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Falls from height
In a fall from height the internal injuries are far worse than the external ones, and their pattern is set by the height, the surface and the part of the body that lands first — so distinguishing a fall, a jump and a push relies on the scene and the investigation as much as on the autopsy.
Why it matters in the exam
A typical question: an older man is found in the street beside a building, a window is open high above, and passers-by have "arranged" the body; what is important to establish? The autopsy will establish that the injuries fit a fall and that there are no signs it does not explain — defence injuries, neck injuries, sharp wounds — and will look for diseases and drugs that could explain dizziness or fainting. Distinguishing accident, suicide and homicide also relies on the horizontal distance from the building, the state of the window, a note or psychiatric history, and witnesses.
The landing pattern tells a great deal. Landing on the feet causes fractures of the heel bone, leg, femoral neck and pelvis, vertebral compression fractures, and sometimes a ring fracture of the skull base as the spine is driven upwards. Landing on the head causes comminuted skull fractures. In any fall from a great height, tears of the liver and spleen, aortic rupture at the isthmus and "hanging" tears of the pulmonary artery and organ attachments are common — an expression of deceleration. The skin can look relatively intact over shattered bones.
When the victim passed through glass or struck projections on the building on the way down, there are additional wounds that can be misread as assault. At low height — a fall down stairs or from standing height, for example in an older adult on anticoagulants — a single head injury can be fatal. In addition, findings such as a fractured hyoid bone or neck haemorrhage are not expected in a fall and need an explanation.
Key points
- Internal injuries are far more severe than external ones.
- Landing on the feet: heel, leg, pelvis, vertebrae and ring fracture.
- Deceleration: liver and spleen tears and aortic rupture.
- The manner of death is decided together with scene and investigation.
- Neck and defence injuries are not explained by a fall.
Summary table
| Landing | Typical injuries | Mechanism | Pitfall |
|---|---|---|---|
| On the feet | Heel, leg, femoral neck, pelvis, vertebral compression, ring fracture | Force transmitted along the skeleton | Thinking intact skin means a minor fall |
| On the head | Comminuted skull fractures, brain contusions | Direct contact | Confusing it with a blow from an object |
| Any high fall | Liver and spleen tears, aortic rupture | Deceleration | Ignoring the internal injuries |
| Obstacles on the way | Wounds from glass and projections | Injury during the fall | Reading them as assault |
| Fall from standing height | A single head injury | Anticoagulants, older adults | Underrating a "simple" mechanism |
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Sources
- Knight's Forensic Pathology, 4th edition (2016) — Falls from a height
- Spitz and Fisher's Medicolegal Investigation of Death, 5th edition (2020) — Blunt force injury
- Simpson's Forensic Medicine, 14th edition (2020) — Injury assessment and interpretation
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.