Stratification of Musculoskeletal Injuries Caused by Tree Stand Falls During Deer Hunting: A Single Health System Retrospective Study

Background/Objectives: Tree stand falls have become one of the leading causes of hunting-related injuries in the United States, surpassing firearm incidents. These injuries often result in significant morbidity, particularly musculoskeletal trauma, yet detailed anatomical stratification of fractures remains underreported. The purpose of this study is to classify and analyze the anatomical distribution of musculoskeletal injuries sustained from tree stand falls during deer hunting and to describe associated demographics, injury severity, and resource utilization in a rural health system. Methods: A retrospective review was conducted on patients aged ≥18 years who presented to a Level I or II trauma center in central Pennsylvania between 2005 and 2020 following a tree stand fall. Data were extracted from electronic medical records and trauma registry, including demographics, mechanism of injury, fracture location, Injury Severity Score (ISS), Intensive Care Unit (ICU) admission, and discharge disposition. Two orthopedic surgeons independently reviewed radiographs for accuracy. Results: A total of 144 patients were included (mean age was 53.0 ± 14.6 years; 143 of 144 were male). Falls had a median height of 15 ft (range, 2–45 ft), with harness use documented in only 2 patients. The mean ISS was 11.97 (range 2–36). Twenty patients required ICU admission (mean stay 4.8 days), and seven required mechanical ventilation. Most injuries occurred between October and December. Fractures most frequently involved the spine (36.3%), followed by the thorax (ribs and sternum; 36.1%), the hip and lower extremity (9.0%), the pelvis (9.0%), the shoulder and upper extremity (6.0%), and the skull and facial bones (3.5%). No fatalities were recorded. Conclusions: Tree stand falls during deer hunting result in complex, multi-system injuries with high resource utilization but low mortality. Spine and thorax fractures predominate, underscoring the need for trauma centers serving hunting communities to maintain subspecialty capabilities in orthopedic, spine, thoracic, and multidisciplinary trauma care. Preventive strategies, including targeted safety education during peak hunting months, may be implemented to potentially reduce injury burden.