Fatal Free Falls: A Clinical and Forensic Analysis of Skeletal Injury Patterns Using PMCT and Autopsy

Background: Free fatal falls (FFF) are a frequent occurrence in forensic medicine. Many variables, such as the victim's sex, BMI, intoxication, height of the fall, and mental illness, can influence injury patterns. Previous studies identified fracture patterns and frequencies mostly with general anatomical detail, focusing on broad areas. As specific fractures might be roots for new statistical connections, this leaves a gap in our understanding. Using postmortem computed tomography, we aim to establish fracture frequencies and identify possible new statistical connections. Methods: In total, we retrospectively analyzed seventy-nine cases of confirmed deaths due to falls using the database of the Department and Institute of Forensic Medicine in Lublin. Our inclusion criteria were death due to free fall onto hard, non-deformable surfaces. We excluded cases of ground-level falls. All victims must have undergone postmortem computed tomography. Furthermore, each analyzed case documented individual intrinsic variables (sex, age, body mass, height, pre-existing mental conditions, and drug or alcohol use) and extrinsic variables (fall height, landing surface, time between the fall and death, and known cause of the fall). Results: Injuries in free fatal falls tend to focus on the axial skeleton. Suicides experience more severe, bilateral fractures, often involving the pelvis and limbs, while accidents tend to have unilateral injuries with rare limb involvement. We established new correlations with the height of the fall for the maxilla, mandible, anterior and posterior regions of the occipital bone, and the temporal bone. Moreover, our research confirmed previously noted correlations between the height of the fall and fractures of the limbs (and their individual bones), the lumbar vertebrae, and the chest. Conclusions: Our findings highlight that free fatal falls are characterized by distinct skeletal injury patterns that differ between accidents and suicides, with bilateral pelvic and limb fractures being particularly indicative of intentional falls. The integration of PMCT with autopsy improves the detection of these patterns. It provides valuable diagnostic and medico-legal insights, supporting a more precise determination of the cause and manner of death.