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Case Reports
.2011 Oct 25:19:63.
doi: 10.1186/1757-7241-19-63.

Survival following a vertical free fall from 300 feet: the crucial role of body position to impact surface

Affiliations
Case Reports

Survival following a vertical free fall from 300 feet: the crucial role of body position to impact surface

Sebastian Weckbach et al. Scand J Trauma Resusc Emerg Med..

Abstract

We report the case of a 28-year old rock climber who survived an "unsurvivable" injury consisting of a vertical free fall from 300 feet onto a solid rock surface. The trauma mechanism and injury kinetics are analyzed, with a particular focus on the relevance of body positioning to ground surface at the time of impact. The role of early patient transfer to a level 1 trauma center, and "damage control" management protocols for avoiding delayed morbidity and mortality in this critically injured patient are discussed.

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Figures

Figure 1
Figure 1
Injury pattern of bilateral lower extremities and pelvic fracture on initial multislice CT scan. The patient sustained a right-side open, comminuted talar body fracture, and a contralateral comminuted "joint-depression"-type calcaneus fracture, and a highly unstable pelvic ring injury with bilateral sacro-iliac joint disruptions (arrows).
Figure 2
Figure 2
Physiological response to resuscitation during the first 72 hours after trauma. MAP, mean arterial pressure; HR, heart rate; BPM, beat per minute.
Figure 3
Figure 3
Unstable spine injuries at T6 and L1 on initial multislice CT scan (left panel). The MRI of the T-spine (right panel) revealed a spinal cord transsection at the T6 injury level (arrow).
Figure 4
Figure 4
The patient after successful extubation on hospital day 4, with her boyfriend who witnessed the free fall from 300 feet.
Figure 5
Figure 5
Right femur shaft fracture managed by "damage control orthopaedics" with initial spanning external fixation (left panel) and delayed conversion to intramedullary nail fixation (right panel).
Figure 6
Figure 6
Postoperative X-rays after stabilization of the pelvic ring injury with bilateral lumbo-pelvic/triangular osteosynthesis, and 360° fusion of the unstable T6 and L1 injuries.
Figure 7
Figure 7
Less-invasive two-cavity approach for anterior corpectomy, spinal canal decompression, and anterior spinal fusion of the unstable thoracic and lumbar spine fractures. The T6 injury was managed through a small posterolateral thoracotomy (1), while the L1 fracture was addressed through a retroperitoneal approach along the 11thrib (2). The less-invasive procedure was tolerated well by the patient, and allowed for early mobilization without restrictions.
Figure 8
Figure 8
Early fracture healing documented by X-rays obtained at 6 weeks post injury.
Figure 9
Figure 9
Presumed trauma mechanism resulting from a 300 feet vertical fall in the present case. Landing feet first is the likely root cause for survival in this 28-year old patient who sustained an injury mechanism generally classified as "non-survivable". Please refer to text for details.
See this image and copyright information in PMC

References

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