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Forced inversion or eversion of the foot is considered a common mechanism of ankle injury in vehicle crashes. The objective of this study was to model empirically the injury tolerance of the human ankle/subtalar joint to dynamic inversion and eversion under three different loading conditions: neutral flexion with no axial preload, neutral flexion with 2 kN axial preload, and 30° of dorsiflexion with 2 kN axial preload. 44 tests were conducted on cadaveric lower limbs, with injury occurring in 30 specimens. Common injuries included malleolar fractures, osteochondral fractures of the talus, fractures of the lateral process of the talus, and collateral ligament tears, depending on the loading configuration. The time of injury was determined either by the peak ankle moment or by a sudden drop in ankle moment that was accompanied by a burst of acoustic emission. Characteristic moment-angle curves to injury were generated for each loading configuration.

Axial loading of the foot/ankle complex is an important injury mechanism in vehicular trauma that is responsible for severe injuries such as calcaneal and tibia pilon fractures. Axial loading may be applied to the leg externally, by the toepan and/or pedals, as well as internally, by active muscle tension applied through the Achilles tendon during pre-impact bracing. In order to evaluate the effect of active muscle tension on the injury tolerance of the foot/ankle complex, blunt axial impact tests were performed on 44 isolated lower legs with and without experimentally simulated Achilles tension. The primary fracture mode was calcaneal fracture in both groups, but tibia pilon fractures occurred more frequently with the addition of Achilles tension. Acoustic emission demonstrated that fracture initiated at the time of peak local axial force.

A series of 26 human cadaver tests with chestband instrumentation and accelerometers were completed to assess side impact injury tolerance. A Heidelberg-type sled test system was used with thorax, abdomen, and pelvic load plates. Tests were conducted at the Medical College of Wisconsin and through the Ohio State University College of Medicine at the NHTSA Vehicle Research and Test Center at two different velocities: 24 kph and 32 kph. Test conditions included rigid wall, padded wall, and pelvic offset. Accelerations were recorded at rib 4, rib 8, and T12. Up to three chestbands were placed on each surrogate. Chest deflections were derived by computing chest contours at every millisecond throughout the event. The derived chest deflection-time curves were differentiated to obtain velocity of chest compression. Injury criteria including ASA15N, TTI, normalized chest deflection, and VC were computed. Resulting injuries ranged from AIS = 0 to AIS = 5.

The paper reviews one hundred and three (103) cases of restrained children involved in motor vehicle crashes and admitted to the level I trauma center at Children's National Medical Center (CNMC). Thirty percent (30%) of these cases involved injuries with an Abbreviated InjuryScore (AIS) severity of 3 or greater. All cases are classified first by type of restraint system, i.e. infant seat, convertible seat, booster seat, lap belt, and lap and shoulder belt, and second, by type of injury sustained, i.e. head/face and neck, upper extremity, thorax, pelvic and abdominal, and lower extremity. The links between these classifications are examined to identify particular injury patterns associated with the use of individual restraint systems, e.g. the incidence of pelvic and abdominal injury associated with the use of both lap and lap and shoulder belts. For the severe injury cases the paper further examines the injury mechanisms for the most commonly observed patterns.