Jason Forman

Human surrogates for injury biomechanics research

This article reviews the attributes of the human surrogates most commonly used in injury biomechanics research. In particular, the merits of human cadavers, human volunteers, animals, dummies, and computational models are assessed relative to their ability to characterize the living human response and injury in an impact environment. Although data obtained from these surrogates have enabled biomechanical engineers and designers to develop effective injury countermeasures for occupants and pedestrians involved in crashes, the magnitude of the traffic safety problem necessitates expanded efforts in research and development. This article makes the case that while there are limitations and challenges associated with any particular surrogate, each provides a critical and necessary component in the continued quest to reduce crash‐related injuries and fatalities. Clin. Anat. 24:362–371, 2011.

Injuries among powered two-wheeler users in eight European countries: A descriptive analysis of hospital discharge data

Powered two-wheelers (PTWs--mopeds, motorcycles, and scooters) remain the most dangerous form of travel on todays roads. This study used hospital discharge data from eight European countries to examine the frequencies and patterns of injury among PTW users (age≥14 years), the predicted incidence of the loss of functional ability, and the mechanisms of the head injuries observed (all in light of increased helmet use). Of 977,557 injured patients discharged in 2004, 12,994 were identified as having been injured in PTW collisions. Lower extremity injuries accounted for 26% (25.6-26.7, 95% C.I.) of the total injuries, followed by upper extremity injuries (20.7%: 20.3-21.2), traumatic brain injuries (TBI) (18.5%: 18-19), and thoracic injuries (8.2%: 7.8-8.5). Approximately 80% of the lower extremity injury cases were expected to exhibit some functional disability one year following discharge (predicted Functional Capacity Index, pFCI-AIS98<100), compared to 47% of the upper extremity injury cases and 24% of the TBI cases. Although it occurred less frequently, patients that were expected to experience some functional limitation from TBI were predicted to fair worse on average (lose more functional ability) than patients expected to have functional limitations from extremity injuries. Cerebral concussion was the most common head injury observed (occurring in 56% of head injury cases), with most concussion cases (78%) exhibiting no other head injury. Among the AIS3+ head injuries that could be mapped to an injury mechanism, 48% of these were associated with a translational-impact mechanism, and 37% were associated with a rotational mechanism. The observation of high rates of expected long-term disability suggests that future efforts aim to mitigate lower and upper extremity injuries among PTW users. Likewise, the high rates of concussion and head injuries associated with a rotational mechanism provide goals for the next phase of PTW user head protection.

Assessment and Validation of a Methodology for Measuring Anatomical Kinematics of Restrained Occupants During Motor Vehicle Collisions

Efforts to improve restraint design for human occupant protection require a detailed knowledge of human kinematic response. However, to improve the current understanding of human kinematic response to restraint loading it is necessary to obtain a more detailed knowledge of how structures within the body such as individual ribs and vertebrae move during an impact event. Video-based optoelectronic stereo photogrammetric systems (OSS) have recently been employed for kinematic measurement during simulated vehicle collisions with restrained post mortem human surrogates (PMHS). Application of this methodology requires specialized optical sensor hardware to be surgically attached to anatomical structures of interest such as acromia, ribs orvertebrae. The hardware supports retro reflective spherical targets which are visible to the OSS. The recorded target motions are then transformed to the underlying anatomical structures to quantify the trajectories of individual bone centers throughout the impact event. This study presents the results of seven tests that were conducted to practically assess the efficacy of this emerging methodology for measuring anatomical kinematics during impact loading. The tests used a 16-camera 1000Hz OSS and a single simulated anatomical structure with attached target hardware to quantify the uncertainty in the calculated trajectory of the bone center. Specifically, the tests assessed the intrinsic optical error associated with the OSS, and also evaluated the ability of the rigid body transformation to reproduce a directly measured bone center trajectory. The tests also assessed the effect of compliance in the assumed rigid connection between the visible target hardware and underlying bone on the transformed trajectories. The results demonstrate robust performance of a novel methodology combining state-of-the-art optoelectronic technology, specialized target hardware, and rigid body transformation to obtain kinematic measurements of anatomical structures within the human body which are not visible or accessible for direct measurement during an impact event

Posterior acceleration as a mechanism of blunt traumatic injury of the aorta

Rupture of the thoracic aorta is a leading cause of rapid fatality in automobile crashes, but the exact mechanisms of this injury remain unidentified. One commonly postulated mechanism is a differential motion of the aortic arch relative to the heart and its neighboring vessels caused by high-magnitude acceleration of the thorax. This paper investigates acceleration as an aortic injury mechanism using nine impact-sled tests with human cadaver thoraces. The test system utilized generates very high posteriorly directed thoracic accelerations with minimal compression of the chest. The sled tests resulted in peak mid-spine accelerations of 169+/-35.0 g (mean+/-standard deviation) with sustained mid-spine accelerations of up to 80 g for 20 ms in most cases. The tests resulted in maximum chest compressions of 7+/-3.1% of the total chest depth, and maximum recorded increases in intra-aortic, tracheal, and esophageal pressure of 177, 112, and 156 kPa, respectively. No macroscopic injuries to the thoracic aorta resulted from these tests, though other limited visceral injury was observed. The results suggest that posteriorly directed acceleration alone (up to the magnitudes studied here) is not sufficient to cause gross aortic injury. Furthermore, the observed transient increases in intra-aortic and extra-aortic pressure indicate that complex pressure distributions are present during dynamic thoracic deceleration events. This suggests that any attempt to model traumatic aortic injury should include consideration for both the intra-aortic fluid pressure and the extra-aortic, intra-thoracic pressure present during the event.

The Feasibility and Effectiveness of Belt Pretensioning and Load Limiting for Adults in the Rear Seat

The US Fatality Analysis Reporting System (FARS) and State Data System (SDS) for Florida, Pennsylvania and Maryland were utilised to estimate relative fatality rates and injury risk ratios between the front and rear-seat passengers, and a parametric study of rear-seat restraint parameters was performed to assess chest deflection and head excursion trends. The fatality and serious injury risk in frontal crashes is found to be higher for older occupants in rear seats than for those in front seats. In addition, the relative effectiveness of rear seats is lower in newer vehicle models, presumably due to the advances in front-seat restraint technology. The simulations demonstrate that injury risk in the rear seat can be reduced by incorporating front-seat restraint technology (load limiting and pretensioning), even in the absence of an air bag and knee bolster. A force-limiting belt with a pretensioner can maintain or reduce head excursion relative to a standard belt, while reducing thoracic injury risk. In fact, 42 sets of restraint parameters were identified that reduced both head excursion and chest deflection relative to the baseline belt.

Modeling costal cartilage using local material properties with consideration for gross heterogeneities

Contemporary computer models of the thorax designed to predict injury in automobile collisions model the costal cartilage as a homogeneous material using properties derived from local material characterization tests. No studies have validated the accuracy of these models in predicting the structural mechanics of costal cartilage. Two heterogeneities - the perichondrium and calcified regions - may affect the behavior of costal cartilage in a manner not accounted for by current models. This study sought to investigate the predictive ability of subject-specific models of whole costal cartilage segments, with the calcified regions modeled distinctly and with the perichondrium removed (from the physical specimens as well as from the simulations). Finite element models were developed in the case of five cadaveric costal cartilage segments. The properties of the cartilage were derived from indentation testing of each specimen, where the characteristic average instantaneous elastic moduli ranged from 8.7 to 12.6 MPa. Matched simulations and experiments were then performed, subjecting each specimen to cantilever-like loading with a dynamic posterior displacement of the sternal boundary (all other boundary degrees-of-freedom fixed). The models predicted the resulting peak anterior-posterior forces generated on the costal boundary with a minimum error of 1% and a maximum error of 36%. These results provide support to the previous implicit assumption that insight can be gained into the structural behavior of costal cartilage by observing the local material properties (when calcified regions are included and the perichondrium is removed). Future work includes the addition of the perichondrium, so as to model the whole costal cartilage composite structure.

Development and assessment of a device and method for studying the mechanical interactions between shoes and playing surfaces in situ at loads and rates generated by elite athletes

The literature is lacking the description of a device and method for simulating and measuring shoe–turf interactions at loads and rates generated in situ by elite athletes during performance. A transportable device was built to quantify these interactions through three tests that reflect generic classes of tasks: 1) translation test; 2) rotation test; and 3) translation/drop test. All the three tests were performed using the cleated portion of a molded American football shoe on two types of natural grass surfaces. To assess repeatability of tests, we performed multiple trials of each test under the same testing conditions. To assess sensitivity of the device, the type of playing surface, temperature, and moisture level were varied. The variation among the results of repeated trials of a given set of testing conditions was less than that between the results of a given test under differing testing conditions, so the device and method were deemed to have acceptable levels of repeatability and sensitivity in the set of conditions considered.

The effect of calcification on the structural mechanics of the costal cartilage

The costal cartilage often undergoes progressive calcification with age. This study sought to investigate the effects of calcification on the structural mechanics of whole costal cartilage segments. Models were developed for five costal cartilage specimens, including representations of the cartilage, the perichondrium, calcification, and segments of the rib and sternum. The material properties of the cartilage were determined through indentation testing; the properties of the perichondrium were determined through optimisation against structural experiments. The calcified regions were then expanded or shrunk to develop five different sensitivity analysis models for each. Increasing the relative volume of calcification from 0% to 24% of the cartilage volume increased the stiffness of the costal cartilage segments by a factor of 2.3–3.8. These results suggest that calcification may have a substantial effect on the stiffness of the costal cartilage which should be considered when modelling the chest, especially if age is a factor.

The Contribution of the Perichondrium to the Structural Mechanical Behavior of the Costal-Cartilage

The costal-cartilage in the human ribcage is a composite structure consisting of a cartilage substance surrounded by a fibrous, tendon-like perichondrium. Current computational models of the human ribcage represent the costal-cartilage as a homogeneous material, with no consideration for the mechanical contributions of the perichondrium. This study sought to investigate the role of the perichondrium in the structural mechanical behavior of the costal-cartilage. Twenty-two specimens of postmortem human costal-cartilage were subjected to cantilevered-like loading both with the perichondrium intact and with the perichondrium removed. The test method was chosen to approximate the cartilage loading that occurs when a concentrated, posteriorly directed load is applied to the midsternum. The removal of the perichondrium resulted in a statistically significant (two-tailed Students t-test, p< or =0.05) decrease of approximately 47% (95% C.I. of 35-58%) in the peak anterior-posterior reaction forces generated during the tests. When tested with the perichondrium removed, the specimens also exhibited failure in the cartilage substance in the regions that experienced tension from bending. These results suggest that the perichondrium does contribute significantly to the stiffness and strength of the costal-cartilage structure under this type loading, and should be accounted for in computational models of the thorax and ribcage.

A method for the experimental investigation of acceleration as a mechanism of aortic injury

Rupture of the thoracic aorta is a leading cause of rapid fatality in automobile crashes, but the mechanism of this injury remains unknown. One commonly postulated mechanism is a differential motion of the aortic arch relative to the heart and its neighboring vessels caused by high-magnitude acceleration of the thorax. Recent Indy car crash data show, however, that humans can withstand accelerations exceeding 100 g with no injury to the thoracic vasculature. This paper presents a method to investigate the efficacy of acceleration as an aortic injury mechanism using high-acceleration, low chest deflection sled tests. The repeatability and predictability of the test method was evaluated using two Hybrid III tests and two tests with cadaver subjects. The cadaver tests resulted in sustained mid-spine accelerations of up to 80 g for 20 ms with peak mid-spine accelerations of up to 175 g, and maximum chest deflections lower than 11% of the total chest depth. Transient increases in intra-aortic pressure up to 177 kPa were measured. No macroscopic injuries to the thoracic aorta resulted from these tests. The method employed proved consistent and repeatable. This method may be appropriate for future investigation of the efficacy of acceleration as a predictor of aortic injury.