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At least 19 recordsLinked to original sources

PubMed2004

Influence of fall height and impact surface on biomechanics of feet-first free falls in children.

OBJECTIVE: The objectives of our study were to assess biomechanics associated with feet-first free falls in 3-year-old children and to investigate the influence of impact surface type and fall height on key biomechanical measures associated with injury risk. METHODS: Repeatable feet-first free fall experiments were conducted in a laboratory mock-up environment using an instrumented Hybrid II 3-year-old test dummy. Impact surface type and fall height were varied to examine their influence on biomechanical measures. RESULTS: Feet-first falls from short distances (27 in.) (0.69 m) were found to have a low risk of contact-type head injury, regardless of impact surface type. When comparing different types of impact surfaces in a 27 in. (0.69 m) fall, head acceleration associated with falls onto playground foam was significantly less than that associated with falls onto wood, linoleum or padded carpet. For falls onto playground foam, femoral compressive loads and bending moments were found to significantly increase as fall height increased. CONCLUSIONS: Impact surface type and fall height were found to influence biomechanics associated with injury risk in feet-first free falls as assessed through experimental mock-ups using an instrumented child test dummy. Feet-first falls from short distances (27 in.) (0.69 m) were associated with a low risk of contact-type head injury as assessed using HIC, irrespective of impact surface type.

Acceleration↗

PubMed2005

Influence of wet surfaces and fall height on pediatric injury risk in feet-first freefalls as predicted using a test dummy.

INTRODUCTION: Falls are a major cause of morbidity and mortality in children, but are also reported falsely in child abuse. Therefore, it is of interest to understand those factors which may lead to a higher likelihood of injury in a feet-first freefall. METHODS: We used laboratory freefall experiments and a 3-year-old Hybrid III anthropomorphic test dummy (ATD) to assess head and femur injury risk. Wet and dry linoleum impact surfaces were used from three fall heights: 22, 35 and 47 in. RESULTS: For a given fall height, dry surfaces were associated with higher head injury criteria (HIC) values than wet surfaces. Changes in fall height 22-47 in. did not significantly affect HIC values for falls onto either surface. Generally, compressive and bending femur loading increased significantly for wet as compared to dry linoleum. CONCLUSIONS: In simulated feet first freefall experiments up to 47 in. using a 3-year-old test dummy, a low risk of contact type head injury and femur fracture was found. However, both fall height and surface conditions influenced femur loading and head injury measures. Future efforts should explore the risk of head injury associated with angular acceleration in freefalls.

Acceleration↗

PubMed2003

The effect of falling height on muscle activity and foot motion during landings.

The aims of this study were: (a) to examine the effect of falling height on the kinematics of the tibiotalar, talonavicular and calcaneocuboid joints and (b) to study the influence of falling height on the muscle activity of the leg during landings. Six female gymnasts (height: 1.63 +/- 0.04 m, weight: 58.21 +/- 3.46 kg) participated in this study. All six gymnasts carried out barefoot landings, falling from 1.0, 1.5 and 2.0 m height onto a mat. Three genlocked digital high speed video cameras (250 Hz) captured the motion of the left shank and foot. Surface electromyography (EMG) was used to measure muscle activity (1000 Hz) from five muscles (gastrocnemius medialis, tibialis anterior, peroneus longus, vastus lateralis and hamstrings) of the left leg. The kinematics of the tibiotalar, talonavicular and calcaneocuboid joints were studied. The lower-leg and the foot were modelled by means of a multi-body system, comprising seven rigid bodies. The falling height does not show any influence on the kinematics neither of the tibiotalar nor of the talonavicular joints during landing. The eversion at the calcaneocuboid joint increases with increasing falling height. When augmenting falling height, the myoelectric activity of the muscles of the lower limb increases as well during the pre-activation phase as during the landing itself. The muscles of the lower extremities are capable of stabilizing the tibiotalar and the talonavicular joints actively, restricting their maximal motion by means of a higher activation before and after touchdown. Maximal eversion at the calcaneocuboid joint increases about 52% when landing from 2.0 m.

Biomechanical Phenomena↗

PubMed2005

Severity of playground fractures: play equipment versus standing height falls.

AIM: To compare the severity of fractures from playground equipment falls to the severity of fractures from standing height falls occurring on the playground. METHODS: This case control study used data on all children presenting to the Hospital for Sick Children (Toronto) from 1995 to 2002 with a fracture due to a playground fall. Cases were children who fell from a height off playground equipment. Controls were children who fell from standing height on a playground. Fractures were major if they required reduction and minor if they did not. RESULTS: Fractures from equipment falls were 3.91 (95% CI 2.76 to 5.54) times more likely to require reduction than were fractures from standing height falls. CONCLUSIONS: Major fractures were strongly associated with falls from playground equipment, whereas minor fractures came from both play equipment and standing height falls. Efforts to prevent major fractures should target playground equipment and the impact absorbing surface beneath it.

Accidental Falls↗

PubMed1996

Risk of dying after a free fall from height.

Falls from height are predominantly an urban phenomenon and represent an important form of blunt trauma. Disagreement predominates regarding the height at which death results. The aim of this study was to investigate the risk of dying after a free fall from height in relation to the distance fallen. Therefore, medical records of victims of a fall from height treated in 1989 at Viennese emergency units were analysed. In addition, post-mortem reports of deaths due to falls from height, examined in the same year at the Institute of Forensic Medicine in Vienna, were studied. For the purpose of an homogenous investigation sample in regard to physical condition, only people aged from 20 to 50 years were taken into account. A total of 11 females and 30 males suffered an accidental fall from buildings, seven men from scaffolding and two men from a tree. A total of 18 females and 18 males jumped from residential buildings. One woman and nine men intentionally fell from other buildings. All victims landed on concrete or pavement. Suicidal jumps occurred from significantly higher places than accidental falls. The results of this analysis suggest that death usually occurs when distance is more than five storeys.

Accidental Falls↗

PubMed1978

Falls from heights.

Falls from heights are most commonly due to accidents in children and suicide, accident, and crime-related incidents in adults. Two types of injury result from falls from heights: injury resulting from direct impact and deceleration-type injury. The injuries resulting from direct impact are mostly fractures. The body position at impact is crucial. The deceleration forces immediately post-impact result primarily in visceral and internal injury, including cranial injury. There is a lack of correlation between os calcis fractures and vertebral fractures. Spinal cord injury is infrequent. Survival figures are higher than usually assumed.

Accidental Falls↗

PubMed1998

Fatal falls from a height: the use of mathematical models to estimate the height of fall from the injuries sustained.

The authors undertook a review of fatal falls from a height, that occurred in 1991-92 in Singapore, with the objective of constructing mathematical models relating the height of fall to the injuries sustained. The 603 cases studied showed a mean age of 41.4 years with a male to female ratio of approximately 2:1. A sub-sample of 416 (69%) of these subjects had fallen from known heights (mean, 26.9 m; range, 3-69.6 m) and were studied in further detail. Bivariate analysis of this group showed that their injury severity score (ISS) was significantly correlated with the height of fall (H) and age (P < 0.01; r = 0.412 and 0.187, respectively). As the ISS is not strictly a continuous variable and varied markedly with H, it was categorised into bands (ISSB) before being subjected to further analysis. Regression modelling to adjust for mutual confounding showed that both height of fall and age were significant independent determinants of the ISSB (P < 0.0001). A model with H as the dependent variable was then constructed to relate the height of fall to ISSB and other statistically significant indicators of the extent and the severity of the injuries sustained. A second model with bands of height (HB) as the dependent variable was similarly constructed to assess the effect of banding both height and ISS. Our findings suggested that the height of fall was significantly associated with age, ISS and the extent of injury (mostly AIS > or = 3), and confirmed the usefulness of these models for investigative purposes. Statistical models could be designed and used to assess any apparent discrepancy between injury severity as determined at autopsy and the suspected/alleged height of fall.

Accidental Falls↗

PubMed2004

External injuries to the neck after free fall from great height.

Falls from great height are suicidal in most cases. Any antecedent trauma that would indicate an involvement of a third party should, however, be excluded in each case. Herein lies the difficulty in such cases since injuries prior to the fall which could be of criminal nature may be masked by the impact injuries. Injuries on unexposed parts of the body should always raise the suspicion of an involvement of a third party. This applies especially for neck injuries. By a retrospective analysis of 132 cases of falls from great height, the authors conclude, however, that neck injuries may occur after free fall from great height on a flat surface without antecedent trauma.

Accidental Falls↗

PubMed1996

Hip impact velocities and body configurations for voluntary falls from standing height.

Fall dynamics have largely been ignored in the study of hip fracture etiology and in the development of hip fracture prevention strategies. In this study, we asked the following questions: (1) What are the ranges of hip impact velocities associated with a sideways fall from standing height? (2) What are the ranges of body configurations at impact? and (3) How do protective reflexes such as muscle activation or using an outstretched hand influence fall kinematics? To answer these questions, we recruited six young healthy athletes who performed voluntary sideways falls on a thick foam mattress. Several categories of falls were investigated: (a) muscle-active vs muscle-relaxed falls; (b) falls from a standing position or from walking; and (c) falls in which an outstretched arm was used to break the fall. Each fall was videotaped at 60 frames s(-1). Fall kinematics parameters were obtained by digitizing markers placed on anatomical points of interest. The mean value for vertical hip impact velocity was 2.75 ms(-1) (+ or - 0.42 ms(-1) [S.D.]). The mean value for trunk angle (the angle between the trunk and the vertical) was 17.3 degrees (+ or - 11.5 degrees [S.D.]). We found a 38 percent reduction in the trunk angle at impact, and a 7 percent reduction in hip impact velocity for relaxed vs muscle-active falls. Finally, regarding the. falls in which an outstretched arm was used, only two out of the six subjects were able to break the fall with their arm or hand. For the remaining subjects hip impact occurred first, followed by contact of the arm or hand.

Accidental Falls↗

PubMed2005

Prognostic factors in victims of falls from height.

OBJECTIVE: Falls from height cause significant mortality in the urban environment, but reliable prognostic factors have not been identified. Even the intuitive relation between the distance fallen and mortality rate has been questioned. Our objective was to determine factors predictive of increased mortality rate in victims of falls from height. DESIGN: Clinical observational study, retrospective for January 1998 to May 1999 and prospective from June 1999 to September 2000. SETTING: The study population was drawn from Seine-Saint-Denis, an urban region near Paris with 1.3 million inhabitants treated by a French out-of-hospital medical emergencies unit. PATIENTS: Patients were victims of falls from height >3 m, age >12 yrs. Study entry was performed on the scene by an emergency physician from the medical emergencies unit. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Studied data included age, gender, circumstances of fall, height of fall, nature of the impact surface (soft or hard), transient impact preceding final impact, and part of the body touching the ground first. The primary end point was mortality. The study included 287 patients, 116 (40%) during the retrospective phase and 171 (60%) during the prospective phase. Ninety-seven patients (34%) ultimately died. In multivariate analysis, age (mean, 41.6 +/- 16.6 yrs in patients who died vs. 34.9 +/- 14.9 in survivors; odds ratio, 1.05; p < .0005); height of fall (median, 5.0; 3.8-8.0 vs. 2.0; 1.2-3.0 floors; odds ratio, 1.24; p < .0001); nature of the impact surface (hard in 39% vs. soft in 22%; odds ratio, 2.7; p < .05); and head, anterior, and lateral body surfaces touching the ground first (with respectively mortality rates of 44%, odds ratio, 16.7, p = .0001; 57%, odds ratio, 10.6, p < 0.005; 32%, odds ratio, 11.1, p < .001) were independently correlated with the final mortality rate. CONCLUSIONS: Patient age, height of fall, impact surface nature, and body part first touching the ground are independent prognostic factors in victims of falls from height.

Accidental Falls↗

PubMed2004

Pathologic features of fatal falls from height.

Deaths due to falls from height are common in urban settings. At the time the body is found, it is often unclear whether the mode of death is accident, suicide, or homicide. To assess the injury pattern in fatal falls from height with special regard to criteria that might be helpful in discrimination between accident, suicide, and homicide, respectively, we reviewed 68 medicolegal autopsy cases (22 females, 46 males, age range 13-89 years) of fatal falls from height regarding demographic data, findings at the death scene, results of the postmortem examination, psychiatric history, and toxicologic findings. Among the 68 cases, there were 34 suicides, 23 accidents, and 11 unclarified cases, in 3 of which homicide was suspected. In general, suicides were from greater heights than accidents (mean height 22.7 m for suicides and 10.8 m for accidents, respectively; 79% of suicides from more than 16 m). Strikingly, severe head injuries predominantly occurred in falls from heights below 10 m (84%) and above 25 m (90%), whereas in the group of falls from 10 to 25 m, these lesions were seen less frequently (28%). Neck injuries like muscle bleeds and fractures of the hyoid bone were found in 33% of falls from more than 10 m and did not occur from less than 10 m. Our data stress that the evaluation of pathologic features alone is not sufficient to assess the mode of death in fatal falls from height. Instead, postmortem findings have to be considered within the framework of the subject's social, medical, and psychiatric history in conjunction with findings at the death scene and toxicology results to obtain the clearest possible picture of the circumstances of death.

Accidental Falls↗

PubMed1991

Pediatric falls from heights.

Injuries resulting from falls from heights still constitute a significant portion of urban trauma. At this pediatric trauma center, 70 children were admitted from 1985 to 1988 after sustaining a fall of 10 feet or greater or at least one story. The mean patient age was 5 years and 68% of the patients were boys. Seventy-eight percent of falls occurred from 2 stories or less and usually took place at or near the home. Most patients sustained a single major injury and all survived. The majority of injuries involved the head or skeleton and residual functional deficits were uncommon. The incidence of falls from heights has remained high in urban areas despite public education and building codes that require window guards and safety rails.

Accidental Falls↗

PubMed2006

Falls from height: spine, spine, spine!

BACKGROUND: Falls from a height are a major cause of morbidity and hospital cost. Spinal injury is frequently associated with falls from height, but reliable predictive factors have not been identified. Diagnostic evaluation of the spine is complex and debated. Our objective was to characterize spinal injury after falls from height and identify predictive factors of spinal injuries. STUDY DESIGN: Medical records of patients with falls from height>10 feet admitted in a Level I trauma center during a period of 66 months were reviewed. Univariate and multivariate analyses were performed to identify independent risk factors of spinal injuries. RESULTS: Of 414 patients, 127 (31%) suffered 277 spinal injuries. Multiple spinal injuries at different levels were found in 62 (49%) patients; in 19 (15%) spinal injuries were at noncontinuous levels. The only independent predictor of spinal injury was alcohol intoxication (odds ratio=3.305; 95% CI, 1.75-6.242; p<0.001) but the number of intoxicated patients was low and the predictive ability weak. Level of falls from height did not correlate with likelihood of spinal injury. Twenty-four of 107 (22%) patients with spinal injuries and a reliable clinical examination had no symptoms related to the spine; all but 2 had distracting injuries. CONCLUSIONS: Spinal injury is frequent among survivors of falls from height>10 feet. Because of the absence of reliable predictors of spinal injury, the possibility of multiple noncontinuous fractures, and the presence of distracting injuries clouding the clinical presentation, aggressive evaluation of the entire spine is warranted.

Accidental Falls↗

PubMed2005

Frequency and severity of injuries in correlation with the height of fall.

The main aim of this study was to examine the correlation between the height of fall and the frequency, extensiveness, and type of injuries of certain body regions and organs. The specific objective was to determine characteristic injuries of the analyzed body regions in relation to the certain height of fall. The study included 660 cases of fatal falls from height (469 males and 191 females). Results support the hypothesis that the frequency and extent of the injured body regions and organs are related to the fall height. Head injuries are characteristic of the falls from heights up to 7 m and beyond 30 m. Brain injuries in high falls from heights beyond 30 m show an absence of contre coup contusions and macroscopically evident intracranial bleeding. The extensiveness of chest injuries is significantly statistically associated with fall height. In cases of high falls, the frequency of abdominal injuries is not significantly statistically related to the height of fall. Liver injuries are the most common abdominal injury and the critical height of fall at which the liver injury occurs is 15 m. Injuries of liver and spleen are concomitant in high falls from heights beyond 24 m, irrespective of the manner of impact. The height of fall over 15 m appears to be a reasonable boundary height beyond which the injuries of two or three body regions are generally associated.

Accidental Falls↗

PubMed1998

Horizontal distance and height determining falling pattern.

Falling from a height, usually from a building, occurs ordinarily in suicide, in some accidents, and sometimes as an act of homicide. The point of trajectory, the horizontal distance and the impact point are closely related to the initial velocity, angle and height. This study examines the falling pattern in order to determine the mental status of the jumper as well as the manner of death. Initial velocity is found using horizontal movement and height. A serial study of athletes performing both the running jump (long jump) and standing jump (swimmer's start jump) via biomechanical methods is described. The initial velocity of the running jump and standing jump in normal athletics is 9.15 and 2.70 m/s with initial jumping angles of 21 and 38 deg, respectively. The maximal horizontal velocity of 9.15 m/s is closely related to maximal strength of initial velocity, angle of engaged force, and height. Theoretical estimation of the initial velocity between 2.70 and 9.15 m/s is correlative with the unique initial velocity and running jump to fall from a height that is closely related to the voluntary and attempted jump. Hence, the jumping victim with an initial velocity higher than 2.70 m/s implies suicide. These results indicate that horizontal distance and height are legitimate measures to use in speculating on the falling pattern and the manner of death. A unique case of suicide involving a run and jump with initial velocity greater than 2.70 m/s is illustrated.

Acceleration↗

PubMed2001

American Academy of Pediatrics: Falls from heights: windows, roofs, and balconies.

Falls of all kinds represent an important cause of child injury and death. In the United States, approximately 140 deaths from falls occur annually in children younger than 15 years. Three million children require emergency department care for fall-related injuries. This policy statement examines the epidemiology of falls from heights and recommends preventive strategies for pediatricians and other child health care professionals. Such strategies involve parent counseling, community programs, building code changes, legislation, and environmental modification, such as the installation of window guards and balcony railings.

Accidental Falls↗

PubMed1999

Falls from heights among children: a retrospective review.

BACKGROUND: Falls are a major cause of emergency room visits and admissions in pediatric hospitals. METHODS: To better understand the epidemiology of falls from height and develop prevention strategies, the authors reviewed all admissions after a fall at a single institution from 1994 to 1997. Inclusion criteria are falls from a minimum height of 10 feet. RESULTS: Of 1,410 patients admitted after a fall, 64 patients including 45 boys and 19 girls with a mean age of 7.4 years (range, 1 to 18) are included in this study. Fifty (78%) children fell from 20 feet or less (two stories) and 14 (22%) from height greater than 20 feet. Patients mainly fell from balconies (n = 15), windows (n = 13), trees (n = 9), roofs (n = 6), stairs (n = 6), diving board (n = 3) and miscellaneous (n = 12). Over 60% of falls occurred in private houses and during the summer months. Fifty-five patients (86%) sustained only one system injury, two patients had no significant injury, and seven patients had multisystem injury. Major injuries included head trauma (39%), musculoskeletal (34%), abdominal (12%), maxillofacial (8%), and spine (6%). A surgical intervention was required for 43% of intracranial trauma, 39% of musculoskeletal injuries, 60% of facial trauma, and 50% of spine fractures. Mean length of stay in hospital varied according to the injured system. The overall survival rate is 98% with only one death after a fall greater than 50 feet. CONCLUSIONS: Although rarely mortal, falls from height carry a significant morbidity and are costly to the health care system. To decrease the occurrence of injuries caused by falls, strategies should include awareness campaigns, parent's education about the mechanisms of falls, increase parenteral supervision during playing activities, and legislative measures to ensure the safety of windows and balconies before the onset of summer.

Accidental Falls↗

PubMed1980

[Rupture of intestine and mesentery due to fall from height (author's transl)].

Twenty-five cases of falls from heights are reported under the aspect of lesions of the intestinal tract depending on height of fall and impact. Rupture of mesentery occurred in five cases, in only one case a rupture of intestinal wall. The results verify the thesis, asserted in a recent investigation of injuries caused by maltreatment: direct and not indirect forces lead to isolated lesions of intestinal tract.

Accidents↗