Background: A fall is defined as an event in which a person inadvertently lands on the ground after falling from a higher place. It is the second most common cause of unintentional injury associated mortality after traffic accidents. Sometimes, when a body is brought for autopsy it is unclear whether injuries are due to a fall from a height or due to blunt trauma from other cause. Objectives: the aim of this study is to spot light on injuries in fatal falls from height so that any pattern which might help in discriminating between these injuries and injuries due to blunt trauma from other causes could be identified. Methods: This work included retrospective study of fatal fall from height cases which subjected to medico-legal autopsy in Tanta Department of Forensic Institute- Gharbia Governorate during the period from the start of January 2012 to the end of October 2015. In addition, a cross-sectional study with autopsy was carried out on fatal fall from height cases from the start of November 2015 to the end of October 2016. Results: The majority of cases (52.38%) were in the age group 20-40 years. Males registered 76.2% of cases. Urban areas recorded 64.3% of cases. Head first impact was noticed in 66.7% of cases. Poly-trauma was the cause of death in 76.2% of cases. Nearly all cases showed diffuse head injuries involving bones, meninges and brain and accompanying intracranial hemorrhage. The majority of cases registered negative drug screening. Conclusion: External injuries including abrasions, contusions and lacerations were diffusely involving different body regions except neck. Skull fractures are distributed evenly amongst vault and base. Polytrauma is the most predominant cause of death. After the brain, thoracic cage and lung injuries were encountered in more than half of the cases. Liver is the most common abdomino-pelvic organ involved.