Injury pattern after a fatal feet-first fall from a building

Abstract

A 49-year-old man was found dead in front of a building. A stairway window (freely accessible, 9th floor) directly above a porch (1st floor) was open. Witnesses close to the building heard a noise and found the man lying on the ground, but the fall itself had not been observed. Emergency personnel were called to the scene immediately, but on arrival—7 min after the incident—resuscitation procedures were not carried out, as the man was dead at the scene. On cursory inspection of the body at the scene— without undressing him—the body seemed to the emergency physician ‘‘too uninjured to have sustained a fall from the 9th floor’’ (approx. 27 m), although both legs were shortened and the lateral seams of the jeans were disrupted on the left side (Fig. 1). Despite the absence of indications of a struggle at the scene, investigators could not exclude involvement of a third party. Forensic pathological examination of the victim, which was performed at the site of the incident, showed that fragments of distal tibia and fibula shafts protruded through the soles of the man’s feet and shoes (Fig. 2). Pelvic and chest areas were unstable, which was consistent with severe internal injury due to a fall from height. In view of autopsy findings, death was attributed to extensive injuries involving severe craniocerebral, chest, vertebral column and pelvic trauma with severe visceral damage, e.g. rupture of the heart and the aortic root. In