Falls from height in forensic medicine: Differentiating accident, suicide, and homicide through case analysis and...

Falls from height represent one of the leading causes of unintentional injury and death worldwide. Distinguishing between accidental, suicidal, and homicidal falls remains a major forensic challenge. Autopsy findings alone may not reveal the true origin, particularly in cases with inconsistent witness statements or complex injury mechanisms. Integrating biomechanical simulations with classical forensic methods offers an opportunity to strengthen interpretative accuracy.

We retrospectively analyzed 258 fall-from-height cases referred to the Department of Forensic Medicine, Akdeniz University, between 2007 and 2016. Demographic variables, fall height, injury patterns, and manner of fall were evaluated. Additionally, a representative case (25-year-old female, 7th-floor fall) was reconstructed using MADYMO and LS-DYNA in three scenarios: accidental backward fall, suicidal forward jump, and homicidal push. Detailed initial and boundary conditions-including friction coefficient (μ=0.60), restitution coefficient (e=0.15), and scenario-specific initial velocities-were defined. Simulation outputs (impact velocity, rotational components, HIC15, VC, AIS-based injury probabilities) were compared with autopsy findings.

Of the 258 cases, 94.9 % were accidents, 4.7 % suicides, and 0.4 % suspected homicides. The mean fall height was 7.03 m, with head-neck trauma being the most common injury (49.2 %). In the representative case, the accidental scenario demonstrated the highest concordance (89 %) with autopsy findings, while suicide and homicide simulations produced inconsistent injury profiles. Biomechanical modeling showed increasing head accelerations and injury probabilities across accident (82 g; 54 %), suicide (94 g; 71 %), and homicide (110 g; 89 %) scenarios. Rotational motion around the railing pivot increased intermediate contact velocity, substantially affecting impact severity.

Accurate determination of fall origin requires a multidisciplinary approach integrating autopsy findings, scene investigation, and biomechanical simulations. Objective simulation-based metrics (HIC, VC, g-forces) complement classical forensic evaluation and improve the interpretative reliability of disputed or ambiguous cases.