Injury Risk Functions for the Midsized Male Wrist and Elbow as a Result of Behind Shield Blunt Trauma.

Ballistic shields protect users from a variety of threats, including projectiles. Shield back-face deformation (BFD) is the result of the shield deflecting or absorbing a projectile and deforming toward the user. Back-face deformation can result in localized blunt loading to the upper extremity, where the shield is supported by the user. Two vulnerable locations along the upper extremity were investigated-the wrist and elbow-on eight postmortem human subjects (PMHS) using a pneumatic impacting apparatus for investigating the fracture threshold as a result of behind shield blunt trauma (BSBT). Impacting parameters were established by subjecting an augmented WorldSID anthropomorphic test device (ATD) positioned behind a ballistic shield to ballistic impacts. These data were used to form the impact parameters applied to PMHS, where the wrist most frequently fractured at the distal radius and the elbow most frequently fractured at the radial head. The fracture threshold for the wrist was 5663±1386 N (mean±standard deviation), higher than the elbow at 4765±894 N (though not significantly, p = 0.15). The failure impact velocity for wrist impacts was 17.7±2.1 m/s, while for the elbow, the failure impact velocity was 19.5±0.9 m/s. An approximate 10% risk of fracture threshold was identified on the modified WorldSID ATD (no flesh analogue included) to inform future protective standards.

Region partitioning of articular cartilage with streaming-potential-based parameters and indentation maps.

Articular cartilage exhibits site-specific tissue inhomogeneity, for which the tissue properties may continuously vary across the articular surface. To facilitate practical applications such as studying site-specific cartilage degeneration, the inhomogeneity may be approximated with several distinct region-wise variations, with one set of tissue properties for one region. A clustering method was previously developed to partition such regions using cartilage indentation-relaxation and thickness mapping instead of simply using surface geometry. In the present study, a quantitative parameter based on streaming potential measurement was introduced as an additional feature to assess the applicability of the methodology with independent datasets. Experimental data were collected from 24 sets of femoral condyles, extracted from fresh porcine stifle joints, through streaming potential mapping, automated indentation, and needle penetration tests. K-means clustering and Elbow method were used to find optimal region partitions. Consistent with previous findings, three regions were suggested for either lateral or medial condyle regardless of left or right joint. The region shapes were approximately triangular or trapezoidal, which was similar to what was found previously. Streaming potentials were confirmed to be region-dependent, but not significantly different among joints. The cartilage was significantly thicker in the medial than lateral condyles. The region areas were consistent among joints, and comparable to that found in a previous study. The present study demonstrated the capability of region partitioning methods with different variables, which may facilitate new applications whenever site-specific tissue properties must be considered.

Injury Risk for the Hand and Forearm Under Loading Representative of Behind Shield Blunt Trauma.

Ballistic shields protect users from a variety of threats, including projectiles. Shield back-face deformation (BFD) is the result of the shield absorbing energy from a projectile and deforming towards the user. Back-face deformation can result in localized blunt loading to the upper extremity, where the shield is supported by the user and may cause injury through behind armour blunt trauma (BABT) mechanisms. Post-mortem human subject (PMHS) responses are critical to identify the injury risk in these high-rate scenarios and are used to quantify the injury tolerance. Two vulnerable locations along the upper extremity were investigated-the hand and forearm-using eight PMHS to identify the fracture threshold resulting from shield BABT loading conditions. Impacts delivered to the hand at 16.4 ± 0.8 m/s resulted in failure loads of 3818 ± 897 N, whilst the forearm impacts delivered at a similar velocity of 16.9 ± 1.9 m/s had lower failure loads at 3011 ± 656 N. The corresponding 10% risk of hand and forearm fractures (as measured on a modified WorldSID Anthropomorphic Test Device) were identified as 11.0 kN and 8.1 kN, respectively, which should be used when evaluating future designs of composite ballistic shields. This study is the first known investigation of the upper extremity to this high loading rate scenario and provides the foundation for future biomechanical research in the area of behind shield blunt trauma.

The Use of Optical Tracking to Characterize Fracture Gap Motions and Estimate Healing Potential in Comminuted Biomechanical Models of Surgical Repair.

Fracture healing is stimulated by micromotion at the fracture site, whereby there exists an optimal amount of strain to promote secondary bone formation. Surgical plates used for fracture fixation are often evaluated for their biomechanical performance using benchtop studies, where success is based on overall construct stiffness and strength measures. Integration of fracture gap tracking to this assessment would provide crucial information about how plates support the various fragments present in comminuted fractures, to ensure there are appropriate levels of micromotion during early healing. The goal of this study was to configure an optical tracking system to quantify 3D interfragmentary motion to assess the stability (and corresponding healing potential) of comminuted fractures. An optical tracking system (OptiTrack, Natural Point Inc, Corvallis, OR) was mounted to a material testing machine (Instron 1567, Norwood, MA, USA), with an overall marker tracking accuracy of 0.05 mm. Marker clusters were constructed that could be affixed to individual bone fragments, and segment-fixed coordinate systems were developed. The interfragmentary motion was calculated by tracking the segments while under load and was resolved into compression-extraction and shear components. This technique was evaluated using two cadaveric distal tibia-fibula complexes with simulated intra-articular pilon fractures. Normal and shear strains were tracked during cyclic loading (for stiffness tests), and a wedge gap was also tracked to assess failure in an alternate clinically relevant mode. This technique will augment the utility of benchtop fracture studies by moving beyond total construct response and providing anatomically relevant data on interfragmentary motion, a valuable proxy for healing potential.

Behind Shield Blunt Trauma: Characterizing the Back-Face Deformation of Shields with a Focus on Upper Limb Loading.

Shield back-face deformation (BFD) is the result of composite ballistic shields deflecting or absorbing a projectile's energy and deforming towards the user. BFD can result in localized loading to the upper extremity, where the shield is secured to the user. An augmented anthropomorphic test device upper extremity was used to quantify this applied load. Four locations along the upper extremity were tested-the hand, wrist, forearm, and elbow-for investigating differing boundary conditions and their effect on resultant load. Varying stand-off distances, the distance between the back of the shield and the force sensor, were investigated. Digital image correlation was also conducted to measure the dynamic displacement of the shield. The mean peak back-face velocity of the shield was 208.4 ± 38.8 m/s, while the average affected area was 1505 ± 158.3 mm2. Impulse was not significantly affected by anatomical location for the same stand-off distance; however, as stand-off distance decreased, the measured force significantly increased (p < 0.05). Notably, impact duration did not differ significantly for any of the impact scenarios. This is the first step in developing injury criteria for this region resulting from behind shield blunt trauma, and these data will be used for developing injury thresholds in post-mortem human surrogates.

Numerical analysis of hip fracture due to a sideways fall.

The primary purpose of this paper is to outline a methodology for evaluating the likelihood of cortical bone fracture in the proximal femur in the event of a sideways fall. The approach includes conducting finite element (FE) analysis in which the cortical bone is treated as an anisotropic material, and the admissibility of the stress field is validated both in tension and compression regime. In assessing the onset of fracture, two methodologies are used, namely the Critical Plane approach and the Microstructure Tensor approach. The former is employed in the tension regime, while the latter governs the conditions at failure in compression. The propagation of localized damage is modeled using a constitutive law with embedded discontinuity (CLED). In this approach, the localized deformation is described by a homogenization procedure in which the average properties of cortical tissue intercepted by a macrocrack are established. The key material properties governing the conditions at failure are specified from a series of independent material tests conducted on cortical bone samples tested at different orientations relative to the loading direction. The numerical analysis deals with simulations of experiments involving the sideways fall, and the results are compared with the experimental data. This includes both the evolution of fracture pattern and the local load-displacement characteristics. The proposed approach is numerically efficient, and the results do not display a pathological mesh-dependency. Also, in contrast to the XFEM approach, the analysis does not require any extra degrees of freedom.

Advanced 2D image processing technique to predict hip fracture risk in an older population based on single DXA scans.

A new technique to enhance hip fracture risk prediction in older adults was presented and assessed. The new method dramatically improved prediction at high specificity levels using only a standard clinical diagnostic scan. This has the potential to be implemented in clinical practice to enhance patient fragility diagnosis. INTRODUCTION: Diagnosis of osteoporosis is based on the measurement of bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA) scans. However, studies have shown this to be insufficient to accurately predict hip fractures. Therefore, complementary methods are needed to enhance hip fracture risk prediction to identify vulnerable patients. METHODS: Hip DXA scans were obtained for 192 subjects from the Canadian Multicenter Osteoporosis Study (CaMos), 50 of whom had experienced a hip fracture within 5 years of the scan. 2D statistical shape and appearance modeling was performed to account for the effect of the femur's geometry and BMD distribution on hip fracture risk. Statistical shape modeling (SSM), and statistical appearance modeling (SAM) were also used separately to predict the fracture risk based solely on the femur's geometry and BMD distribution, respectively. Combined with BMD, age, and body mass index (BMI), logistic regression was performed to estimate the fracture risk over the 5-year period. RESULTS: Using the new technique, hip fractures were correctly predicted in 78% of cases compared with 36% when using the T-score. The accuracy of the prediction was not greatly reduced when using SSM and SAM (78% and 74% correct, respectively). Various geometric and BMD distribution traits were identified in the fractured and non-fractured groups. CONCLUSION: 2D SSAM can dramatically improve hip fracture prediction at high specificity levels and estimate the year of the impending fracture using standard clinical images. This has the potential to be implemented in clinical practice to estimate hip fracture risk.

Chronic arsenicosis and cadmium exposure in wild snowshoe hares (Lepus americanus) breeding near Yellowknife, Northwest Territories (Canada), part 2: Manifestation of bone abnormalities and osteoporosis.

Various bone abnormalities, including osteoporosis, have been associated with chronic arsenic and cadmium exposure in experimental animal models, but information regarding the bone pathology of wild population of small mammals breeding in contaminated environment is limited. This present study was conducted to comparatively assess the prevalence and pattern of skeletal abnormalities in free ranging snowshoe hares inhabiting an area heavily contaminated by arsenic and other trace metals, near the vicinity of the abandoned Giant mine, and in a reference location approximately 20km from the city of Yellowknife, Northwest Territories, Canada. The femur and vertebrae of snowshoe hares from the mine area and reference location were subjected to bone densitometry examination and biomechanical testing using dual energy X-ray absorptiometry (DXA) and 3-point bending test. t-test results indicated that femoral densitometry parameters such as bone mineral density (BMD) (p=0.5), bone mineral content (BMC) (p=0.675), bone area (BA) (p=0.978) and tissue area (TA) (p=0.549) were not significantly different between locations. All densitometry parameters of the vertebrae (BMD, BA and TA) differed between locations (p<0.05), except for BMC (p=0.951) which showed no significant difference between the two locations. Vertebrae from the mine area also showed relatively lower BA and TA compared to the reference location. A constellation of skeletal abnormalities were also observed along the axial and appendicular bones respectively. Specifically, growth defects, osteoporosis, cortical fractures, sclerosis, and cyst like changes were commonly observed in the femurs and vertebrae of hares from both locations. With respect to biomechanical properties, only bone stiffness and peak load tended to be relatively reduced in specimens from the mine area, whereas work to failure was notably increased in specimens from the reference site compared to those from the mine area. Taken together, the results of this preliminary study suggest that chronic concomitant exposure to arsenic and cadmium may be involved in the etiology of various bone abnormalities, including osteoporosis in wild population of snowshoe hares from the Yellowknife area. The result presented in this study represent the first evaluation of osteological effects in free-ranging furbearers (snowshoe hares) diagnosed with arsenicosis, and concomitantly exposed to environmental levels of cadmium.

Evaluation of synthetic composite tibias for fracture testing using impact loads.

Composite synthetic bones are a commercially available substitute for cadaveric specimens, and they have previously been validated to replicate natural bone under quasistatic, non-destructive testing. Synthetic tibias could be used to analyse injury risk to the lower leg during impact events, but their failure mode must be validated by way of comparative tests to human bone. Synthetic tibias were instrumented with strain gauges and subjected to axial impact loading. Two different projectile masses were used for the tests, and the effects of force, momentum, and energy on failure were compared with previous cadaveric data. The composite tibias failed at forces between 37-45 per cent of those from cadavers, and failed via cortical delamination in combination with fracture. A Weibull analysis generated a survivability curve based on axial force at failure, and was shown to be lower than previous cadaveric curves. Failure was dependent on both the momentum and energy applied. Strain distributions through the synthetic tibias were significantly different from those of cadavers. The convex distal articular surface of the synthetic bones may partially account for the lower fracture tolerance. As a result of the many differences in response, these synthetic tibias are not recommended for use in impact fracture studies.