PATTERNS OF INJURY IN VICTIMS OF URBAN FREE-FALLS

The objective of this study was to identify the patterns of injury in urban free-fall victims so as to establish guidelines of management. T his prospective study at an academic level 1 trauma center included 18 7 consecutive patients who presented to our trauma center during a 9-m onth period (September 1994 to June 1995) after a fall from a height o f 5 to 70 feet. Only three falls were from heights of more than 40 fee t. Of these patients, 116 (65.1%) suffered significant trauma. Fractur es were the most common injuries, accounting for 76.2% of all injuries . Spinal fractures were detected in 37 patients and were associated wi th neurologic deficits in 7. Intraabdominal injuries occurred in 11 pa tients, requiring operative intervention in 9 of them. Solid organ lac erations prevailed, but small bowel perforation and bladder rupture we re present in one case each. A significant retroperitoneal hematoma wa s detected in only one case and a thoracic aortic rupture in one more. The height of the fall correlated highly with the incidence of intoxi cation and severity of injury, the need for operation, the length of h ospitalization, and mortality. Most urban free-falls occur from modera te heights. The spinal column is frequently injured and therefore shou ld be thoroughly assessed clinically and radiographically in all fall victims. Intraabdominal organ injuries are much more common than retro peritoneal ones. Thus the abdominal cavity should be the primary targe t of aggressive workup in hemodynamically unstable patients. The heigh t of the fall is a good predictor of injury severity and outcome progn osis.