title: Ground-level geriatric falls: a not-so-minor mechanism of injury.
abstract: Introduction. Ground-level falls are typically regarded as a minor mechanism of injury that do not necessitate trauma team activation; however, they represent a significant proportion of hospitalised trauma and can result in multisystem injury. Case Presentation. A 79-year-old nursing home resident was brought to the emergency department following an unwitnessed fall. She suffered dementia and had a seizure in the department resulting in a reduced GCS, making history and examination difficult. She was diagnosed with a right proximal humerus fracture and admitted under joint orthopedic and medical care. Following orthopedic review, further X-rays were requested which showed bilateral neck of femur fractures. The following day she had bilateral hip hemiarthroplasties and K-wire stabilisation of the right shoulder. Several days later, when cognition had improved, she was noted to be avoiding use of the left arm and was found to also have a left proximal humerus fracture which was managed conservatively. Conclusion. Trauma patients with reduced cognitive function should undergo full ATLS assessment, and a prospective trial is required to see if age should be incorporated as a criteria for trauma team activation. More liberal use of advanced imaging such as a full body CT-scan may be beneficial.
authors.affiliation: North Central Thames Foundation School, UCL Medical School, Royal Free Hospital, Room GF/664, Rowland Hill Street, London NW3 2PF, UK.
authors.forename: Simon
authors.identifier: 0000-0003-4739-3641
authors.initials: S
authors.lastname: Parker
authors.affiliation: Trauma & Orthopaedics, Barnet Hospital, Wellhouse Lane, Barnet, Hertfordshire EN5 3DJ, UK.
authors.forename: Arash
authors.initials: A
authors.lastname: Afsharpad