title: Pontomedullary lacerations in falls from a height--a retrospective autopsy study.
abstract: Brainstem pontomedullary laceration (PML) in falls from a height appears as isolated cases and usually in feet-first impacts with a ring fracture. The aim of this study was to determine the frequency of PML in falls from a height, as well as the frequency of concomitant head and neck injuries. Out of 261 cases, PML was present in 40. An impact to the chin, as well as a feet- or buttocks-first impact, most often led to PML owing to transmission of the impact force. Also, a lateral, frontal, or posterior head impact, with subsequent hinge fracture, as well as the frontoposterior hyperextension of the head associated with an upper spine fracture, could be possible mechanisms of PML in falls from a height. The jawbone and other facial bones act as shock absorbers, and their fracture diminishes energy transfer toward the skull and protects the brain and brainstem from injury.
authors.affiliation: University of Belgrade - School of Medicine, Institute of Forensic Medicine, Belgrade, Serbia. vladinmejl@yahoo.com
authors.forename: Vladimir
authors.initials: V
authors.lastname: Zivković
authors.forename: Slobodan
authors.initials: S
authors.lastname: Nikolić
authors.forename: Dragan
authors.initials: D
authors.lastname: Babić
authors.forename: Danijela
authors.initials: D
authors.lastname: Djonić
authors.forename: Tatjana
authors.initials: T
authors.lastname: Atanasijević
authors.forename: Marija
authors.initials: M
authors.lastname: Djurić
mesh_terms: D000058:Accidental Falls; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D055592:Biophysical Phenomena; D004735:Energy Transfer; D005151:Facial Injuries / Q000473:pathology; D005260:Female; D049429:Forensic Pathology; D006801:Humans; D007568:Jaw / Q000293:injuries; D008297:Male; D008526:Medulla Oblongata / Q000293:injuries* / Q000473:pathology; D008875:Middle Aged; D011149:Pons / Q000293:injuries* / Q000473:pathology; D012189:Retrospective Studies; D012887:Skull Fractures / Q000473:pathology; D013124:Spinal Injuries / Q000473:pathology; D055815:Young Adult