Wrist impact velocities are smaller in forward falls than backward falls from standing

The wrist is a common fracture site for both young and older adults. The purpose of this study was to compare wrist kinematics in backward and forward falls with different fall protective responses. We carried out within-subject comparison of impact velocities and maximum velocities during descent of the distal radius among three different fall configurations: (a) backward falls with knees flexed, (b) backward falls with knees extended and (c) forward falls with knees flexed. We also examined the effect of fall configuration on fall durations, elbow flexion, trunk flexion and forearm angles at impact. Forward falls resulted in smaller impact velocities of the distal radius, longer fall duration, longer braking duration, greater elbow flexion and more horizontal landing position of the forearm compared to backward falls. The distal radius impact velocity during forward falls (1.33 m/s) was significantly lower than in backward falls, and among the backward falls the impact velocity of the flexed knee strategy (2.01 m/s) was significantly lower than the extended knee strategy (2.27 m/s). These impact velocities were significantly reduced from the maximum velocities observed during descent (forward falls=3.57 m/s, backward falls with knee flexed=3.16 m/s, backward falls with knees extended=3.52 m/s). We conclude that (1) smaller impact velocities of the wrists in forward falls could imply a lower fracture risk compared to backward falls, and (2) fall protective responses reduced wrist impact velocities in all fall directions.