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At least 145 records · Page 8Linked to original sources
PubMed1999

Urban free falls and patterns of renal injury: a 20-year experience with 396 cases.

OBJECTIVE: To determine the distribution and stage of renal injuries from free falls and to determine the appropriate methods for their evaluation and management. MATERIALS AND METHODS: We reviewed the records of 423 patients with renal injuries after a fall from height. Twenty-seven patients did not survive their injuries and were removed from the study. RESULTS: Based on the American Association for the Surgery of Trauma grading scale, 372 of the renal injuries (94%) were grade 1, whereas 24 injuries (6%) were grade 2 to 4. None of the injuries was grade 5. Of the patients with grade 2 to 4 renal injuries, nine patients had grade 2, three patients had grade 3, nine patients had grade 4, and one patients had a forniceal rupture, as well as two patients with ureteropelvic junction disruptions (one bilateral), four with segmental vascular injuries, and two with hilar vessel injuries. Mean height of free fall was 23.1 feet (range, 10-60 feet) and mean Injury Severity Score was 20.6. Neither the degree of renal injury nor the Injury Severity Score statistically correlated to the height of the free fall. Patients with grade 2 to 4 were more likely than patients with grade 1 renal injuries to be in shock and to have intra-abdominal injuries, gross hematuria, and higher Injury Severity Score(33%, 34%, 62%, 24.6 vs. 6%, 9%, 14%, 20.1, respectively). The degree of hematuria and the grade of renal injury, however, did not correlate. Grade 2 to 4 renal injuries had microscopic hematuria and no shock in 8.3% (2 of 24 patients) and no hematuria in 20.8% (5 of 24 patients). Thus, standard selection criteria for renal imaging of blunt trauma, namely gross hematuria or microhematuria and shock would have missed 7 or 29% of our grade 2 to 4 renal injuries, or 1.8% of all grade 1 to 4. Half of the patients with grade 2 to 4 renal injuries had associated multiple-system injuries, and half had flank ecchymosis or tenderness. Of the patients with grade 2 to 4 injuries, 9 patients (37%) underwent surgical exploration and repair of injury. All renal units were preserved and underwent successful reconstruction. Six of the nine patients initially were explored because of associated intra-abdominal injuries. No major urological sequelae were noted postoperatively or in follow-up of all renal injuries. CONCLUSION: The height of the free fall cannot reliably predict the degree of the resulting renal injury. Despite the absence of hematuria or shock, vertical deceleration injuries, in particular those associated with multiple-system injuries and/or physical signs of potential renal injury (e.g., flank ecchymosis), demand renal imaging. After a fall from height, the ureteropelvic junction and renal vasculature should also be imaged for potential injury.

Accidental Falls↗
PubMed1991

Injuries in infants and small children resulting from witnessed and corroborated free falls.

The height of a free fall necessary to cause injury to infants and small children is a confusing and controversial issue among health care, law enforcement, and legal professionals responsible for evaluating cases of possible child abuse. To resolve this confusion, the circumstances of falls were recorded prospectively for 398 consecutive victims of falls seen at Children's Hospital, Oakland, California. From these cases, 106 were selected for further analysis where the falls were witnessed by a second person other than the caretaker and the circumstances of the fall were documented. No injuries occurred in 15 patients, including seven falling more than 10 feet. Mild bruises, abrasions, or simple fractures occurred in 77 patients, including 43 falling more than 10 feet. Severe injuries, including intracranial hemorrhages, cerebral edema, depressed skull fractures, and compound or comminuted fractures occurred in 14 patients falling between 5 and 40 feet. However, no life-threatening injuries occurred in the 3 patients who fell less than 10 feet. These three had small, depressed skull fractures without loss of consciousness, from falling against an edged surface. Only one death occurred in this series, resulting from a fall of 70 feet. In conclusion, infants and small children are relatively resistant to injuries from free falls, and falls of less than 10 feet are unlikely to produce serious or life-threatening injury.

Accidental Falls↗
PubMed1999

[Injuries due to falls from a great height. A comparative analysis of injuries and their outcome following suicide-related and accidental falls].

The aim of this study was to compare the outcome and clinical course of multiple trauma patients with accidental or intentional (suicide related) fall from heights > 4 m. 211 patients with an injury severity score (ISS) > 17 were assigned to the following groups: I: intentional fall, n = 94; A: accidental fall, n = 117) and ISS (I: 28 +/- 1; A: 30 +/- 1), ventilation time (I: 16 +/- 2; A: 15 +/- 1) were not different. Significant differences were found in sex (m/f: I: 56/44; A: 73/27%), fractures of lumbarspine (I: 34; A: 15%), pelvis (I: 51; A: 38%), lower leg (I: 47; A: 20%), pilon (I: 15; A: 5%), and os calcis (I: 17; A: 9%). Liver lacerations occurred more often after intentional fall (I: 16; A: 6%). Single or multiple organ failure (MOF) was diagnosed significantly more often in group A(I: 1; A: 8%). Main cause of death in both groups was single or multiple organ failure (MOF: I: 47; A: 69%) or related to brain-injuries (I: 35; A: 19%). Prognosis and rehabilitation of multiple trauma patients after intentional fall is related to brain-injuries, spine-fractures and the functional outcome of the injured lower leg. Prognosis of patients after accidental fall is related to the development of MOF during the ICU-course.

Accidental Falls↗
PubMedDate not supplied

Fracture patterns in children and young adults who fall from significant heights.

Trauma is a leading cause of morbidity and mortality for children and young adults. When all causes of trauma are considered, falls are the most common mechanism of injury. To address specifically age-related fracture patterns in children who fall, we identified 125 consecutive patients, 21 years old or younger, who fell from a height of 10 feet or greater. The medical records and radiographs for 110 of these patients were available for review. Patients were divided into three groups based on age: there were 25 infant/toddlers (0-2 years), 55 children (3-10 years), and 30 adolescent/young adults (11-21 years). We found statistically significant differences in fracture distribution between the groups. The adolescent/young adult group sustained a greater number of vertebral fractures (p<0.003) and total fractures per fall (p<0.015). The children, in contrast, had a greater number of long bone fractures (p<0.05). Knowledge of age-related fracture patterns could result in improved diagnosis and treatment of these injuries.

Accidental Falls↗
PubMed1997

Pediatric cervical spine injury sustained in falls from low heights.

STUDY OBJECTIVE: To determine whether history and clinical examination findings can identify young children who have sustained cervical injury after falling short distances. METHODS: We conducted a retrospective review of the medical records of children younger than 6 years old with the diagnosis of cervical vertebral fracture or cervical spinal cord injury after a fall of less than 5 feet. Data from medical records over an average time span of 11 years at four large children's hospitals were compiled. RESULTS: We identified eight children who sustained cervical spine injury after a fall of less than 5 feet. These children ranged in age from 9 to 68 months. Three had rotary subluxation of C1, and three had subluxation of C1-C2. One of the children in the latter group also had an odontoid fracture. Two children had a fracture of C2. All the children had limited range of motion of the neck or neck pain. CONCLUSION: All children in this study with the diagnosis of cervical spine injury had clinical evidence of that injury on history or physical examination. Clinicians treating asymptomatic young children who sustain short falls may not need to perform radiographic evaluation of the cervical spine.

Accidental Falls↗
PubMed1993

An analysis of accidental free falls from a height: the 'spring break' syndrome.

Vertical deceleration injuries represent a distinct form of urban blunt trauma. Mechanisms of injury differ from those of horizontal vehicular trauma, and severity primarily depends on velocity of impact. We describe 33 free-fall injuries in adults occurring under purely nonintentional circumstances at a popular college "spring break" resort. Patterns of injuries were found to differ significantly from previously reported patterns of injuries sustained by adults from both accidental and intentional vertical deceleration.

Accidental Falls↗
PubMed2005

Jumping and falling death in children, adolescents, and young adults.

INTRODUCTION: Evaluation of fatal jumps and falls from height in children, adolescents and young adults needs careful medico-legal investigation. The aim of this study was to examine the distribution of undetermined falling from height, accidental falling, and suicidal jumping cases between 1990-2003. METHODS: Copies of death certificates relating to falling from height and jumping deaths in Hungarian youths from the ages of 0-24 years of those resident in Hungary were obtained. RESULTS: 215 (34.1%) accidental falls, 394 (62.6%) suicidal jumping, and 21 (3.3%) undetermined intent were investigated. A significant increase was detected in suicidal jumping death in the age group of 15-19 years (OR=0.7, CI=0.49-0.98, p=0.039), and in the age group of 20-24 years (OR=0.72, CI=0.54-0.96, p=0.025) in the most recent 5 year study period. CONCLUSION: Data concerning the scene investigation, detailed forensic autopsy, and family history have important role in the differentiation of fatal jumping or falling cases. Further investigation about the characteristics injuries may help the final determination of violent death causes at youth, and more effort should be directed to an effective prevention strategy for jumping or falling death cases.

Accidental Falls↗
PubMed1996

Height and surfacing as risk factors for injury in falls from playground equipment: a case-control study.

OBJECTIVES: Despite the widespread promotion of safety standards no epidemiological studies have adequately evaluated their effectiveness in preventing injury in falls from playground equipment. This study evaluated the effectiveness of the height and surfacing requirements of the New Zealand standard for playgrounds and playground equipment. SETTING: Early childhood education centres and schools in two major cities in the South Island of New Zealand. METHODS: Data were collected on 300 children aged 14 years or less who had fallen from playground equipment. Of these, 110 (cases) had sustained injury and received medical attention, while 190 (controls) had not sustained injury requiring medical attention. RESULTS: Logistic regression models fitted to the data indicated that the risk of injury being sustained in a fall was increased if the equipment failed to comply with the maximum fall height (odds ratio (OR) = 3.0; 95% confidence interval (CI) 0.7 to 13.1), surfacing (OR = 2.3; 95% CI 1.0 to 5.0), or safe fall height (OR = 2.1; 95% CI 1.1 to 4.0) requirements. Falls from heights in excess of 1.5 metres increased the risk of injury 4.1 times that of falls from 1.5 metres or less and it was estimated that a 45% reduction in children attending emergency departments could be achieved if the maximum fall height was lowered to 1.5 metres. CONCLUSIONS: Although the height and surfacing requirements of the New Zealand standard are effective in preventing injury in falls from playground equipment, consideration should be given to lowering the maximum permissible fall height to 1.5 metres.

Accidental Falls↗
PubMed1989

[Stepladder accidents--a 5-year analysis of these falls from a height].

156 injuries by a stepladder are reported. In the whole of plunge injuries occurred with a stepladder we found 12%. The painters are involved in 34.6% in this kind of accident, apprentices in 5.8%. Most people were aged from 20-24 and the lower limb was more often injured than the upper limb. Fractures were present in 24% and we registered 48.8 days in which workers were unfit to work. Most patients (95.2%) obtained total rehabilitation.

Absenteeism↗
PubMed1998

The control of timing and amplitude of EMG activity in landing movements in humans.

The control of self-initiated falls from different heights was studied. The objective of the study was to investigate in a quantitative manner the modulation of EMG timing (i.e. onset from take-off and duration from onset to touch-down) and amplitude (before and after foot contact) as a function of fall height. The muscles studied were m. soleus and m. tibialis anterior. Kinematic (ankle joint angle) and kinetic (ground reaction force) variables were also measured. Six subjects took part in the experiments that consisted of ten landings from each of five heights (0.2, 0.4, 0.6, 0.8 and 1 m) onto a force platform. We found a consistent pattern of co-contraction before and after touch-down across the fall heights studied. In both muscles, the onset of pre-landing EMG activity occurred at a longer latency following take-off when landing from greater heights. The absolute EMG duration was affected to a lesser extent by increasing fall height. These findings suggest that the onset of muscle activity of the muscles studied prior to foot contact is timed relative to the expected time of foot contact. Pre- and post-landing EMG amplitude tended to increase with height. Despite a doubling in the magnitude of ground reaction force, the amplitude of ankle joint rotation caused by the impact remained constant across heights. These findings suggest that the observed pattern of co-contraction is responsible for increasing ankle joint stiffness as fall height is increased. The attainment of an appropriate level of EMG amplitude seems to be controlled by (a) timing muscle activation at a latency timed from the expected instant of foot contact and (b) varying the rate at which EMG builds up.

Adult↗
PubMed2002

Impairment and return to work after intra-articular fractures of the calcaneus.

Intra-articular fractures of the calcaneus typically occur in individuals working on ladders, scaffolding or roofs. Male individuals in their productive age are most at risk. The functional problems that frequently persist are a well-known risk since they may obstruct a safe resumption of the former job. According to the data of the National Institute for Sickness and Invalidity Insurance the number of calcaneal fractures in Belgium have stabilised over the last ten years. These figures indicate the necessity for a better prevention policy. Scientific literature about the problem of impairment and disability in these cases is rare and lacks uniformity. A retrospective study was therefore performed on 65 private insurance compensation patients who were treated for intra-articular calcaneal fractures. The mean period of work incapacity was 260.5 days and the mean percentage of impairment was 12.3%. A large group (86.2%) were able to resume their former activities including the height workers. More than half of the patients (57%) needed a supportive device. Working at heights and falls from a height were a significant risk factor for long-term work incapacity. The figures are compared with the limited literature and further discussed.

Accidental Falls↗
PubMed1999

Spinal cord lesions in Bangladesh: an epidemiological study 1994 - 1995.

OBJECTIVES: Spinal Cord Lesions are a major public health problem in Bangladesh. This epidemiological study was undertaken in order to identify the causes of spinal cord lesions and thus to allow prevention and control programs to be developed. MATERIALS AND METHODS: The records of 247 patients with spinal cord lesions admitted to The Centre for the Rehabilitation of the Paralysed (CRP), Savar, Dhaka from January 1994 to June 1995 were reviewed retrospectively. Comparisons were made with the reports of studies from other countries, both developing and developed. RESULTS: The most common cause of traumatic lesions was a fall from a height followed by falling when carrying a heavy weight on the head and road traffic accidents. Most of the patients were between 20 - 40 years old and the overall age group ranged from 10 - 70 years. The male:female ratio was 7.5 : 1.0. Among the traumatic spinal cord lesions, 60% were paraplegics and 40% tetraplegics. Among the non-traumatic spinal cord lesions cases 84% were paraplegics and 16% tetraplegics. The leading cause of death resulted from respiratory complications and these deaths occurred in the very early period of admission. CONCLUSION: From the results it can be deduced that the high incidence of spinal cord lesion as a result from falls from a height, and from falling when carrying a heavy weight on the head, can be explained by the mainly agricultural based economy of Bangladesh. The most common age group (10 - 40 years) of patients reflects the socio-economic conditions of Bangladesh. The male:female ratio (7.5 : 1.0) of patients with a spinal cord lesion is due to the socio-economic status and to the traditional culture of the society.

Accidental Falls↗