No abstract

Background:Forced external rotation of the foot is a mechanism of ankle injuries. Clinical observations include combinations of ligament and osseous injuries, with unclear links between causation and injury patterns. By observing the propagation sequence of ankle injuries during controlled experiments, insight necessary to understand risk factors and potential mitigation measures may be gained.Hypothesis:Ankle flexion will alter the propagation sequence of ankle injuries during forced external rotation of the foot.Study Design:Controlled laboratory study.Methods:Matched-pair lower limbs from 9 male cadaveric specimens (mean age, 47.0 ± 11.3 years; mean height, 178.1 ± 5.9 cm; mean weight, 94.4 ± 30.9 kg) were disarticulated at the knee. Specimens were mounted in a test device with the proximal tibia fixed, the fibula unconstrained, and foot translation permitted. After adjusting the initial ankle position (neutral, n = 9; dorsiflexed, n = 4; plantar flexed, n = 4) and applying a compressive preload to the tibia, external rotation was applied by rotating the tibia internally while either lubricated anteromedial and posterolateral plates or calcaneal fixation constrained foot rotation. The timing of osteoligamentous injuries was determined from acoustic sensors, strain gauges, force/moment readings, and 3-dimensional bony kinematics. Posttest necropsies were performed to document injury patterns.Results:A syndesmotic injury was observed in 5 of 9 (56%) specimens tested in a neutral initial posture, in 100% of the dorsiflexed specimens, and in none of the plantar flexed specimens. Superficial deltoid injuries were observed in all test modes.Conclusion:Plantar flexion decreased and dorsiflexion increased the incidence of syndesmotic injuries compared with neutral matched-pair ankles. Injury propagation was not identical in all ankles that sustained a syndesmotic injury, but a characteristic sequence initiated with injuries to the medial ligaments, particularly the superficial deltoid, followed by the propagation of injuries to either the syndesmotic or lateral ligaments (depending on ankle flexion), and finally to the interosseous membrane or the fibula.Clinical Relevance:Superficial deltoid injuries may occur in any case of hyper–external rotation of the foot. A syndesmotic ankle injury is often concomitant with a superficial deltoid injury; however, based on the research detailed herein, a deep deltoid injury is then concomitant with a syndesmotic injury or offloads the syndesmosis altogether. A syndesmotic ankle injury more often occurs when external rotation is applied to a neutral or dorsiflexed ankle. Plantar flexion may shift the injury to other ankle ligaments, specifically lateral ligaments.

No abstract

No abstract

Objectives:The objective of this study is to evaluate how the impact energy is apportioned between chest deflection and translation of the vehicle occupant for various side impact conditions.Methods: The Autoliv Total Human Model for Safety (modified THUMS v1.4) was subjected to localized lateral constant velocity impacts to the upper body. First, the impact tests performed on postmortem human subjects (PMHS) were replicated to evaluate THUMS biofidelity. In these tests, a 75-mm-tall flat probe impacted the thorax at 3 m/s at 3 levels (shoulder, upper chest, and mid-chest) and 3 angles (lateral, +15• posterolateral, and −15 • anterolateral), for a stroke of 72 mm. Second, a parametric analysis was performed: the Autoliv THUMS response to a 250-mm impact was evaluated for varying impact levels (shoulder to mid-thorax by 50-mm increments), obliquity (0 • by 5• steps). A total of 139 simulations were run. The impactor force, chest deflection, spine displacement, and spine velocity were calculated for each simulation.Results: The Autoliv THUMS biofidelity was found acceptable. Overall, the predictions from the model were in good agreement with the PMHS results. The worst ratings were observed for the anterolateral impacts. For the parametric analysis, maximum chest deflection (MCD) and maximum spine displacement (MSD) were found to consistently follow opposite trends with increasing obliquity. This trend was level dependent, with greater MCD (lower MSD) for the higher impact levels. However, the spine velocity for the 250-mm impactor stroke followed an independent trend that could not be linked to MCD or MSD. This suggests that the spine velocity, which can be used as a proxy for the thorax kinetic energy, needs to be included in the design parameters of countermeasures for side impact protection. Conclusion:The parametric analysis reveals a trade-off between the deformation of the chest (and therefore the risk of rib fracture) and the lateral translation of the spine: reducing the maximum chest deflection comes at the cost of increasing the occupant lateral displacement. The trade-off between MCD and MSD is location dependent, which suggests that an optimum point of loading on the chest for the action of a safety system can be found.