Differential Diagnosis for Face Forward Fall from 12 Foot Ladder

Single Most Likely Diagnosis

• Traumatic Brain Injury (TBI): Given the height of the fall and the fact that it was a face-forward fall, the impact on the head is likely to be significant, making TBI the most probable diagnosis due to the direct trauma to the brain.

Other Likely Diagnoses

• Facial Fractures: The impact of a face-forward fall from a height can easily cause fractures to the facial bones, including the orbits, maxilla, and mandible.
• Cervical Spine Injury: Falls from heights can result in injuries to the cervical spine, including fractures, dislocations, or ligamentous injuries, due to the force of the impact and the potential for awkward landing positions.
• Thoracic and Abdominal Injuries: Depending on how the person landed, there could be injuries to the thoracic and abdominal organs, including the lungs, liver, spleen, and intestines, due to the force of the impact.

Do Not Miss Diagnoses

• Cervical Spine Fracture/Dislocation: Although mentioned as an "other likely diagnosis," it's crucial to emphasize that missing a cervical spine injury could lead to devastating consequences, including paralysis or death, if not promptly and properly managed.
• Aortic Dissection: While less common, the force of the fall could potentially cause a traumatic aortic dissection, which is immediately life-threatening and requires urgent diagnosis and treatment.
• Splenic Rupture: A fall from a significant height can cause blunt abdominal trauma leading to splenic rupture, which can be life-threatening due to internal bleeding.

Rare Diagnoses

• Basilar Skull Fracture: Although less common, a face-forward fall from a height could result in a basilar skull fracture, which might not be immediately apparent but can have serious complications.
• Spinal Cord Injury without Radiographic Abnormality (SCIWORA): This is a rare condition where there is a spinal cord injury without evidence of a fracture or dislocation on imaging studies, which could occur in the context of a high-impact fall.
• Air Embolism: In rare cases, the trauma from the fall could lead to an air embolism, particularly if there is a significant injury to the lungs or other gas-containing organs.