Fatal falls involving stairs: an anthropological analysis of skeletal trauma

  • Samantha K. Rowbotham
  • Soren Blau
  • Jacqueline Hislop-Jambrich
  • Victoria Francis
Original Article

Abstract

The skeletal blunt force trauma resulting from fatal falls involving stairs is complex. There are countless ways an individual may fall when stairs are involved, and thus a variety of ways the skeleton may fracture. Therefore anecdotally, it may be said that there is no specific skeletal trauma characteristic of this fall type. In order to scientifically investigate this anecdotal understanding, this study provides a detailed investigation of the skeletal fracture patterns and morphologies resulting from fatal falls involving stairs. Skeletal trauma was analyzed using the full-body postmortem computed tomography scans of 57 individuals who died from a fall involving stairs. Trauma was examined in the context of the variables that potentially influence how an individual falls (i.e. sex, age, body mass index, number of stairs involved, psychoactive drugs, pre-existing conditions, landing surface and manner of the fall) using logistic regression. Skeletal trauma primarily occurred in the axial skeleton. An analysis of fracture patterns showed the cranial base was less likely to fracture in younger individuals and the cervical vertebrae were more likely to fracture in falls that involved more than half a flight of stairs. A total of 56 fracture morphologies were identified. Of these, diastatic fractures were less likely to occur in older individuals. Findings indicate that there are skeletal fracture patterns and morphologies characteristic of a fatal fall involving stairs.

Keywords

Forensic anthropology Forensic pathology Fatal fall Fall involving stairs Skeletal trauma Blunt force trauma Postmortem computed tomography Fracture pattern Fracture morphology Autopsy Bone 

Notes

Acknowledgements

The authors wish to thank the Victorian Institute of Forensic Medicine for providing access to the PMCT data; the National Coronial Information System for their assistance in attaining the relevant cases, and the manuscript reviewers for their constructive comments. Author SKR would like to acknowledge the Australian Government Research Training Program Scholarship who funded her doctoral research, for which this paper was a component.

Compliance with ethical standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Supplementary material

12024_2018_9964_MOESM1_ESM.pdf (212 kb)
ESM 1 (PDF 212 kb)

References

  1. 1.
    Scott A. Falls on stairways - literature review. Report No. HSL/2005/10. 2005. http://www.hse.gov.uk/research/hsl_pdf/2005/hsl0510.pdf. Accessed 15 May 2017.
  2. 2.
    Roys MS. Serious stair injuries can be prevented by improved stair design. Appl Ergon. 2001;32:135–9.CrossRefPubMedGoogle Scholar
  3. 3.
    Jackson PL, Cohen HH. An in-depth investigation of 40 stairway accidents and the stair safety literature. J Saf Res. 1995;26:151–9.CrossRefGoogle Scholar
  4. 4.
    Jacobs JV. A review of stairway falls and stair negotiation: lessons learned and future needs to reduce injury. Gait Posture. 2016;49:159–67.CrossRefPubMedGoogle Scholar
  5. 5.
    Madea B, Dettmeyer R, Musshoff F. Fall downstairs: accident, homicide or natural death? Forensic Sci Med Pathol. 2008;4:122–8.CrossRefPubMedGoogle Scholar
  6. 6.
    Rowbotham SK, Blau S. Skeletal fractures resulting from fatal falls: a review of the literature. Forensic Sci Int. 2016;266:582.e1–e15.CrossRefGoogle Scholar
  7. 7.
    Wyatt JP, Beard D, Busuttil A. Fatal falls down stairs. Injury. 1999;30:31–4.CrossRefPubMedGoogle Scholar
  8. 8.
    Preuß J, Padosch SA, Dettmeyer R, Driever F, Lignitz E, Madea B. Injuries in fatal cases of falls downstairs. Forensic Sci Int. 2004;141:121–6.CrossRefPubMedGoogle Scholar
  9. 9.
    Behera C, Rautji R, Dogra TD. Patterns of injury seen in deaths from accidental falls down a staircase: a study from South Delhi. Med Sci Law. 2009;49:127–31.CrossRefPubMedGoogle Scholar
  10. 10.
    Pierce MC, Bertocci GE, Janosky JE, Aguel F, Deemer E, Moreland M, et al. Femur fractures resulting from stair falls among children: an injury plausibility model. Pediatrics. 2005;115:1712–22.CrossRefPubMedGoogle Scholar
  11. 11.
    Pennock AT, Gantsoudes GD, Forbes JL, Asaro AM, Mubarak SJ. Stair falls: caregiver's "missed step" as a source of childhood fractures. J Child Orthop. 2014;8:77–81.CrossRefPubMedPubMedCentralGoogle Scholar
  12. 12.
    Docherty E, Hassan A, Burke D. Things that go bump... bump... bump: an analysis of injuries from falling down stairs in children based at Sheffield Children's Hospital. Emerg Med J. 2010;27:207–8.CrossRefPubMedGoogle Scholar
  13. 13.
    Mitchell SE, Aitken SA, Court-Brown CM. The epidemiology of fractures caused by falls down stairs. ISRN Epidemiology. 2013;  https://doi.org/10.5402/2013/370340.
  14. 14.
    Boele van Hensbroek P, Mulder S, Luitse JSK, van Ooijen MR, Goslings JC. Staircase falls: high-risk groups and injury characteristics in 464 patients. Injury. 2009;40:884–9.CrossRefPubMedGoogle Scholar
  15. 15.
    O'Donnell C, Rotman A, Collett S, Woodford N. Current status of routine post-mortem CT in Melbourne, Australia. Forensic Sci Med Pathol. 2007;3:226–32.CrossRefPubMedGoogle Scholar
  16. 16.
    Rowbotham SK, Blau S. The circumstances and characteristics of fatal falls in Victoria, Australia: a descriptive study. Aus J Forensic Sci. 2017;49:403–20.CrossRefGoogle Scholar
  17. 17.
    Ozanne-Smith J, Guy J, Kelly M, Clapperton A. The relationship between slips, trips and falls and the design and construction of buildings. Monash University Accident Research Centre; 2008.Google Scholar
  18. 18.
    Australian Building Codes Board. Building code of Australia class 1 and class 10 buildings. In: National construction code -volume 2. 2016. http://www.abcb.gov.au/Resources/Publications/NCC/NCC-2016-Volume-Two. Accessed 20 June 2017.
  19. 19.
    Bux R, Parzeller M, Bratzke H. Causes and circumstances of fatal falls downstairs. Forensic Sci Int. 2007;171:122–6.CrossRefPubMedGoogle Scholar
  20. 20.
    Ragg M, Hwang S, Steinhart B. Analysis of serious injuries caused by stairway falls. Emerg Med. 2000;12:45–9.CrossRefGoogle Scholar
  21. 21.
    Wedel VL, Galloway A. Broken bones: anthropological analysis of blunt force trauma. 2nd ed. Charles C. Thomas: Springfield; 2014.Google Scholar
  22. 22.
    Scientific Working Group of Forensic Anthropologists. Trauma analysis. 2011. http://swganth.startlogic.com. Accessed 15 Sept 2014.
  23. 23.
    Buikstra J, Ubelaker D. Standards for data collection from human skeletal remains: proceedings of a seminar at the Field Museum of Natural History. Arkansas Archaeological Survey: Arkansas; 1994.Google Scholar
  24. 24.
    Celenk C, Celenk P. Bone density measurement using computed tomography. In: Saba L, editor. Computed tomography - clinical applications. Croatia: InTech; 2012. p. 123–36.Google Scholar
  25. 25.
    Mickey RM, Greenland S. The impact of confounder selection criteria on effect estimation. Am J Epidemiol. 1989;129:125–37.CrossRefPubMedGoogle Scholar
  26. 26.
    Court-Brown CM, Heckman JD, McQueen MM, Ricci WM, Tornetta P, McKee MD. Rockwood and Green's fractures in adults. 8th ed. Philadelphia: Wolters Kluwer Health; 2015.Google Scholar
  27. 27.
    Startzell JK, Alfred Owens D, Mulfinger LM, Cavanagh PR. Stair negotiation in older people: a review. J Am Geriatr Soc. 2000;48:567–80.CrossRefPubMedGoogle Scholar
  28. 28.
    Kieser J. Biomechanics of bone and bony trauma. In: Kieser J, Taylor M, Carr D, editors. Forensic biomechanics. Chichester: Wiley-Blackwell; 2012. p. 36–69.CrossRefGoogle Scholar
  29. 29.
    Schuit SCE, van der Klift M, Weel AEAM, de Laet CEDH, Burger H, Seeman E, et al. Fracture incidence and association with bone mineral density in elderly men and women: the Rotterdam study. Bone. 2004;34:195–202.CrossRefPubMedGoogle Scholar
  30. 30.
    Switzer JA, Gammon SR. High-energy skeletal trauma in the elderly. J Bone Joint Surg Am. 2012;94A:2195–204.CrossRefGoogle Scholar
  31. 31.
    Woolcott JC, Richardson KJ, Wiens MO, Patel B, Marin J, Khan KM, et al. Meta-analysis of the impact of 9 medication classes on falls in elderly persons. Arch Intern Med. 2009;169:1952–60.CrossRefPubMedGoogle Scholar
  32. 32.
    Kool B, Ameratunga S, Jackson R. The role of alcohol in unintentional falls among young and middle-aged adults: a systematic review of epidemiological studies. Inj Prev. 2009;15:341–7.CrossRefPubMedGoogle Scholar
  33. 33.
    Friedman LS. Dose-response relationship between in-hospital mortality and alcohol following acute injury. Alcohol. 2012;46:769–75.CrossRefPubMedGoogle Scholar
  34. 34.
    Bartoletti A, Fabiani P, Bagnoli L, Cappelletti C, Cappellini M, Nappini G, et al. Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J. 2008;29:618–24.CrossRefPubMedGoogle Scholar
  35. 35.
    Templar J. The staircase: studies of hazards, falls and safer design. Massachusetts: MIT Press Ltd; 1992.Google Scholar
  36. 36.
    Rowbotham SK, Blau S, Hislop-Jambrich J, Francis V. Skeletal trauma resulting from fatal low (≤ 3 m) free falls: an analysis of fracture patterns and morphologies. J Forensic Sci. 2017;  https://doi.org/10.1111/1556-4029.13701.
  37. 37.
    Yamamoto T, Takasu K, Emoto Y, Shikata N, Matoba R. Case report of death from falling: did heart tumor cause syncope? Int J Legal Med. 2012;126:633–6.CrossRefPubMedGoogle Scholar
  38. 38.
    Robinovitch SN, Normandin SC, Stotz P, Maurer JD. Time requirement for young and elderly women to move into a position for breaking a fall with outstretched hands. J Gerontol A Biol Sci Med Sci. 2005;60A:1553–7.CrossRefGoogle Scholar
  39. 39.
    Luetters CM, Keegan THM, Sidney S, Quesenberry CP, Prill M, Sternfeld B, et al. Risk factors for foot fracture among individuals aged 45 years and older. Osteoporos Int. 2004;15:957–63.CrossRefPubMedGoogle Scholar
  40. 40.
    Kremer C, Racette S, Dionne CA, Sauvageau A. Discrimination of falls and blows in blunt head trauma: systematic study of the hat brim line rule in relation to skull fractures. J Forensic Sci. 2008;53:716–9.CrossRefPubMedGoogle Scholar
  41. 41.
    Kremer C, Sauvageau A. Discrimination of falls and blows in blunt head trauma: assessment of predictability through combined criteria. J Forensic Sci. 2009;54:923–6.CrossRefPubMedGoogle Scholar
  42. 42.
    Roccia F, Boffano P, Bianchi FA, Zavattero E. Maxillofacial fractures due to falls: does fall modality determine the pattern of injury? J Oral Maxillofac Res. 2014;5:e5.CrossRefPubMedPubMedCentralGoogle Scholar
  43. 43.
    Freeman MD, Eriksson A, Leith W. Head and neck injury patterns in fatal falls: epidemiologic and biomechanical considerations. J Forensic Legal Med. 2014;21:64–70.CrossRefGoogle Scholar
  44. 44.
    McElhaney JH, Hopper RH, Nightingale RW, Myers BS. Mechanisms of basilar skull fracture. J Neurotrauma. 1995;12:669–78.CrossRefPubMedGoogle Scholar
  45. 45.
    Lillie EM, Urban JE, Lynch SK, Weaver AA, Stitzel JD. Evaluation of skull cortical thickness changes with age and sex from computed tomography scans. J Bone Miner Res. 2016;31:299–307.CrossRefPubMedGoogle Scholar
  46. 46.
    Nightingale RW, McElhaney JH, Richardson WJ, Best TM, Myers BS. Experimental impact injury to the cervical spine: relating motion of the head and the mechanism of injury. J Bone Joint Surg Am. 1996;78A:412–21.CrossRefGoogle Scholar
  47. 47.
    Voight GE, Sköld G. Ring fractures of the base of the skull. J Trauma. 1974;14:494–505.CrossRefGoogle Scholar
  48. 48.
    DiMaio VJ, DiMaio D. Forensic pathology. 2nd ed. Boca Raton: CRC Press; 2001.Google Scholar
  49. 49.
    Bakke HK, Dehli T, Wisborg T. Fatal injury caused by low-energy trauma – a 10-year rural cohort. Acta Anaesthesiol Scand. 2014;58:726–32.CrossRefPubMedPubMedCentralGoogle Scholar
  50. 50.
    White TD, Black M, Folkens PA. Human osteology. 3rd ed. Amsterdam: Academic Press, Elsevier; 2012.Google Scholar
  51. 51.
    Sharkey EJ, Cassidy M, Brady J, Gilchrist MD, NicDaeid N. Investigation of the force associated with the formation of lacerations and skull fractures. Int J Legal Med. 2012;126:835–44.CrossRefPubMedGoogle Scholar
  52. 52.
    Grossart KWM, Samuel E. Traumatic diastasis of cranial sutures. Clin Radiol. 1961;12:164–70.CrossRefPubMedGoogle Scholar
  53. 53.
    Hershkovitz I, Latimer B, Dutour O, Jellema LM, Wish-Baratz S, Rothschild C, et al. Why do we fail in aging the skull from the sagittal suture? Am J Phys Anthropol. 1997;103:393–9.CrossRefPubMedGoogle Scholar
  54. 54.
    Donato L, Cipolloni L, Ozonoff A, di Luca A. A preliminary study of the relationship between obliteration of cranial sutures and age at time of death. Biol Syst. 2016;  https://doi.org/10.4172/2329-6577.1000163.
  55. 55.
    Meindl RS, Lovejoy OC. Ectocranial suture closure: a revised method for the determination of skeletal age at death based on the lateral-anterior sutures. Am J Phys Anthropol. 1985;68:57–66.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Forensic MedicineMonash UniversitySouthbankAustralia
  2. 2.Victorian Institute of Forensic MedicineSouthbankAustralia
  3. 3.Centre for Medical Research, Toshiba MedicalNorth RydeAustralia

Personalised recommendations