostly involved. Assault related head injuries occurred also in young adult males commonly at the weekend with more than 50% occurring on Saturday and Sunday. Fifty per cent were sustained at home, a quarter on the streets and surprisingly few at drinking houses making them the safest place to be in Malawi to avoid assaults! Alcohol usage was not statistically significant among those assaulted; it was not possible to define its aetiological role among assailants. The head injuries associated with falls from heights (FFH) involved eight males and one female; five were children. Strategies for the prevention of assaults, the various types of road traffic accidents and falls from heights are discussed.
Accidents↗
[Polytrauma following a fall from a great height. The injury pattern and the intensive medicine aspects].
We report on 10 polytraumatised patients who were treated in an ICU after a free-fall injury. The injury pattern of these patients proved to be relatively uniform. Brain oedema occurred in many victims. Remarkable was the fact that 8 out of 10 patients developed a pneumothorax, but only three of them had rib fractures on the same side. All patients suffered from fractures of the extremities with the lower extremities being affected more often. Abdominal injuries were not of importance.
Abdominal Injuries↗
Patterns of injury in victims of urban free-falls.
The objective of this study was to identify the patterns of injury in urban free-fall victims so as to establish guidelines of management. This prospective study at an academic level I trauma center included 187 consecutive patients who presented to our trauma center during a 9-month period (September 1994 to June 1995) after a fall from a height of 5 to 70 feet. Only three falls were from heights of more than 40 feet. Of these patients, 116 (65.1%) suffered significant trauma. Fractures were the most common injuries, accounting for 76.2% of all injuries. Spinal fractures were detected in 37 patients and were associated with neurologic deficits in 7. Intraabdominal injuries occurred in 11 patients, requiring operative intervention in 9 of them. Solid organ lacerations prevailed, but small bowel perforation and bladder rupture were present in one case each. A significant retroperitoneal hematoma was detected in only one case and a thoracic aortic rupture in one more. The height of the fall correlated highly with the incidence of intoxication and severity of injury, the need for operation, the length of hospitalization, and mortality. Most urban free-falls occur from moderate heights. The spinal column is frequently injured and therefore should be thoroughly assessed clinically and radiographically in all fall victims. Intraabdominal organ injuries are much more common than retroperitoneal ones. Thus the abdominal cavity should be the primary target of aggressive workup in hemodynamically unstable patients. The height of the fall is a good predictor of injury severity and outcome prognosis.
Accidental Falls↗