Background: Patients who have fallen from great height with suicidal intent present unique challenges, including delayed medical attention, injury patterns that are often difficult to detect, severe hypothermia, and difficulties obtaining informed consent due to the patient’s mental state. Further delays to treatment can be caused by legal and logistical hurdles, such as coordinating with legal guardians or family members. These co-factors contribute to the high reported overall complication rates in these cases, which can reach up to 50%. This study aims to analyse injury patterns, inflammatory responses and complication rates in people who have jumped to their death, compared to those who have fallen unintentionally. It also aims to investigate the correlation between jump height and injury severity. Methods: This retrospective monocentric study analysed patient data such as age, gender, injuries, treatments and duration of hospitalisation. A total of 68 suicidal falls were included during the period from January 2014 to January 2024. Subsequently, 68 unintentional falls from a height of more than three meters were included from the same period as a control group, which was analysed alongside the suicidal falls. We analysed injuries sustained in clinical and radiological findings, as well as the inflammatory response and coagulation status of patients in blood gas analysis (BGA) and laboratory analysis of blood drawn in the first hours/days after trauma (C-reactive protein, white blood cell count, lactate, pH value, base excess, procalcitonin and prothrombin time). During hospitalisation, we analysed mortality rates, complication rates, transfusions performed, and intensive care unit/hospital stay for each group. Results: The group of suicidal jumps had an equal number of male and female patients (50% and 50%, respectively). In contrast, a predominance of male patients was observed in the subgroup of unintentional falls (76.5%, p = 0.002). Overall, suicidal falls resulted in a significantly more severe injury pattern. The average mean reported fall height was 9.61 m (± 6.42 m) in the suicidal group compared to 6.14 m (± 4.08 m) in the unintentional group. The injury severity score (ISS) was significantly higher in the suicidal group with 32.04 (± 23.43) compared to 17.37 (± 14.01) in the unintentional group ( p < 0.001). In accordance with this, higher complication rates (wound healing disorders and total number of complications) were observed in the suicidal group (52.5% vs. 29.9%, p = 0.011). A greater number of total surgeries were also required in this group (3.21 ± 4.27 vs. 1.69 ± 2.81, p = 0.016). Patients in the suicidal group had significantly worse measurable coagulation status (prothrombin time) upon admission (74.95 (± 21.89) vs. 89.09 (± 21.66), p < 0.001), resulting in a significantly higher requirement for transfusions of erythrocyte concentrates (4.07 (± 9.39) vs. 0.97 (± 2.29), p < 0.001). Interestingly, comparable trends in ISS, injury patterns, complication rates and coagulation status were observed in a subgroup analysis, even after adjusting the cohorts for fall height (8.41 ± 4.38 m vs. 8.52 ± 3.80 m; p = 0.495). Conclusion: Patients who had attempted suicide by jumping suffered more severe injuries and had a significantly higher ISS than those in the group who had fallen unintentionally. This remained true even when fall height was considered. Suicidal patients exhibited a higher complication rate ( p = 0.011), increased overall transfusion requirements, impaired coagulation status upon admission and a greater number of operations (including repeat operations) compared to the unintentional fall cohort. Our data suggest that these patients require more resources and are more challenging to treat. We therefore recommend that they be treated in level 1 trauma centres with interdisciplinary intensive care capacities.

Background/Objectives: Vertebral fractures (VFs) often remain clinically unrecognized. We estimated the prevalence of previously unrecognized VFs among older adults presenting with major nonvertebral fragility fractures and explored associated clinical characteristics. Methods: This single-center prospective observational study enrolled 49 consecutive patients aged ≥60 years presenting with low-energy proximal femur, proximal humerus, or distal radius fractures between January 2023 and January 2024. Standardized thoracolumbar radiographs were evaluated using a combined modified algorithm-based qualitative and Genant semiquantitative approach. FRAX probabilities were calculated without bone mineral density. Associations were examined in exploratory unadjusted analyses. Results: Previously unrecognized VFs were found in 22/49 patients (44.9%; Wilson 95% CI, 31.9–58.7%), comprising 34 fractures. The most frequently affected levels were L2 (10/34) and T12 (8/34). A prior fracture history was associated with newly detected VFs in exploratory analysis (p = 0.002). Mean FRAX major osteoporotic fracture probability without bone mineral density was 16.66 ± 10.59% in patients with and 9.72 ± 7.80% in those without a newly identified VF (mean difference 6.94 percentage points; 95% CI, 1.45–12.43; p = 0.011). Conclusions: Previously unrecognized VFs were frequent in this small, predominantly hip-fracture cohort. The findings suggest a potential diagnostic gap and justify larger studies assessing targeted vertebral imaging in secondary fracture prevention; they do not establish a benefit from universal screening.

Background Patients following falls from great height with suicidal intent present unique challenges including delayed medical attention, different often masked injury patterns, severe hypothermia and difficulties obtaining informed consent due to the patient's mental state. Legal and logistical hurdles, such as coordinating with legal guardians or family members, can further delay treatment. These co-factors contribute to reported overall high complication rates in these cases, reaching up to 50%. The aim of this study is to analyze injury patterns, inflammatory responses and complication rates in suicidal jumpers compared to unintentional falls. The purpose of this study is also to investigate correlations between jump height and injury severity. Methods In this retrospective monocentric study patient data such as age, gender, injuries, treatments, and the duration of hospitalization were analysed. Over the last decade it was possible to include 68 suicidal falls. Subsequently, 68 work related falls from >3m were included as a control group to analyse against the suicidal ones. Statistical analysis was performed with SPSS 28 (SPSS Inc.) on the included patients (total n=136; male=86, female=48) with parametric analysis using t-tests, chi-squared tests and correlation analyses. The classification of injury outcomes was based on German polytrauma guidelines. The significance level was set at 5% and an exploratory data analysis with one-sided testing was carried out. Results In the analysis of the subgroup of unintentional falls, a predominance of male patients was observed (76.5%, p = 0.002). In contrast, the group of suicidal jumps exhibited a balanced gender distribution, with 50% male (n=34) and 50% female (n=34) patients. Overall, suicidal falls presented with a significantly more severe injury pattern. The average reported fall height was 9.61 m (± 6.42 m) in the suicidal group compared to 6.14 m (± 4.08 m) in the unintentional group. Regarding the assessment of injury severity based on the Injury Severity Score (ISS), higher values were observed in the suicide group, with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01). In accordance with this we observed higher complication rates for the suicidal cases (52.5% vs. 29.9%, p = 0.011), and a greater number of total surgeries required in the suicidal group (3.21 (± 4.27) vs. 1.69 (± 2.81), p = 0.016). The measurable coagulation status (prothrombin time) of patients upon admission was significantly worse in the suicidal group (74.95 (± 21.89) vs. 89.09 (± 21.66), p < 0.001), which resulted in a significantly higher transfusion requirement for erythrocyte concentrates (4.07 (± 9.39) vs. 0.97 (± 2.29), p < 0.001). Conclusion Patients with suicidal jumps suffered from more severe injury patterns with an ISS of 32.04 (± 23.43) compared to 17.37 (± 14.01) in the unintentional group (p< 0.001). The suicidal patients exhibited a higher complication rate (p=0.011), an increased overall transfusion requirement, and a greater number of (re-)operations compared to the cohort of unintentional falls. Our data suggests that these patients require more resources and are more challenging to treat. In these patients, particular attention should be given to the frequent occurrence of complications (e.g., wound healing disorders and infections), the elevated transfusion demand, and the significantly impaired coagulation status upon hospital admission.