Falling injuries

Last revised by Leonardo Lustosa on 21 Feb 2022

Falling injuries are the second most common cause of accidental or unintentional deaths in the world. Falling trauma is the most common mechanism of injury in persons 21 years old or younger 1,2.

Clinical presentation

Many factors influence the presentation of a fall-from-height victim, such as height, age, body position, cause of the fall, and landing surface. Thus, the clinical presentation can be extremely varied, ranging from a patient with a minor complaint on a single region of the body to a fall victim sustaining injuries in multiple body regions.

In relation to the distribution of fractures, it seems to be no difference when considering the cause of the fall (either intentional or accidental), with the exception of the laterality of the fractures. Intentional jumpers are more likely to sustain bilateral fractures 1

Regarding the pediatric population, it is important to be alert to possible child abuse, as falling trauma may be intentionally provoked or a fake history given by the abusers.

Imaging features

Fall-from-height victims will usually present with a fracture or multiple fractures, which can be assessed on radiographs. Patients may also sustain soft tissue lesions, such as brain injury, blunt cardiac injury, traumatic aortic rupture, spinal cord injury, and abdominal organs injuries which are better assessed by other imaging modalities 1,3.

Adult population

The higher the fall, the more likely the patient is to present with fractures on multiple regions of the body, with the exception of head fractures, which seem to not be related to height. In falls from lower heights, the patient is more likely to fracture the forearm and/or the leg while humeral and femoral fractures are more common when falling from higher falls 1.

The most common sites of fractures are, in order:

  • rib cage
  • head
  • spine - cervical and thoracic being more common than lumbar
  • lower extremities
  • upper extremities
  • pelvis
Pediatric population

The immature skeleton and the different mechanisms of fall in the pediatric population make for a different spectrum of presentation when compared to adults. Being aware of the age-related patterns of fracture can lead to better diagnosis and treatment of these injuries 2.

In the pediatric population, a skeletal survey may be performed if a non-accidental injury is suspected.

Similarly to adults, the most common region of fractures is the skull. But unlike adults, rib fractures are rare in children 1,2.

The most common sites of fractures are, in order:

  • skull
  • spine
  • forearm
  • femur
  • humerus
  • hand
  • pelvis
  • foot
  • clavicle
  • lower leg

This distribution however is greatly impacted by age group, which can be further divided into infants and toddlers, children, and adolescents and young adults.

Infants and toddlers

This group is extremely unlikely to present vertebral fractures and is the most likely to present skull fractures, especially with head-first landings 2


This group is the most likely to present long bone fractures. Vertebral fractures are quite uncommon in this group, especially when compared to adolescents and young adults. Regarding long bone fractures, children are more likely to fracture upper extremities than adolescents and young adults 2.

Adolescents and young adults

This group is more likely to present vertebral fractures. This group is more prone to feet-first landings, thus it is more likely to fracture lower extremities than children 2.


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