Journal of Forensic Medicine & Toxicology Vol. 27 No.
1, Jan-June 2010
ORIGINAL ARTICLE
INJURIES DUE TO FALL FROM HEIGHT – A RETROSPECTIVE STUDY
Jagannatha SR1, Pradeep Kumar MV1, Naveen Kumar T2, Ananda K3, Venkatesha VT4
ABSTRACT
Fall from height cause serious and fatal injuries every
year which add significantly to morbidity and mortality
of the area. The fatality of the injuries depends not only on
the height of fall but also on body landing position, impact
surface, clothing and the safety measures used as seen in
cases of laborers working in higher altitude. Fall from
high places are frequently encountered in accidents,
suicides & rarely in homicides. The severity of the injury
increases by increasing the rate of deceleration &
decreasing the distance through which the body is
decelerated. This retrospective study has been undertaken
on 120 cases during a period of seven years and pattern of
injuries was evaluated. An effort is also made to correlate
it with the height of fall.
Keywords: Fall from Height; Vertical Deceleration
Injuries; Soft tissue injuries; Safety measures.
INTRODUCTION
Injury is recognized as a major health problem and a
leading cause of death globally1. Fall from height are
responsible for many serious and fatal injuries every year.
In an urban setting, morbidity and mortality of the area is
dependent on the accidental injuries out of which, injuries
due to fall from height add significantly. If the height of fall
is less; it may leave the victim with disability so as to make
him unable to do his routine work. If a person falls from a
height above six feet and more, there is likelihood that he
may sustain serious injury, examples include fall from roof
top, from tanks, from the edge of elevated structures, or
from the top of vehicles or trailers. The extent of injuries
1 MBBS, MD, Assistant Professor
3 MBBS, MD, Professor & HOD
4 Professor
Department of Forensic Medicine,
Kempegowda Institute of Medical Sciences
Banashankari II stage, Bangalore-560070
2 MBBS, MD Assistant Professor
Department of Forensic Medicine
Rajarajeshwari Medical College and Hospital
Bangalore-560074.
Corresponding Author:
Dr Jagannatha SR MBBS, MD
Assistant Professor, Department of Forensic Medicine
Kempegowda Institute of Medical Sciences
Banashankari II stage, Bangalore-560070
Karnataka State, INDIA E-mail: pradi003@rediffmail.com
47
sustained vary depending on the falling height, the
composition of the impact surface, rate of deceleration,
intermediate objects encountered during the process of
fall, the position of the body when landing and individual
factors such as age, body weight, pre-existing disease,
and type of the person (child, adult, elderly). In India,
fall from height is one of the common causes of severe
blunt trauma. Fall from high places are frequently
encountered in accidents, suicides & sometimes rarely
in homicides.
Falls are examples of vertical deceleration injuries (VDI)
and the patterns of injury differ from horizontal deceleration
injuries (HDI) associated with motor vehicle accidents.
Vertical deceleration injuries characteristically involve major
weight bearing structures with forces transmitted through
the foot, leg, pelvis & vertebral column2. Injuries of the
lower extremity are likely to be unilateral & comminuted
because the force of deceleration is applied to a small area.
The severity of the injury increases by increasing the rate
of deceleration & decreasing the distance through which
the body is decelerated. More severe injury occurs when
deceleration forces are applied to the body in the vertical
axis compared with the transverse, provided that mass,
velocity & stopping distance remain the same.
The mode of impact influence the individual injuries
sustained independently of deceleration force, hence, it is
known that fall on the head is more likely to be fatal than on
any other position, there is no way in which the pathology
of falls can be generalized as the circumstance will differ in
major aspect in every case.
Head (depressed skull fracture, cerebral contusion,
intracranial hemorrhage), thoracic (pulmonary contusion,
ruptured bronchus or aorta, sternal fracture resulting from
hyper flexion of the chin), spinal (burst vertebral bodies) &
abdominal (shearing of the bowel at the junction of fixed
and mobile portions) injuries are common, most often
skeletal injuries predominate3.
Several studies exist which evaluate the pattern of
injuries from falls. However there are very few studies
exclusively discussing the pattern of injuries in vertical
deceleration injuries to major cavities of the body.
This study has been undertaken to evaluate the pattern
of skeletal & soft tissue injuries and to correlate it with the
height of fall. Also an effort is made to look into the
demographic profile, manner of death in cases of fall from
heights.
Journal of Forensic Medicine & Toxicology Vol. 27 No. 1, Jan-June 2010

MATERIALS AND METHODS victims were construction workers by occupation. The

The Department of Forensic Medicine at KIMS, a Post
Graduate institute conducts autopsies of all violent,
unexpected and suspicious death in the southern part of
Bangalore. This retrospective study was conducted by
scrutinizing the Post mortem reports & other relevant
documents that are suggestive of fall from height. The
relevant documents considered are police reports, suicide
notes, medical records & scene photographs. The age, sex,
height of descent, injuries, circumstances, place of fall &
manner of death where available were reviewed. The other
types of violent deaths & fall from the same level were
excluded from the study. Toxicological results were reviewed
in available cases. The patterns of injuries were discussed
according to type of body region. It is divided into head,
chest and abdomen and the injuries are compared with level
of descent.
youngest was a baby of 18 months old & the oldest being
80 years. Out of 120 cases 112 (93.33 %) cases are accidental
and 8 (6.66%) cases were suicidal. The descent of fall varied
from 8 feet to 75 feet. Most of the victims 37 (30.8%) fell
from a height ranging from 31-40 feet followed by 21 (17.5%)
victims who fell from a height of 41-50 feet (Fig 1).
Toxicological tests were performed only on selected
cases. Ethanol was detected in 5(4.1%) cases. Blood alcohol
concentrations ranged from 0.08 to 0.490%.
Abrasions, contusions & lacerations were evenly
distributed all over the body. As the height of fall increased
there was an increase in the severity of the injuries, involving
soft tissues and skeleton. Skeletal injuries involved Skull
87, followed by Ribs 51 & Femur in 31 cases (Fig 2). Among
soft tissue injuries brain involved in 91 cases followed by
liver in 42 cases & lungs in 33 cases (Fig 3). Majority of

RESULTS
Department of Forensic Medicine, KIMS, a post
graduate institute, Bangalore conducted autopsies
concerned with our study on 120 cases during a period of
seven years. The 120 fatalities due to descent from height
comprised 4.139 % of the 2899 autopsies performed during
the study period.
Among 120 cases studied, 104 were males & 16 were
females (Table 1). 21 to 30 years age group individuals
dominated other age group victims (Table 2). Most of the
Table 1 Fig 1

Year No. of No. of Sex distribution of

Autopsies fall from fall from height cases
conducted height cases Males Females
2003 345 12 11 01
2004 409 15 14 01
2005 421 14 12 02
2006 410 20 17 03
2007 416 17 16 01
2008 433 20 14 06
2009 465 22 20 02
Total 2899 120 104 16 Fig 2
Table 2
Age in years Male Female Total
00-10 3 2 5
11-20 15 3 18
21-30 37 2 39
31-40 19 3 22
41-50 16 2 18
51-60 8 3 11
>60 6 1 7
Total 104 16 120 Fig 3
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 Journal of Forensic Medicine & Toxicology Vol. 27 No. 1, Jan-June 2010
head injuries were due to primary impact of head. Vault
fractures 44 (36.66%) were the most common type of skeletal
injury of skull followed by basal fractures with vault fracture
in 30 cases (25%).
DISCUSSION
Falls are examples of vertical deceleration injuries (VDI)
and the patterns of injury differ from horizontal deceleration
injuries (HDI) associated with motor vehicle accidents.
Vertical deceleration injuries characteristically involve major
weight bearing structures where forces transmit through
the foot, leg, pelvis & vertebral column2. The pattern of
injuries can help in the determination of causation of
injuries & manner of death 4. In the abrupt vertical
deceleration that occurs on impact after a free fall, tissue
damage is caused by the absorption by the body of the
energy accumulated during the free fall. Patients sustain a
unique injury pattern that is predictably different from that
seen with other forms of blunt multiple trauma5.
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 of
injury. The injuries resulting from direct impact are mostly
fractures. The body position at the time of impact is very
crucial. The deceleration forces immediately post-impact
result primarily in visceral and internal injury, including
Cerebral injury. Height of descent, body landing position,
impact surface and clothing affects the extent & distribution
of skeletal injuries and soft tissue injuries 6.
The frequency and extent of the injured body regions
and organs are related to the fall height. In the present
study it was found that 37 victims (30.8%) fell from a height
ranging from 31-40 feet followed by 21 (17.5%) victims who
fell from a height of 41-50 feet. Skeletal injuries involved
Skull 87, followed by Ribs 51, Femur 31 and Vertebrae in 25
cases. Among soft tissue injuries brain involved in 91 cases
followed by liver in 42 cases and lungs in 33 cases. Various
studies describe that head injuries are characteristic of the
falls from heights and brain injuries in high falls from heights
beyond 30 m show an absence of contre coup contusions
and macroscopically evident intracranial bleeding. In our
study, we could not compare the height of fall with that of
coup and contre coup injuries as it is an retrospective study
and in most of the reports these specific findings were
missing as only the presence of injuries were mentioned in
the reports and not mentioning the exact location of the
injuries. This can be considered as one of the limitation of
the study. In our study 37 victims (30.8%) fell from a height
ranging from 31-40 feet and head being the target region of
the body of impact. The Severity of chest and abdominal
injuries have statistically significant association with the
fall height which is in accordance with our study. Liver
injuries are the most common abdominal injury seen in most
of the studies. This can be explained by the fact that the
49
liver is a solid organ, covering most of the area in the
abdominal cavity. Injuries of liver and spleen are seen in
high falls from heights beyond 24m, irrespective of the
manner of impact 7. In our study liver lacerations were seen
in falls from a height of 40 ft (12-2m) and above which can
be explained by the fact that most of the victims are laborers
by occupation and probably at the time of fall they might
have not maintained the safety measures needed. It is not
the scenario in the western world, as most of them follow
the protocol so the injury pattern and height differ.
If the person falls on the head, both vault and base of
skull can fracture, with extrusion of brain. When the person
falls to the side of the body, severe abdominal and thoracic
injuries can occur 8. Cardiac injuries (54%) are found in
falls from height exceeding 6m 9. But in our study we did
not find a single case of cardiac injury, probably due to the
fact the mode of impact, influence the individual injuries
sustained independently of deceleration force and in most
of the cases it is the body lands on the head or on the feet
and very rarely on the side of the body. The cardiac injuries
may be seen in cases where the fractured ends of the ribs
or sternal pierce the heart. In most of the cases in our study
the lungs were edematous covering the surface of heart
which might have acted as a cushion, preventing cardiac
injuries. Direct impact to the chest can lead to cardiac
injuries. Haemothorax was seen in cases of rib fractures 9,
10
. Workers in maintenance and construction and many other
people in a variety of jobs could be at risk of falling from
height at work. Bangalore being a developing city with the
emerging buildings is the main cause behind the accidental
fall involving laborers. Most of the victims were workers
aged 21 to 30 years, contributing for daytime falls. This is
in contrast to findings of Kohli & Banerjee 11 who were of
the view that most of the falls occurred late at night as in
our study out of 120 cases 112 (93.33 %) cases are accidental
and 8 (6.66%) cases were suicidal in nature. In India
poisoning (34.8%) is the common type followed by hanging
(32.2%) to commit suicide. Jumping from building accounted
only 0.5% of the total number of suicide deaths in 2008 12.
CONCLUSION
The extent of injuries sustained due to fall from height
vary depending on the falling height, composition of the
impact surface, rate of deceleration, intermediate objects
encountered during the process of fall, position of the
body when landing, individual factors such as age, body
weight, pre-existing disease and also type of the person
(child, adult, elderly). Craniocerebral trauma (head injury)
is the primary cause of mortality amongst skeletal injuries.
Among soft tissue injuries, injury to brain followed by
liver, lung and spleen were frequent. As most of the victims
were construction workers and where work at height cannot
be avoided, a risk assessment should be carried out before
any work at height is undertaken by the employers. Fall
restraint and arrest equipment such as nets, airbags and
Journal of Forensic Medicine & Toxicology Vol. 27 No. 1, Jan-June 2010
harnesses, etc. should be considered as safety measures
at the work place. All work at height should be planned,
organized and carried out by competent persons. But none
the less every case has to be weighed on its own merits.
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