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.
Highlights
Vertical deceleration injuries represent a significant cause of preventable deaths and long-term morbidity in survivors [1]
The amount of energy absorbed by the falling body is dependent on the fall height and the characteristics of the contact surface
A retrospective analysis of 101 patients who survived vertical deceleration injuries revealed an average fall height of 23 feet and 7 inches (7.2 meters), confirming the notion that survivable injuries occur below the critical threshold of a falling height around 20-25 feet [1]
Summary
Vertical deceleration injuries represent a significant cause of preventable deaths and long-term morbidity in survivors [1]. After securing the anchor at that height, the rope - which was lacking a security knot - slid through her harness She fell a total of 300 feet, with a first impact at 200 feet onto a flat rock surface, and a further fall for about 100 feet. An MRI of her C-/T-/ and L-spine was obtained the morning which documented a traumatic spinal cord transsection at the level of the rotationally unstable T6 flexion/distraction injury (Figure 3) She was taken the same day for preliminary spinal fixation as a “spine damage control” procedure [9]. The patient recovered well from her injuries and from the “damage control” procedures She was extubated on hospital day 4, and was successfully weaned to room air (Figure 4). She had a normal neurological function to bilateral upper extremities, but lack of sensory function below T6, and complete paraplegia to bilateral lower
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