Stiffness of a type II external skeletal fixator and locking compression plate in a fracture gap model.

OBJECTIVE: To compare the stiffness of constructs fixed with a type II external skeletal fixator (ESF) or a 3.5-mm locking compression plate (LCP) in axial compression and bending with a fracture gap model. STUDY DESIGN: Quasi-static four-point bending and axial compression tests. SAMPLE POPULATION: Ten LCP and 10 ESF immobilizing epoxy cylinders with a 40-mm fracture gap. METHODS: Five constructs of each type were tested in nondestructive mediolateral (ML) four-point bending and then rotated and tested in nondestructive craniocaudal (CC) four-point bending. Five additional constructs of each type were tested in nondestructive axial compression. Stiffness was compared between loading modes by construct type and between construct types by loading mode. RESULTS: Type II ESF were stiffer than LCP in ML bending (difference, 1474 N/mm, P < .0001) and in axial compression (difference, 458 N/mm, P = .008) but not in CC bending (P = .1673). Type II ESF were stiffer in ML bending than in CC bending (difference, 999 N/m, P < .0001), while LCP were stiffer in CC bending than in ML bending (difference, 634 N/mm, P < .0001). CONCLUSION: Type II ESF generated stiffer constructs compared with LCP in ML bending and in axial compression without a difference in CC bending. External skeletal fixator and LCP bending stiffness varied by loading direction. CLINICAL SIGNIFICANCE: A type II ESF should be considered in a comminuted fracture requiring increased stability in ML and axial directions.

Laboratory Reconstructions of Bicycle Helmet Damage: Investigation of Cyclist Head Impacts Using Oblique Impacts and Computed Tomography.

Although head injuries are common in cycling, exact conditions associated with cyclist head impacts are difficult to determine. Previous studies have attempted to reverse engineer cyclist head impacts by reconstructing bicycle helmet residual damage, but they have been limited by simplified damage assessment and testing. The present study seeks to enhance knowledge of cyclist head impact conditions by reconstructing helmet damage using advanced impact testing and damage quantification techniques. Damage to 18 helmets from cyclists treated in emergency departments was quantified using computed tomography and reconstructed using oblique impacts. Damage metrics were related to normal and tangential velocities from impact tests as well as peak linear accelerations (PLA) and peak rotational velocities (PRV) using case-specific regression models. Models then allowed original impact conditions and kinematics to be estimated for each case. Helmets were most frequently damaged at the front and sides, often near the rim. Concussion was the most common, non-superficial head injury. Normal velocity and PLA distributions were similar to previous studies, with median values of 3.4 m/s and 102.5 g. Associated tangential velocity and PRV medians were 3.8 m/s and 22.3 rad/s. Results can inform future oblique impact testing conditions, enabling improved helmet evaluation and design.

Development of the STAR Evaluation System for Assessing Bicycle Helmet Protective Performance.

Cycling is a leading cause of mild traumatic brain injury in the US. While bicycle helmets help protect cyclists who crash, limited biomechanical data exist differentiating helmet protective capabilities. This paper describes the development of a bicycle helmet evaluation scheme based in real-world cyclist accidents and brain injury mechanisms. Thirty helmet models were subjected to oblique impacts at six helmet locations and two impact velocities. The summation of tests for the analysis of risk (STAR) equation, which condenses helmet performance from a range of tests into a single value, was used to summarize measured linear and rotational head kinematics in the context of concussion risk. STAR values varied between helmets (10.9-25.3), with lower values representing superior protection. Road helmets produced lower STAR values than urban helmets. Helmets with slip planes produced lower STAR values than helmets without. This bicycle helmet evaluation protocol can educate consumers on the relative impact performance of various helmets and stimulate safer helmet design.

Differences in Impact Performance of Bicycle Helmets During Oblique Impacts.

Cycling is a leading cause of sport-related head injuries in the U.S. Although bicycle helmets must comply with standards limiting head acceleration in severe impacts, helmets are not evaluated under more common, concussive-level impacts, and limited data are available indicating which helmets offer superior protection. Further, standards evaluate normal impacts, while real-world cyclist head impacts are oblique-involving normal and tangential velocities. The objective of this study was to investigate differences in protective capabilities of ten helmet models under common real-world accident conditions. Oblique impacts were evaluated through drop tests onto an angled anvil at common cyclist head impact velocities and locations. Linear and rotational accelerations were evaluated and related to concussion risk, which was then correlated with design parameters. Significant differences were observed in linear and rotational accelerations between models, producing concussion risks spanning >50% within single impact configurations. Risk differences were more attributable to linear acceleration, as rotational varied less between models. At the temporal location, shell thickness, vent configuration, and radius of curvature were found to influence helmet effective stiffness. This should be optimized to reduce impact kinematics. At the frontal, helmet rim location, liner thickness tapered off for some helmets, likely due to lack of standards testing at this location. This is a frequently impacted location for cyclists, suggesting that the standards testable area should be expanded to include the rim. These results can inform manufacturers, standards bodies, and consumers alike, aiding the development of improved bicycle helmet safety.

Eye injury risk from water stream impact: biomechanically based design parameters for water toy and park design.

PURPOSE: Interactive water displays are becoming increasingly popular and can result in direct eye contact. Therefore, the purpose of this study is to investigate eye injury risk from high speed water stream impacts and to provide biomechanically based design parameters for water toys and water park fountains. METHODS: An experimental matrix of 38 tests was developed to impact eight porcine eyes with water streams using a customized pressure system. Two stream diameters (3.2 mm and 6.4 mm) were tested at water velocities between 3.0 m/s and 8.5 m/s. Intraocular pressure was measured with a small pressure sensor inserted through the optic nerve and used to determine the injury risk for hyphema, lens dislocation, retinal damage, and globe rupture for each impact. RESULTS: Experimental water stream impacts created a range of intraocular pressures between 3156 mmHg and 7006 mmHg (61 psi to 135 psi). Injury risk varied between 4.4%-27.8% for hyphema, 0.0%-3.0% for lens dislocation, and 0.1%-3.3% for retinal damage. All tests resulted in 0.0% injury risk for globe rupture. The two water stream diameters did not result in significantly different water stream velocities (P = 0.32); however, the variation in water stream diameter did result in significantly different intraocular pressures (P = 0.03) with higher pressures for the 6.4 mm stream. CONCLUSIONS: This is the first study to experimentally measure intraocular pressure from high speed water stream impacts and quantify the corresponding eye injury risk. It is recommended that toy water guns and water park fountains use an upper threshold of 8.5 m/s for water stream velocities to minimize the risk of serious acute eye damage from impacts.

Evaluating the risk of eye injuries: intraocular pressure during high speed projectile impacts.

PURPOSE: To evaluate the risk of eye injuries by determining intraocular pressure during high speed projectile impacts. METHODS: A pneumatic cannon was used to impact eyes with a variety of projectiles at multiple velocities. Intraocular pressure was measured with a small pressure sensor inserted through the optic nerve. A total of 36 tests were performed on 12 porcine eyes with a range of velocities between 6.2 m/s and 66.5 m/s. Projectiles selected for the test series included a 6.35 mm diameter metal ball, a 9.25 mm diameter aluminum rod, and an 11.16 mm diameter aluminum rod. Experiments were designed with velocities in the range of projectile consumer products such as toy guns. RESULTS: A range of intraocular pressures ranged between 2017 mmHg to 26,426 mmHg (39 psi-511 psi). Four of the 36 impacts resulted in globe rupture. CONCLUSIONS: Intraocular pressures dramatically above normal physiological pressure were observed for high speed projectile impacts. These pressure data provide critical insight to chronic ocular injuries and long-term complications such as glaucoma and cataracts.

The tolerance of the maxilla to blunt impact.

This study reports the results of 38 infraorbital maxilla impacts performed on male cadavers. Impacts were performed using an unpadded, cylindrical impactor (3.2 kg) at velocities between 1 and 5 m/s. The peak force and acoustic emission data were used to develop a statistical relationship of fracture risk as a function of impact force. Acoustic emission sensors were used to provide a noncensored measure of the maxilla tolerance and were essential due to the increase in impactor force after fracture onset. Parametric and nonparametric techniques were used to estimate the risk of fracture tolerance. The nonparametric technique produced an estimated 50% risk of fracture between 970 and 1223 N. The results obtained from the parametric and nonparametric techniques were in good agreement. Peak force values achieved in this study were similar to those of previous work and were unaffected by impactor velocity. The results of this study suggest that an impact to the infraorbital maxilla is a load-limited event due to compromise of structural integrity.

The tolerance of the frontal bone to blunt impact.

The current understanding of the tolerance of the frontal bone to blunt impact is limited. Previous studies have utilized vastly different methods, which limits the use of statistical analyses to determine the tolerance of the frontal bone. The purpose of this study is to determine the tolerance of the frontal bone to blunt impact. Acoustic emission sensors were used to provide a noncensored measure of the frontal bone tolerance and were essential due to the increase in impactor force after fracture onset. In this study, risk functions for fracture were developed using parametric and nonparametric techniques. The results of the statistical analyses suggest that a 50% risk of frontal bone fracture occurs at a force between 1885 N and 2405 N. Subjects that were found to have a frontal sinus present within the impacted region had a significantly higher risk of sustaining a fracture. There was no association between subject age and fracture force. The results of the current study suggest that utilizing peak force as an estimate of fracture tolerance will overestimate the force necessary to create a frontal bone fracture.

The tolerance of the nasal bone to blunt impact.

The nasal bone is among the most frequently broken facial bone due to all types of trauma and is the most frequently fractured facial bone due to motor vehicle collisions. This study reports the results of anterior-posterior impacts performed on male cadavers using a free-falling impactor with a flat impacting surface. The force at fracture onset was determined using an acoustic emission sensor. These non-censored data were utilized in parametric and non-parametric techniques to determine a relationship between applied force and fracture risk. Based on these analyses a 50% risk of fracture corresponded to an applied force of approximately 450 to 850 N. There was no correlation between fracture force and anthropometric measures of the nasal bone. Interestingly, age had a statistically significant relationship with the risk of nasal bone fracture. This study demonstrates the need for a non-censored measure of fracture occurrence when evaluating structures that can continue to support load after fracture onset.

Can footwear affect achilles tendon loading?

OBJECTIVE: To investigate the effects of footwear on Achilles tendon tension by directly measuring Achilles tendon tension and dorsiflexion range of motion. DESIGN: A total of 48 matched pair tests were performed comparing the effects of shoe type (high-top vs low-top) for each shoelace configuration (tied vs untied). These were performed using the Achilles tendons of 4 human cadaver lower extremities that were instrumented with a customized load cell designed to measure tension. The lower extremity was inverted in a custom testing apparatus designed to inertially invoke dorsiflexion of the foot, putting the Achilles tendon in tension. SETTING: Research laboratory. PATIENTS: Left and right lower extremities of 2 human cadavers. INTERVENTIONS: None. Independent variables were shoe type and shoelace configuration. MAIN OUTCOME MEASURES: Achilles tendon tension and dorsiflexion range of motion. RESULTS: High-top shoes significantly reduced peak Achilles tendon tension by an average of 9.9% when compared with low-top shoes. Tied laces significantly reduced peak tension for low-top (3.7%) and high-top (12.8%) shoes when compared with untied laces. With tied laces, high-top shoes significantly reduced peak dorsiflexion angle by an average of 7.2% when compared with low-top shoes. Tied laces with high-top shoes significantly reduced peak dorsiflexion angle by an average of 4.7% when compared with untied laces. A P value of 0.05 was determined to be significant. CONCLUSIONS: This study offers valuable insight that footwear can affect Achilles tendon loading during dorsiflexion.

Effect of strain rate on the tensile material properties of human placenta.

Automobile crashes are the largest cause of injury death for pregnant females and the leading cause of traumatic fetal injury mortality in the United States. Computational models, useful tools to evaluate the risk of fetal loss in motor vehicle crashes, are based on a limited number of quasistatic material tests of the placenta. This study presents a total of 64 uniaxial tensile tests on coupon specimens from six human placentas at three strain rates. Material properties of the placental tissue were evaluated at strain rates of 0.07/s, 0.70/s, and 7.00/s. The test data have average failure strains of 0.34, 0.36, and 0.37, respectively. Failure stresses of 10.8 kPa, 11.4 kPa, and 18.6 kPa correspond to an increase in strain rate from 0.07/s to 7.0/s. The results indicate rate dependence only when comparing the highest strain rate of 7.0/s to either of the lower rates. There is no significant rate dependence between 0.07/s and 0.70/s. When compared with previous testing of placental tissue, the current study addresses the material response to more strain rates as well as provides a much larger set of available data. In summary, tensile material properties for the placenta have been determined for use in computational modeling of pregnant occupant kinematics in events ranging from low impact activities to severe impacts such as in motor vehicle crashes.

Biomechanical response of the human clavicle: the effects of loading direction on bending properties.

The purpose of this study was to determine the influence of loading direction on the structural response of the human clavicle subjected to three-point bending. A total of 20 clavicles were obtained from 10 unembalmed fresh-frozen postmortem human subjects ranging from 45 to 92 years of age. The right and left clavicles from each subject were randomly divided into two test groups. One group was impacted at 0 degrees from the transverse plane, and the second group was impacted at 45 degrees angle from the transverse plane. There was no statistically significant difference in peak force (p = .22), peak moment (p = .30), or peak displacement (p = .44) between specimens impacted at 0 degrees versus 45 degrees from the transverse plane. However, there was a significant difference in the structural stiffness (p = .01) and peak strain (p < .01) between specimens impacted at 0 degrees versus 45 degrees from the transverse plane. The peak strain, however, must be evaluated with caution because of the variation in fracture location relative to the strain gauge. Due to the controlled matched data set, the differences in the structural stiffness with respect to loading direction can be attributed to the complex geometry of the clavicle and not material differences.

Dynamic material properties of the human sclera.

As a result of trauma, approximately 30,000 people become blind in one eye every year in the United States. A common injury prediction tool is computational modeling, which requires accurate material properties to produce reliable results. Therefore, the purpose of this study was to determine the dynamic material properties of the human sclera. A high-rate pressurization system was used to create dynamic pressure to the point of rupture in 12 human eyes. Measurements were obtained for the internal pressure, the diameter of the globe, the thickness of the sclera, and the changing coordinates of the optical markers using high-rate video. A relationship between true stress and true strain was determined for the sclera tissue in two directions. It was found that the average maximum true stress was 13.89+/-4.81 MPa for both the equatorial and meridional directions, the average maximum true strain along the equator was 0.041+/-0.014, and the average maximum true strain along the meridian was 0.058+/-0.018. Results show a significant difference in the maximum strain in the equatorial and meridional directions (p=0.02). In comparing these data with previous studies, it is concluded that the human sclera is both anisotropic and viscoelastic. The dynamic material properties presented in this study can be used for advanced models of the human eye to help prevent eye injuries in the future.

The effect of the periosteum and strain gages on the structural response of human ribs - biomed 2009.

The purpose of this study was to determine if the removal of the periosteum or the application of a strain gage has any significant effect on the structural response of human ribs. A total of 32 three-point bending tests were performed on 16 matched whole rib sections obtained from the left and right sides of five male human thoraces. For one test group, matched specimens were tested to determine the effect of removing the soft tissue and periosteum versus leaving it intact. For a second test group, matched specimens were tested to determine the effects of placing a strain gage on the tension side of the specimen versus no strain gage attachment. The specimens were tested using a servo-hydraulic material testing machine (MTS) at a displacement rate of 17.78 cm/s with a fixed testing span of 10.16 cm. Prior to testing, a microCT was used to obtain a detailed cross-sectional image of each specimen at the point of the impactor blade contact. There were no statistical differences in area moment of inertia (p=0.60), distance to the neutral axis (p=0.29), peak moment (p=0.14), peak impactor displacement (p=0.13), estimated peak stress (p=0.42), or estimated peak strain (p=0.15) between specimens with the periosteum and those without the periosteum. There were no statistical differences in area moment of inertia (p=0.76), distance to the neutral axis (p=0.20), peak moment (p=0.81), peak impactor displacement (p=0.91), estimated peak stress (p=0.59), or estimated peak strain (p=0.29) between specimens with a strain gage and those without a strain gage. In summary, neither the removal of the periosteum nor the application of a strain gage has any significant effect on the structural response of human ribs in dynamic three-point bending.

In situ measurement of achilles tendon tension during dorsiflexion - biomed 2009.

The objective of this study was to develop a methodology to measure the tension of the Achilles tendon in cadavers during dorsiflexion. The Achilles tendon was instrumented with a customized load cell designed to measure tension. The leg was inverted and secured in a custom testing apparatus designed to invoke dorsiflexion of the foot. The ball of the foot was secured to an aluminum foot mount, which was instrumented with a load cell to measure effective ground reaction force and an angular rate sensor to provide range of motion. The lateral malleolus was aligned with the pivot point of the foot mount. The mass of the foot mount was used to force dorsiflexion and put the Achilles tendon under tension. The tendon load cell was calibrated to the specific thickness of the Achilles tendon and provided a strong correlation (R2 = 1.00) with average error > 1%. Average peak tension in the Achilles tendon for these tests was 997.5 N and proved to be repeatable. This methodology allows the force-angle relationship between the Achilles tendon and ankle during dorsiflexion to be investigated. Although this testing did not approach potentially injurious Achilles tendon forces, it offers a unique way of measuring Achilles tendon forces in situ and can be used in future studies to evaluate the effect of extrinsic factors on the Achilles tendon.

Freezing affects the mechanical properties of bovine liver - biomed 2009.

The need to quantify the mechanical properties of human abdominal organs is becoming increasingly important in the automotive industry due to the large incidence of injuries to these organs as a result of motor vehicle crashes. The need to develop appropriate preservation and testing methodology is of particular importance because of how quickly abdominal organ tissues degrade after death. The purpose of this study was to determine the effects of freezing on the mechanical properties of bovine liver parenchyma in uni-axial tension. In the current study, one fresh never frozen bovine liver was divided in half. One half was frozen and then thawed prior to preparation, and the other half tested immediately. Each half was sliced and stamped so that multiple parenchyma tension coupons were produced. A total of 16 failure tests were performed at an average strain rate of 0.07 s-1, 8 fresh and 8 previously frozen, using a custom uni-axial tension system. The results showed that there was no statistically significant difference (p=0.07) in the average failure stress between fresh and previously frozen tissue. However, the average failure strain of the previously frozen tissue was found to be significantly less (p>0.01) than the average failure strain of the fresh tissue. It was concluded from these data that in order to obtain accurate tensile mechanical properties of bovine liver parenchyma, the liver must not be frozen prior to testing.

The effect of temperature on the mechanical properties of bovine liver - biomed 2009.

Abdominal organ injuries account for approximately 3-5% of all injuries in automobile accidents. Because of incidence of injury, understanding the mechanical properties of these organs is vital to preventing and caring for injuries. Abdominal organs degrade quickly after death and therefore the need to develop appropriate procurement and testing methodologies is imperative. The purpose of this paper was to collect data from uniaxial tension tests to determine the effects of testing temperature on the mechanical properties of bovine liver parenchyma. Slices were taken from the parenchyma of two fresh, never frozen bovine livers and then stamped into a tension coupon. The specimens for each liver were then divided into two groups. One group was tested in an environment held at 98 degrees F with the other tested in an environment held at 75 degrees F. A total of 13 failure tests were preformed at 98 degrees F, physiological temperature, and a total of 11 failure tests were conducted at 75 degrees F, which corresponds to room temperature. There was no statistical difference in the failure stress and strain (p>0.05) for either of the two livers between the two temperatures. This shows that the calculated mechanical properties are not dependent on testing temperature in this range.

Acquiring non-censored pelvic bone fracture data during dynamic side impact loading - biomed 2009.

The purpose of this study was to quantify the strain and fracture timing of the pelvic bones during dynamic side impact loading. A total of 3 high-energy side impact tests, 23.4 kg at 12 m/s, were performed on 3 fresh, previously frozen human male cadavers using a custom pneumatic impactor. For two cadavers the impacting surface was a rigid aluminum plate, 250mm x 250mm, while the third cadaver was impacted using a 102 mm thick block of foam attached to the aluminum plate. For all cadavers the impacting surface contacted both the ilium wing and greater trochanter. In order to obtain pelvic bone strain and fracture timing, strain gages were applied to the ilium wing, superior pubic ramus, and inferior pubic ramus. The results of the study showed that for all impact conditions, the superior and inferior pubic rami were subjected to compressive loading. The time histories of each strain gage were analyzed to determine the time of fracture which could then be directly correlated to impactor force. For both rigid impact tests, the superior pubic ramus was found to fracture at approximately the time of peak impactor force, 18,109 N to 20,541 N, followed by the fracture of the inferior pubic ramus, 14,275 N to 15,930 N. Conversely, the test conducted with the foam block was found to successfully attenuate the peak impactor force and prevent injury to the pelvic boney structures.

High-rate internal pressurization of human eyes to predict globe rupture.

OBJECTIVE: To determine the dynamic rupture pressure of the human eye by using an in vitro high-rate pressurization system to investigate blunt-impact eye injuries. METHODS: Internal pressure was dynamically induced in the eye by means of a drop-tower pressurization system. The internal eye pressure was measured with a small pressure sensor inserted into the eye through the optic nerve. A total of 20 human eye tests were performed to determine rupture pressure and characterize rupture patterns. RESULTS: The high-rate pressurization resulted in a mean (SD) rupture pressure of 0.97 (0.29) MPa (7275.60 [2175.18] mm Hg). A total of 16 eyes ruptured in the equatorial direction, whereas 4 ruptured in the meridional direction. There was no significant difference in the rupture pressure between the equatorial and meridional directions (P= .16). CONCLUSION: As the loading rate increases, the rupture pressure of the human eye increases. CLINICAL RELEVANCE: Eye injuries are expensive to treat, given that the estimated annual cost associated with adult vision problems in the United States is $51.4 billion. Determining globe rupture properties will establish injury criteria for the human eye to prevent these common yet devastating injuries.

Dynamic biaxial tissue properties of pregnant porcine uterine tissue.

Automobile crashes are the largest single cause of death for pregnant females and the leading cause of traumatic fetal injury mortality in the United States. Current research for pregnant occupant safety utilizing computational models is limited by available pregnant tissue data. The purpose of this study is to collect experimental data from biaxial tissue tests on pregnant uterine tissue at a dynamic rate. Experimental tests were completed on pregnant porcine uterus which was chosen as a surrogate for the human pregnant uterus given its similarity and availability. Biaxial dynamic tensile tests were performed using a custom designed system of linear motors to pull a cruciform shaped specimen in tension simultaneously with four tissue clamps. The test series included 23 tests with corresponding peak stress and strain measurements of the central region of the specimen where optical markers tracked local displacements. The specimen was loaded at a rate of 0.7 strains per second to match the uterine strain rate in a motor vehicle crash. Experimental results include peak stresses and peak strains for the pregnant uterine tissue in tension. When loaded biaxially, the circumferential peak stress is 500 +/- 219 kPa with a corresponding peak true strain 0.30 +/- 0.09 and the longitudinal peak stress is 320 +/- 176 kPa with a corresponding peak true strain 0.30 +/- 0.09. This material information can be implemented in pregnant occupant models to evaluate the uterine tissue response to impact loading scenarios.