![]() Left comminuted joint-depression type calcaneus fracture (AO/OTA type 82-C3). Right type IIIA open talar body fracture (AO/OTA type 81-C3) and associated posterior facet calcaneus fracture (AO/OTA type 82-C2) Right femur shaft fracture (AO/OTA type 42-A3.2). ![]() Unstable pelvic ring injury with bilateral SI-joint disruption, bilateral L5 transverse process fractures, bilateral pubic rami fractures, and left-side transalar/transforaminal Denis type 2 sacral fracture (Young-Burgess type LC-3, AO/OTA type 61-B3.3). Unstable L1 burst/split fracture (AO/OTA type 53-A3.2). Rotationally unstable flexion/distraction injury at T6 (AO/OTA type 52-C2.1) with traumatic spinal cord transsection and complete paraplegia ASIA grade A below T6. The patient sustained the following combination of injuries:īlunt chest trauma with sternal fracture, bilateral hemo-/pneumothoraces, bilateral pulmonary contusions, right 1 and 2 rib fractures, left 9-11 rib fractures.īlunt abdominal trauma with grade 3 liver laceration, grade 2 splenic laceration, and a devascularized right kidney. The patient was managed according to the ATLS guidelines for initial assessment and management, and by our institutional "damage control" protocols, including the initial spanning external fixation of femur shaft fractures and a proactive "spine damage control" approach. She was successfully resuscitated with crystalloids and blood products, using a standardized institutional massive transfusion protocol with point-of-care thrombelastography-guided resuscitation. She was hypotensive, with systolic pressures in the 80s. On arrival, the patient was intubated and sedated. Due to ongoing hypotension and transfusion requirements, a decision was made for transfer to our regional level 1 trauma center. She was intubated at the scene and transported to a local level IV trauma center, where she was resuscitated and transfused with 4 units of packed red blood cells (PRBC). The patient was awake and moaning, but not responsive to verbal or painful stimuli. Her boyfriend witnessed the entire fall, climbed back down and provided first aid at the scene. Based on this falling height, the velocity at the time of impact is estimated around 75-80 mph. She then 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. After securing the anchor at that height, the rope - which was lacking a security knot - slid through her harness. The girl took the lead on the third pitch, to a total height of 300 feet (ca. The climbing distance was defined by the climbing rope which had been fixed at a defined length. The ascent consisted of three pitches of 90-100 feet (ca. ![]() The girl had 20 years of experience of rock climbing, being taught early tricks by her father at the age of 8 years. Both were wearing a helmet and a harness for safety. This report emphasizes the crucial relevance of body positioning at the time of impact, and the importance of standardized institutional "damage control" management protocols for survival.Ī 28-year old woman was free climbing with her boyfriend near Gunnison, Colorado. The present case report describes the rare survival of a 28-year old rock climber who survived a free fall from 300 feet onto a solid rock surface. Thus, a vertical falling height of more than 100 feet is generally considered to constitute a "non-survivable" injury. around 90-100 feet) and higher, are associated with a 100% mortality. A more recent study on 287 vertical fall victims revealed that falls from height of 8 stories (i.e. 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. The American College of Surgeons' Committee on Trauma (ACS-COT) defines a critical threshold for a fall height in adults as > 20 feet (6 meters), as part of the field triage decision scheme for transport to a designated trauma center. In addition, the position of the body relative to the impact surface represents an important determinant of injury severity. ![]() For example, a fall onto concrete results in an instantaneous loss of speed, whereas falling onto a soft surface will allow for a more gradual deceleration over time. The amount of energy absorbed by the falling body is dependent on the fall height and the characteristics of the contact surface. Vertical deceleration injuries represent a significant cause of preventable deaths and long-term morbidity in survivors. ![]()
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