Analysis of Injury Metrics From Experimental Cardiac Injuries From Behind Armor Blunt Trauma Using Live Swine Tests: A Pilot Study.

INTRODUCTION: Warfighters are issued hard body armor designed to defeat ballistic projectiles. The resulting backface deformation can injure different thoracoabdominal organs. Developed over decades ago, the behind armor blunt impact criterion of maximum 44 mm depth in clay continues to be used independent of armor type or impact location on the thoracoabdominal region covered by the armor. Because thoracoabdominal components have different energy absorption capabilities, their mode of failures and mechanical properties are different. These considerations underscore the lack of effectiveness of using the single standard to cover all thoracoabdominal components to represent the same level of injury risk. The objective of this pilot study is to conduct cardiac impact tests with a live animal model and analyze biomechanical injury candidate metrics for behind armor blunt trauma applications. MATERIALS AND METHODS: Live swine tests were conducted after obtaining approvals from the U.S. DoD. Trachea tubes. An intravenous line were introduced into the swine before administering anesthesia. Pressure transducers were inserted into lungs and aorta. An indenter simulating backface deformation profiles produced by body armor from military-relevant ballistics to human cadavers delivered impact to the heart region. The approved test protocol included 6-hour monitoring and necropsies. Indenter accelerometer signals were processed to compute the velocity and deflection, and their peak magnitudes were obtained. The deflection-time signal was normalized with respect to chest depth along the impact axis. The peak magnitude of the viscous criterion, kinetic energy, force, momentum and stiffness were obtained. RESULTS: Out of the 8 specimens, 2 were sham controls. The mean total body mass and soft tissue thickness at the impact site were 81.1 ± 4.1 kg and 3.8 ± 1.1 cm. The peak velocities ranged from 30 to 59 m/s, normalized deflections ranged from 15 to 21%, and energies ranged from 105 to 407 J. The range in momentum and stiffness were 7.0 to 13.9 kg-m/s and 22.3 to 79.9 N/m. The maximum forces and impulse data ranged from 2.9 to 11.7 kN and 1.9 to 5.8 N-s. The peak viscous criterion ranged from 2.0 to 5.3 m/s. One animal did not sustain any injuries, 2 had cardiac injuries, and others had lung and skeletal injuries. CONCLUSIONS: The present study applied blunt impact loads to the live swine cardiac region and determined potential candidate injury metrics for characterization. The sample size of 6 swine produced injuries ranging from none to pure skeletal to pure organ trauma. The viscous criterion metric associated with the response of the animal demonstrated a differing pattern than other variables with increasing velocity. These findings demonstrate that our live animal experimental design can be effectively used with testing additional samples to develop behind armor blunt injury criteria for cardiac trauma in the form of risk curves. Injury criteria obtained for cardiac trauma can be used to enhance the effectiveness of the body armor, reduce morbidity and mortality, and improve warfighter readiness in combat operations.

Matched-pair hybrid test paradigm for behind armor blunt trauma using an experimental animal model.

Background: The current behind armor blunt trauma (BABT) injury criterion uses a single penetration limit of 44 mm in Roma Plastilina clay and is not specific to thoracoabdominal regions. However, different regions in the human body have different injury tolerances. This manuscript presents a matched-pair hybrid test paradigm with different experimental models and candidate metrics to develop regional human injury criteria. Methods: Live and cadaver swine were used as matched pair experimental models. An impactor simulating backface deformation profiles produced by body armor from military-relevant ballistics was used to deliver BABT loading to liver and lung regions in cadaver and live swine. Impact loading was characterized using peak accelerations and energy. For live swine, physiological parameters were monitored for 6 hours, animals were euthanized, and a detailed necropsy was done to identify injuries to skeletal structures, organs and soft tissues. A similar process was used to identify injuries to the cadaver swine for targeted thoracoabdominal regions. Results: Two cadavers and one live swine were subjected to BABT impacts to the liver. One cadaver and one live swine were subjected to BABT impacts to the left lung. Injuries to both regions were similar at similar energies between the cadaver and live models. Conclusions: Swine is an established animal for thoracoabdominal impact studies in automotive standards, although at lower insult levels. Similarities in BABT responses between cadaver and live swine allow for extending testing protocols to human cadavers and for the development of scaling relationships between animal and human cadavers, acting as a hybrid protocol between species and live and cadaver models. Injury tolerances and injury risk curves from live animals can be converted to human tolerances via structural scaling using these outcomes. The present experimental paradigm can be used to develop region-based BABT injury criteria, which are not currently available.

Investigating the Impact of Blunt Force Trauma: A Probabilistic Study of Behind Armor Blunt Trauma Risk.

Evaluating Behind Armor Blunt Trauma (BABT) is a critical step in preventing non-penetrating injuries in military personnel, which can result from the transfer of kinetic energy from projectiles impacting body armor. While the current NIJ Standard-0101.06 standard focuses on preventing excessive armor backface deformation, this standard does not account for the variability in impact location, thorax organ and tissue material properties, and injury thresholds in order to assess potential injury. To address this gap, Finite Element (FE) human body models (HBMs) have been employed to investigate variability in BABT impact conditions by recreating specific cases from survivor databases and generating injury risk curves. However, these deterministic analyses predominantly use models representing the 50th percentile male and do not investigate the uncertainty and variability inherent within the system, thus limiting the generalizability of investigating injury risk over a diverse military population. The DoD-funded I-PREDICT Future Naval Capability (FNC) introduces a probabilistic HBM, which considers uncertainty and variability in tissue material and failure properties, anthropometry, and external loading conditions. This study utilizes the I-PREDICT HBM for BABT simulations for three thoracic impact locations-liver, heart, and lower abdomen. A probabilistic analysis of tissue-level strains resulting from a BABT event is used to determine the probability of achieving a Military Combat Incapacitation Scale (MCIS) for organ-level injuries and the New Injury Severity Score (NISS) is employed for whole-body injury risk evaluations. Organ-level MCIS metrics show that impact at the heart can cause severe injuries to the heart and spleen, whereas impact to the liver can cause rib fractures and major lacerations in the liver. Impact at the lower abdomen can cause lacerations in the spleen. Simulation results indicate that, under current protection standards, the whole-body risk of injury varies between 6 and 98% based on impact location, with the impact at the heart being the most severe, followed by impact at the liver and the lower abdomen. These results suggest that the current body armor protection standards might result in severe injuries in specific locations, but no injuries in others.

Three-Dimensional-Digital Image Correlation Methodology for Kinematic Measurements of Non-Penetrating Blunt Impacts.

Blunt force trauma remains a serious threat to many populations and is commonly seen in motor vehicle crashes, sports, and military environments. Effective design of helmets and protective armor should consider biomechanical tolerances of organs in which they intend to protect and require accurate measurements of deformation as a primary injury metric during impact. To overcome challenges found in velocity and displacement measurements during blunt impact using an integrated accelerometer and two-dimensional (2D) high-speed video, three-dimensional (3D) digital image correlation (DIC) measurements were taken and compared to the accepted techniques. A semi-spherical impactor was launched at impact velocities from 14 to 20 meters per second into synthetic ballistic gelatin to simulate blunt impacts observed in behind armor blunt trauma (BABT), falls, and sports impacts. Repeated measures Analysis of Variance resulted in no significant differences in maximum displacement (p=0.10), time of maximum displacement (p=0.21), impact velocity (p=0.13), and rebound velocity (p=0.21) between methods. The 3D-DIC measurements demonstrated equal or improved percent difference and low root-mean-square deviation compared to the accepted measurement techniques. Therefore, 3D-DIC may be utilized in BABT and other blunt impact applications for accurate 3D kinematic measurements, especially when an accelerometer or 2D lateral camera analysis is impractical or susceptible to error.

Do expandable cage size and number of cages matter in transforaminal lumbar interbody fusion at L5-S1? A comparative biomechanical analysis using finite element modeling.

OBJECTIVE: Expandable transforaminal lumbar interbody fusion (TLIF) cages were designed to address the limitations of static cages. Bilateral cage insertion can potentially enhance stability, fusion rates, and segmental lordosis. However, the benefits of unilateral versus bilateral expandable cages with varying sizes in TLIF remain unclear. This study used a validated finite element spine model to compare the biomechanical properties of L5-S1 TLIF by using differently sized expandable cages inserted unilaterally or bilaterally. METHODS: A finite element model of X-PAC expandable lumbar cages was created and used at the L5-S1 level. This model had cage dimensions of 9 mm in height, 15° in lordosis, and varying widths and lengths. Various placements (unilateral vs bilateral) and sizes were examined under pure moment loading to evaluate range of motion, adjacent-segment motion, and endplate stress. RESULTS: Stability at the L5-S1 level decreased when smaller cages were used in both the unilateral and bilateral cage models. In the unilateral model, cage 1 (the smallest cage) resulted in 47.9% more motion at the L5-S1 level compared to cage 5 (the largest cage) in flexion, as well as 64.8% more motion in extension. Similarly, in the bilateral TLIF model, bilateral cage 1 led to 49.4% more motion at the L5-S1 level in flexion and 73.4% more motion in extension compared to bilateral cage 5. Unilateral insertion of cage 5 provided superior stability in flexion and surpassed cages 1-3 in extension when compared to cages inserted either unilaterally or bilaterally. Reduced motion at L5-S1 correlated with increased adjacent-segment motion at L4-5. Bilateral TLIF resulted in greater adjacent-segment motion compared to unilateral TLIF with the same-size cages. Inferior endplates experienced higher stress during flexion and extension than superior endplates, with this difference being more pronounced in the bilateral model. In bilateral cage placement, stress differences ranged from 46.3% to 60.0%, while they ranged from 1.1% to 9.6% in unilateral cages. Qualitative analysis revealed increased focal stress in unilateral cages versus bilateral cages. CONCLUSIONS: The authors' study shows that using a large unilateral TLIF cage may offer better stability than the bilateral insertion of smaller cages. While large bilateral cages increase adjacent-segment motion, they also provide a uniform stress distribution on the endplates. These findings deepen our understanding of the biomechanics of the available expandable TLIF cages.

A guide to finite element analysis models of the spine for clinicians.

Finite element analysis (FEA) is a computer-based mathematical method commonly used in spine and orthopedic biomechanical research. Advances in computational power and engineering modeling and analysis software have enabled many recent technical applications of FEA. Through the use of FEA, a wide range of scenarios can be simulated, such as physiological processes, mechanisms of disease and injury, and the efficacy of surgical procedures. Such models have the potential to enhance clinical studies by allowing comparisons of surgical treatments that would be impractical to perform in human or animal studies, and by linking model results to treatment outcomes. While traditional ex vivo experiments are limited by variabilities in tissue, the complexity of test setup, cost, measurable biomechanical parameters, and the repeatability of experiments, FEA models can be used to measure a wide range of clinically relevant biomechanical parameters. Generic or patient-specific anatomical models can be modified to simulate different clinical and surgical conditions under simulated physiological conditions. Despite these capabilities, there is limited understanding of the clinical applicability and translational potential of FEA models. For spine surgeons, a comprehensive understanding of the key features, strengths, and limitations of FEA models of the spine and their ability to personalize treatment options and assist in clinical decision-making would significantly enhance the impact of FEA research. Furthermore, fostering collaborations between surgeons and engineers could augment the clinical use of these models. The purpose of this review was to highlight key features of FEA model building for clinicians. To illustrate these features, the authors present an example of the use of FEA models in comparing FDA-approved disc arthroplasty implants.

Complex Neck Loading and Injury Tolerance in Lateral Bending With Head Rotation From Human Cadaver Tests.

Advancements in automated vehicles may position the occupant in postures different from the current standard posture. It may affect human tolerance responses. The objective of this study was to determine the lateral bending tolerance of the head-cervical spine with initial head rotation posture using loads at the occipital condyles and lower neck and describe injuries. Using a custom loading device, head-cervical spine complexes from human cadavers were prepared with load cells at the ends. Lateral bending loads were applied to prerotated specimens at 1.5 m/s. At the occipital condyles, peak axial and antero-posterior and medial-lateral shear forces were: 316-954 N, 176-254 N, and 327-508 N, and coronal, sagittal, and axial moments were: 27-38 N·m, 21-38 N·m, and 9.7-19.8 N·m, respectively. At the lower neck, peak axial and shear forces were: 677-1004 N, 115-227 N, and 178-350 N, and coronal, sagittal, and axial moments were: 30-39 N·m, 7.6-21.3 N·m, and 5.7-13.4 N·m, respectively. Ipsilateral atlas lateral mass fractures occurred in four out of five specimens with varying joint diastasis and capsular ligament involvements. Acknowledging that the study used a small sample size, initial tolerances at the occipital condyles and lower neck were estimated using survival analysis. Injury patterns with posture variations are discussed.

A Novel Paradigm to Develop Regional Thoracoabdominal Criteria for Behind Armor Blunt Trauma Based on Original Data.

INTRODUCTION: For behind armor blunt trauma (BABT), recent prominent BABT standards for chest plate define a maximum deformation distance of 44 mm in clay. It was developed for soft body armor applications with limited animal, gelatin, and clay tests. The legacy criterion does not account for differing regional thoracoabdominal tolerances to behind armor-induced injury. This study examines the rationale and approaches used in the legacy BABT clay criterion and presents a novel paradigm to develop thoracoabdominal regional injury risk curves. MATERIALS AND METHODS: A review of the original military and law enforcement studies using animals, surrogates, and body armor materials was conducted, and a reanalysis of data was performed. A multiparameter model analysis describes survival-lethality responses using impactor/projectile (mass, diameter, and impact velocity) and specimen (weight and tissue thickness) variables. Binary regression risk curves with ±95% confidence intervals (CIs) and peak deformations from simulant tests are presented. RESULTS: Injury risk curves from 74 goat thorax tests showed that peak deflections of 44.7 mm (±95% CI: 17.6 to 55.4 mm) and 49.9 mm (±95% CI: 24.7 to 60.4 mm) were associated with the 10% and 15% probability of lethal outcomes. 20% gelatin and Roma Plastilina #1 clay were stiffer than goat. The clay was stiffer than 20% gelatin. Penetration diameters showed greater variations (on a test-by-test basis, difference 36-53%) than penetration depths (0-12%) across a range of projectiles and velocities. CONCLUSIONS: While the original authors stressed limitations and the importance of additional tests for refining the 44 mm recommendation, they were not pursued. As live swine tests are effective in developing injury criteria and the responses of different areas of the thoracoabdominal regions are different because of anatomy, structure, and function, a new set of swine and human cadaver tests are necessary to develop scaling relationships. Live swine tests are needed to develop incapacitation/lethal injury risk functions; using scaling relationships, human injury criteria can be developed.

Pelvis-Sacrum-Lumbar Spine Injury Characteristics From Underbody Blast Loading.

INTRODUCTION: Combat-related injuries from improvised explosive devices occur commonly to the lower extremity and spine. As the underbody blast impact loading traverses from the seat to pelvis to spine, energy transfer occurs through deformations of the combined pelvis-sacrum-lumbar spine complex, and the time factor plays a role in injury to any of these components. Previous studies have largely ignored the role of the time variable in injuries, injury mechanisms, and warfighter tolerance. The objective of this study is to relate the time or temporal factor using a multi-component, pelvis-sacrum-lumbar spinal column complex model. MATERIALS AND METHODS: Intact pelvis-sacrum-spine specimens from pre-screened unembalmed human cadavers were prepared by fixing at the superior end of the lumbar spine, pelvis and abdominal contents were simulated, and a weight was added to the cranial end of the fixation to account for torso effective mass. Prepared specimens were placed on the platform of a custom vertical accelerator device and aligned in a seated soldier posture. An accelerometer was attached to the seat platen of the device to record the time duration to peak velocity. Radiographs and computed tomography images were used to document and associate injuries with time duration. RESULTS: The mean age, stature, weight, body mass index, and bone density of 12 male specimens were as follows: 65 ± 11 years, 1.8 ± 0.01 m, 83 ± 13 kg, 27 ± 5.0 kg/m2, and 114 ± 21 mg/cc. They were equally divided into short, medium, and long time durations: 4.8 ± 0.5, 16.3 ± 7.3, and 34.5 ± 7.5 ms. Most severe injuries associated with the short time duration were to pelvis, although they were to spine for the long time duration. CONCLUSIONS: With adequate time for the underbody blast loading to traverse the pelvis-sacrum-spine complex, distal structures are spared while proximal/spine structures sustain severe/unstable injuries. The time factor may have implications in seat and/or seat structure design in future military vehicles to advance warfighter safety.

Preliminary Data of Neck Muscle Morphology With Head-Supported Mass in Male and Female Volunteers.

INTRODUCTION: This study quantified parameters related to muscle morphology using a group of upright seated female and male volunteers with a head-supported mass. MATERIALS AND METHODS: Upright magnetic resonance images (MRIs) were obtained from 23 healthy volunteers after approval from the U.S. DoD. They were asymptomatic for neck pain, with no history of injury. The volunteers were scanned using an upright MRI scanner with a head-supported mass (army combat helmet). T1 and T2 sagittal and axial images were obtained. Measurements were performed by an engineer and a neurosurgeon. The cross-sectional areas of the sternocleidomastoid and multifidus muscles were measured at the inferior endplate in the sub-axial column, and the centroid angle and centroid radius were quantified. Differences in the morphology by gender and spinal level were analyzed using a repeated measures analysis of variance model, adjusted for multiple corrections. RESULTS: For females and males, the cross-sectional area of the sternocleidomastoid muscle ranged from 2.3 to 3.6 cm2 and from 3.4 to 5.4 cm2, the centroid radius ranged from 4.1 to 5.1 cm and from 4.7 to 5.7 cm, and the centroid angle ranged from 75° to 131° and from 4.8° to 131.2°, respectively. For the multifidus muscle, the area ranged from 1.7 to 3.9 cm2 and from 2.4 to 4.2 cm2, the radius ranged from 3.1 to 3.4 cm and from 3.3 to 3.8 cm, the angle ranged from 15° to 24.4° and 16.2° to 24.4°, respectively. Results from all levels for both muscles and male and female spines are given. CONCLUSIONS: The cross-sectional area, angulation, and centroid radii data for flexor and extensor muscles of the cervical spine serve as a dataset that may be used to better define morphologies in computational models and obtain segmental motions and loads under external mechanical forces. These data can be used in computational models for injury prevention, mitigation, and readiness.

Strain Response of an Anatomically Accurate Nonhuman Primate Finite Element Brain Model Under Sagittal Loading.

INTRODUCTION: Prevention and treatment of traumatic brain injuries is critical to preserving soldier brain health. Laboratory studies are commonly used to reproduce injuries, understand injury mechanisms, and develop tolerance limits; however, this approach has limitations for studying brain injury, which requires a physiological response. The nonhuman primate (NHP) has been used as an effective model for investigating brain injury for many years. Prior research using the NHP provides a valuable resource to leverage using modern analysis and modeling techniques to improve our understanding of brain injury. The objectives of the present study are to develop an anatomically accurate finite element model of the NHP and determine regional brain responses using previously collected NHP data. MATERIALS AND METHODS: The finite element model was developed using a neuroimaging-based anatomical atlas of the rhesus macaque that includes both cortical and subcortical structures. Head kinematic data from 10 sagittal NHP experiments, four +Gx (rearward) and six -Gx (frontal), were used to test model stability and obtain brain strain responses from multiple severities and vectors. RESULTS: For +Gx tests, the whole-brain cumulative strain damage measure exceeding a strain threshold of 0.15 (CSDM15) ranged from 0.28 to 0.89, and 95th percentile of the whole-brain maximum principal strain (MPS95) ranged from 0.21 to 0.59. For -Gx tests, whole-brain CSDM15 ranged from 0.02 to 0.66, and whole-brain MPS95 ranged from 0.08 to 0.39. CONCLUSIONS: Recognizing that NHPs are the closest surrogate to humans combined with the limitations of conducting brain injury research in the laboratory, a detailed anatomically accurate finite element model of an NHP was developed and exercised using previously collected data from the Naval Biodynamics Laboratory. The presently developed model can be used to conduct additional analyses to act as pilot data for the design of newer experiments with statistical power because of the sensitivity and resources needed to conduct experiments with NHPs.

Regional Strain Response of an Anatomically Accurate Human Finite Element Head Model Under Frontal Versus Lateral Loading.

INTRODUCTION: Because brain regions are responsible for specific functions, regional damage may cause specific, predictable symptoms. However, the existing brain injury criteria focus on whole brain response. This study developed and validated a detailed human brain computational model with sufficient fidelity to include regional components and demonstrate its feasibility to obtain region-specific brain strains under selected loading. METHODS: Model development used the Simulated Injury Monitor (SIMon) model as a baseline. Each SIMon solid element was split into 8, with each shell element split into 4. Anatomical regions were identified from FreeSurfer fsaverage neuroimaging template. Material properties were obtained from literature. The model was validated against experimental intracranial pressure, brain-skull displacement, and brain strain data. Model simulations used data from laboratory experiments with a rigid arm pendulum striking a helmeted head-neck system. Data from impact tests (6 m/s) at 2 helmet sites (front and left) were used. RESULTS: Model validation showed good agreement with intracranial pressure response, fair to good agreement with brain-skull displacement, and good agreement for brain strain. CORrelation Analysis scores were between 0.72 and 0.93 for both maximum principal strain (MPS) and shear strain. For frontal impacts, regional MPS was between 0.14 and 0.36 (average of left and right hemispheres). For lateral impacts, MPS was between 0.20 and 0.48 (left hemisphere) and between 0.22 and 0.51 (right hemisphere). For frontal impacts, regional cumulative strain damage measure (CSDM20) was between 0.01 and 0.87. For lateral impacts, CSDM20 was between 0.36 and 0.99 (left hemisphere) and between 0.09 and 0.93 (right hemisphere). CONCLUSIONS: Recognizing that neural functions are related to anatomical structures and most model-based injury metrics focus on whole brain response, this study developed an anatomically accurate human brain model to capture regional responses. Model validation was comparable with current models. The model provided sufficient anatomical detail to describe brain regional responses under different impact conditions.

Subaxial Cervical Spine Motion With Different Sizes of Head-supported Mass Under Accelerative Forces.

INTRODUCTION: The evolution of military helmet devices has increased the amount of head-supported mass (HSM) worn by warfighters. HSM has important implications for spine biomechanics, and yet, there is a paucity of studies that investigated the effects of differing HSM and accelerative profiles on spine biomechanics. The aim of this study is to investigate the segmental motions in the subaxial cervical spine with different sizes of HSM under Gx accelerative loading. METHODS: A three-dimensional finite element model of the male head-neck spinal column was used. Three different size military helmets were modeled and incorporated into head-neck model. The models were exercised under Gx accelerative loading by inputting low and high pulses to the cervical vertebra used in the experimental studies. Segmental motions were obtained and normalized with respect to the non-HSM case to quantify the effect of HSM. RESULTS: Segmental motions increased with an increase in velocity at all segments of the spine. Increasing helmet size resulted in larger motion increases. Angulations ranged from 0.9° to 9.3° at 1.8 m/s and from 1.3° to 10.3° at 2.6 m/s without a helmet. Helmet increased motion between 5% to 74% at 1.8 m/s. At 2.6 m/s, the helmet increased segmental motion anywhere from 10% to 105% in the subaxial cervical spine. The greatest motion was seen at the C5-C6 level, followed by the C6-C7 level. CONCLUSIONS: The subaxial cervical spine experiences motion increases at all levels at both velocity profiles with increasing HSM. Larger helmet and greater impact velocity increased motion at all levels, with C5-C6 demonstrating the largest range of motion. HSM should be minimized to reduce the risk of cervical spine injury to the warfighter.

Upper cervical spine bone mineral content variations in elderly females.

The purpose of the study was to determine the bone mineral densities (BMDs) of the C1 and C2 vertebrae and discuss their implications for autonomous vehicle environments and vulnerable road users. Using quantitated computed tomography (QCT), the BMDs were obtained at eight regions for the C1 vertebra and seven regions for the C2 vertebra. The spine surgeon author outlined the boundaries of each region, and nine elderly female human cadaver specimens were used. The regions were based on potential stabilization locations for fracture fixation. In the C1 vertebra, the BMD was greatest at the anterior tubercle, followed by the posterior tubercle, the posterior arch, and the lateral and anterior lateral masses. In the C2 vertebra, the distal odontoid had the greatest BMD, followed by the spinous process, the C2-lateral mass, the odontoid-body interface, and the anterior inferior aspect of the body. Use of these data in female-specific finite element models may lead to a better understanding of load paths, injuries, mechanisms, and tolerance.

Regional brain strain dependance on direction of head rotation.

Brain injuries in automated vehicles during crash events are likely to include mechanisms of head impact in non-standard positions and postures (i.e., occupants not facing forward in an upright position). Federal regulations currently focus on impact conditions in primary planes of motion, such as frontal or rear impacts (sagittal plane of motion) or side impact (coronal plane of motion) and do not account for out of position occupants or non-standard postures. The objective of the present study was to develop and use the anatomically accurate brain finite element model to parametrically determine the injury metrics under different vectors with head rotation. A custom developed brain finite element model with anatomical accuracy and several anatomical regions defined was used to evaluate whole-brain strain as well as regional brain strain. Cumulative Strain Damage Measure (CSDM) at a threshold of 20% strain and the 95th percentile of the maximum principal strain (MPS95) were calculated for the whole brain and each brain region under multiple rotational directions. The model was exposed to a sinusoidal angular acceleration pulse of 5000 rad per second squared (rad/s2-) over 12.5 ms. The same pulse was used in the primary axes of motion and (lateral bending, flexion, extension, axial rotation) and combined axes representing oblique flexion and oblique extension. Whole brain CSDM20 was highest for lateral bending. Whole brain MPS95 was highest for axial rotation. The rCSDM20 was more susceptible to impact direction, with several brain regions having substantial accumulation of strain for oblique flexion and lateral bending. Comparatively, rMPS95 was more consistent across all rotation directions. The present study quantified the regional brain strain response under multiple rotational vectors identifying a high amount of variability in the accumulation of strain (i.e., CSDM20) in the hypothalamus, hippocampus, and midbrain specifically. While there was a high amount of variability in the accumulation of strain for multiple regions, the maximum strain measured (i.e., MPS95) in the regions was more consistent.

Analysis of experimental injuries to obese occupants with different postures in frontal impact.

The objective of the present study was to analyze injuries and their patterns to obese occupants in frontal impacts with upright and reclined postures using experimental data. Twelve obese post-mortem human subjects (PMHS) were positioned on a sled buck with seatback angles of 250 or 450 from the vertical, termed as upright and reclined postures. They were restrained with a seat belt and pretensioner. Frontal impact tests were conducted at 8.9 or 13.9 m/s, termed as low and high velocities. After the test, x-rays and CTs were taken, and an autopsy was conducted. The Maximum AIS (MAIS) and Injury Severity Score (ISS) were calculated, and injury patterns were analyzed. The mean age, stature, total body mass, and body mass indexes were 67 years, 112 kg, and 1.7 m, and 38 kg/m2. None of these parameters were statistically significantly different between any groups. The mean thickness of the soft tissues in the left anterior lateral, central, and right anterior lateral aspects were 44 mm, 24 mm, and 46 mm. In the low-velocity tests, the ISS data were 9, 18, and 9 for the upright, and 9, 9, and 4 for the reclined specimens, and in the high velocity tests, they were 29, 17, and 27 for the upright, and 27, 13, and 27 for the reclined postures. Other data are given in the paper. For both postures at the low velocity, injuries were concentrated at one body region, and the ISS data were in the mild category; in contrast, at the high velocity, other body regions also sustained injuries, and the ISS data were in the major trauma category. From MAIS perspectives, injuries to obese occupants did not change between postures and were independent of the energy input to the system. The association of chest with pelvis injuries in upright and reclined postures to obese occupants may have additional consequences following the initial injury to this group of our population.

Finite element modeling of the human cervical spinal cord and its applications: A systematic review.

Background Context: Finite element modeling (FEM) is an established tool to analyze the biomechanics of complex systems. Advances in computational techniques have led to the increasing use of spinal cord FEMs to study cervical spinal cord pathology. There is considerable variability in the creation of cervical spinal cord FEMs and to date there has been no systematic review of the technique. The aim of this study was to review the uses, techniques, limitations, and applications of FEMs of the human cervical spinal cord. Methods: A literature search was performed through PubMed and Scopus using the words finite element analysis, spinal cord, and biomechanics. Studies were selected based on the following inclusion criteria: (1) use of human spinal cord modeling at the cervical level; (2) model the cervical spinal cord with or without the osteoligamentous spine; and (3) the study should describe an application of the spinal cord FEM. Results: Our search resulted in 369 total publications, 49 underwent reviews of the abstract and full text, and 23 were included in the study. Spinal cord FEMs are used to study spinal cord injury and trauma, pathologic processes, and spine surgery. Considerable variation exists in the derivation of spinal cord geometries, mathematical models, and material properties. Less than 50% of the FEMs incorporate the dura mater, cerebrospinal fluid, nerve roots, and denticulate ligaments. Von Mises stress, and strain of the spinal cord are the most common outputs studied. FEM offers the opportunity for dynamic simulation, but this has been used in only four studies. Conclusions: Spinal cord FEM provides unique insight into the stress and strain of the cervical spinal cord in various pathological conditions and allows for the simulation of surgical procedures. Standardization of modeling parameters, anatomical structures and inclusion of patient-specific data are necessary to improve the clinical translation.

Comparison of Axial Force Attenuation Characteristics in Two Different Lower Extremity Anthropomorphic Test Devices.

INTRODUCTION: Any type of boot or footwear is designed to attenuate and distribute loading to the bottom of the foot. Anthropomorphic test device (ATDs) are used to assess potential countermeasures against these loads. The specific aims of this study were to compare and quantify force attenuation characteristics as a function of input energy for Hybrid-III and Mil-Lx ATD human surrogates. MATERIALS AND METHODS: Two lower leg ATD surrogates (Mil-Lx and Hybrid-III) were tested to investigate the influence of a commercially available military boot on lower extremity force response and assess such differences against previously published postmortem human surrogate studies. The testing apparatus impacted the bottom of the foot using a rigid plate at velocities from 2 to 10 m/s. Tests were conducted on each ATD to obtain axial force response with and without boots as a function of input energy. RESULTS: Peak forces ranged from 1 to 16.4 kN for the Hybrid-III, and 1 to 8.4 kN for the Mil-Lx for similar input conditions. The average force attenuation for the Hybrid-III at upper and lower load cells was 71% (59%-80%) and 70% (58%-78%). The average attenuation for the Mil-Lx at upper and lower load cells was 20% (13%-28%) and 37% (36%-37%), respectively. At the knee load cell, the attenuated peak loads ranged from 62% to 81% for the Hybrid-III and 16% to 30% for the Mil-Lx. CONCLUSIONS: Force attenuation characteristics in the booted vs unbooted configuration of the Mil-Lx were significantly different than force attenuation characteristics of the H3 and may better represent in vivo forces during vertical impact injuries, such as IED blasts. Hence for military relevant applications where boots are used, the Mil-Lx may provide a more conservative evaluation of lower extremity protection systems.

Regional variations in C1-C2 bone density on quantitated computed tomography and clinical implications.

Background: Our elderly population is growing and the number of spine fractures in the elderly is also growing. The elderly population in general may be considered as poor surgical candidates experience a high rate of fractures at C1 and C2 compared with the general population. Nonoperative management of upper cervical fractures is not benign as there is a high nonunion rate for both C1 and C2 fractures in the elderly, and orthosis compliance is often suboptimal, or complicated by skin breakdown. The optimal technique for upper cervical stabilization in the elderly may be different than in younger populations as the bone quality is inferior in the elderly. The objective of this basic science study is to determine whether the bone mineral density (BMD) of C1 and C2 vary by region, and if this is a gender difference in this elderly age group. Methods: Twenty cadaveric spines from 45 to 83 years of age were used to obtain BMD using quantitated computed tomography (QCT). BMD was measured using a QCT. For C1, 8 regions were determined: anterior tubercle, bilateral anterior and medial lateral masses, bilateral posterior arches, and posterior tubercle. For C2, 7 regional BMDs were determined: top of odontoid, base of odontoid-body interface, mid body, bilateral lateral masses, anterior inferior body near the discs space, and the C2 spinous process. Results: The BMD was greatest at the C1 anterior tubercle (564.4±175.8 mg/cm3) and C1 posterior ring (420.8±110.2 mg/cm3), and least at the anterior and medial lateral masses (262.8±59.5 mg/cm3, 316.9±72.6 mg/cm3). At C2 QCT BMD was greatest at the top of the dens (400.6±107.9 mg/cm3) decreasing down through the odontoid-C2 body junction (267.8±103.5 mg/cm3) and least in the mid C2 body 249.1±68.8 mg/cm3). The posterior arch of C1 and the spinous process of C2 had higher BMD's 420.8±110.2 mg/cm3 and 284.1±93.0 mg/cm3, respectively. A high correlation was observed between the BMD at the interface of the dens-vertebral body with the vertebral body with a Pearson correlation coefficient of 0.86. The BMD of the top of dens was significantly higher (p<.05) than all the regions in C2. Conclusions: Regional and segmental BMD variations at C1 and C2 have clinical implications for surgical constructs in the elderly population. Given the higher BMDs of the C1 and C2 spinous process and posterior arches, consideration should be given to incorporate these areas using various C1-C2 wiring techniques. In the elderly, lateral masses particularly at C1 with lower BMD may result in potential screw loosening and nonunion in this age group. Old-school wiring techniques have a track record of efficacy and safety with less blood loss, reduced operative time, reduced X-ray exposure, and should be considered in the elderly as a primary stabilization technique or a belt-over suspenders approach based on regional variations in BMD in the elderly.

Determinants of spinal cord stress and strain in degenerative cervical myelopathy: a patient-specific finite element study.

Degenerative cervical myelopathy (DCM) is the commonest cause of spinal cord dysfunction in older adults and is characterized by chronic cervical spinal cord compression. Spinal cord stress and strain during neck motion are also known contributors to the pathophysiology of DCM, yet these factors are not routinely assessed for surgical planning. The aim of this study was to measure spinal cord stress/strain in DCM using patient-specific 3D finite element models (FEMs) and determine whether spinal cord compression is the primary determinant of spinal cord stress/strain. Three-dimensional patient-specific FEMs were created for six DCM patients (mild [n = 2], moderate [n = 2] and severe [n = 2]). Flexion and extension of the cervical spine were simulated with a pure moment load of 2 Nm. Segmental spinal cord von Mises stress and maximum principal strain were measured. Measures of spinal cord compression and segmental range of motion (ROM) were included in a regression analysis to determine associations with spinal cord stress and strain. Segmental ROM in flexion-extension and axial rotation was independently associated with spinal cord stress (p < 0.001) and strain (p < 0.001), respectively. This relationship was not seen for lateral bending. Segmental ROM had a stronger association with spinal stress and strain as compared to spinal cord compression. Compared to the severity of spinal cord compression, segmental ROM is a stronger determinant spinal cord stress and strain. Surgical procedures that address segmental ROM in addition to cord compression may best optimize spinal cord biomechanics in DCM.