Characterizing bone injuries in avalanche fatalities in the French Alps: Comparing anthropological and surgical classifications

Avalanches are a major cause of death in mountainous regions, primarily from asphyxia. However, increased recreational activities and climate change may be leading to more traumatic injuries, such as bone fractures, which are currently understudied. This study compared two distinct bone fracture classification systems, to better understand specific injury mechanisms in avalanche victims. We conducted a retrospective analysis of post-mortem CT scans from 13 adult avalanche victims in Grenoble, France, all with at least one bone fracture. Using MIP, MPR, and 3D reconstructions, we systematically classified fractures across ten major anatomical regions, representing the entire body. We analyzed each fracture to determine its traumatic mechanism using both the surgical AO/OTA and the anthropological Galloway et al. (2014) classification systems. The study included 13 individuals (61.5 % male; mean age: 37 years), with a total of 265 fractured bones. Fractures were most frequently observed in the thorax (52 %), spine (21 %), and skull (14 %). We found that multiple injury mechanisms, such as impact and compression, often occurred simultaneously. Both classification systems consistently identified six "burst"-type spinal fractures. However, for five open-book pelvic fractures, only the Galloway et al. system precisely described the specific injury mechanism. Our findings indicate that the AO/OTA and Galloway et al. classifications are complementary. The AO/OTA system offers standardized clinical utility, while the Galloway et al. system enhances forensic and anthropological interpretation by elucidating trauma mechanisms. These preliminary insights into bone injury mechanisms in avalanche events emphasize the need for interdisciplinary approaches to improve victim care and safety.