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

Area of Science:

• Forensic Medicine
• Radiology
• Orthopedic Pathology

Background:

• Free fatal falls (FFF) are common in forensic medicine, with injury patterns influenced by various factors.
• Previous studies on fracture patterns lack specific anatomical detail, creating a knowledge gap.
• Postmortem computed tomography (PMCT) offers potential for detailed analysis of skeletal trauma.

Purpose of the Study:

• To establish fracture frequencies in free fatal falls using PMCT.
• To identify new statistical correlations between fall variables and specific fractures.
• To differentiate injury patterns between accidental and intentional falls.

Main Methods:

• Retrospective analysis of 79 confirmed free fatal fall cases.
• Inclusion criteria: death from free fall onto hard surfaces, exclusion of ground-level falls.
• Data collected: intrinsic variables (sex, BMI, intoxication, mental health) and extrinsic variables (fall height, surface).

Main Results:

• Injuries in free fatal falls predominantly affect the axial skeleton.
• Suicides exhibit more severe, bilateral fractures (pelvis, limbs) compared to unilateral injuries in accidents.
• New correlations found between fall height and fractures of the maxilla, mandible, occipital, and temporal bones.

Conclusions:

• Skeletal injury patterns in free fatal falls differ significantly between accidents and suicides.
• Bilateral pelvic and limb fractures are strong indicators of intentional falls (suicides).
• Integrating PMCT with autopsy enhances detection of injury patterns, providing crucial medico-legal insights.