This study documents skull fracture characteristics on infant porcine specimens under known impact conditions with respect to age and interface. A single impact causing fracture was conducted on the skull of porcine specimens aged 2-28 days (n = 76). Paired rigid and compliant impacts at the same energy were conducted at each specimen age. Impact force, impact duration, and fracture length were recorded. Energy required to initiate skull fracture increased with specimen age. For a given energy, impact of the skull with a compliant interface caused more fracture damage than with a rigid interface for specimens aged under 17 days, but less damage for specimens aged 24-28 days. The documentation of energy required to cause fracture and resulting fracture propagation with respect to impact interface and age may be of critical importance in forensic investigations of infant skull trauma.

Chronic degeneration of articular cartilage and bone in a rabbit model of post-traumatic osteoarthrosis has been hypothesized to occur due to acute stresses that exceed a threshold for injury. In this study, we impacted the rabbit patellofemoral joint at low and high intensities. High-intensity impacts produced degenerative changes in the joint, such as softening of retropatellar cartilage, as measured by indentation, an increase in histopathology of the cartilage, and an increase in thickness of subchondral bone underlying the cartilage. Low-intensity impacts did not cause these progressive changes. These data suggest that low-intensity impacts produced acute tissue stresses below the injury threshold, while high-intensity impacts produced stresses that exceeded the threshold for disease pathogenesis. This study begins to identify "safe" and "unsafe" ranges of acute tissue stress, using the rabbit patella, which may have future utility in the design of injury prevention devices for the human.

The goal of this study was to document the effect of blunt-impact trauma on the knee in a small animal model that incorporated a known level of physical exercise after impact. We hypothesized that a single blunt impact to the patellofemoral joint, of a magnitude comparable with our earlier studies, would result in degenerative changes to cartilage and to subchondral bone of the patella. Blunt impacts were delivered to rabbit patellofemoral joints without producing bone fracture, and biomechanical and histological analyses were performed on joint tissues at various times. At 12 months, the subchondral bone plate was thicker on the impacted side than on the unimpacted side and than that of the controls at comparable locations (near where surface fissures were found on the impacted side). The instantaneous modulus of cartilage was significantly less on the impacted side than that of controls at 3, 6, and 12 months after impact. The relaxed modulus of cartilage on the unimpacted side increased with time after impact and was significantly greater than that of controls at 12 months. These facts suggest that in this exercise model, the contralateral limb should not be considered a control. The retropatellar cartilage on the impacted side was significantly less thick than that of controls at 12 months, and histological analyses of the cartilage and bone indicated early-stage osteoarthrosis in the impacted joint. Thus, in this animal model a single subfracture blunt impact produced degeneration of joint tissues.

The current criteria used by the automotive industry for predicting joint injury are based on fracture of bone, but clinical studies suggest that chronic diseases such as osteoarthrosis can occur from a single blunt insult without bone fracture. In the current study, blunt insults were delivered to the patellofemoral joints of rabbits without producing bone fractures. Biomechanical and histological studies were performed on joint tissues at various times after insult. The functional integrity of the retropatellar cartilage on the lateral facet was measured with mechanical indentation experiments, and the thickness of the subchondral bone was measured from histological sections. Impacts produced surface lesions on the retropatellar cartilage. The thickness of the subchondral bone in representative animals tended to increase with time after insult, and the bone exhibited significant thickening at 12 months. The overlying cartilage showed signs of degeneration. However, the mechanical stiffness of the cartilage did not change until 12 months after the insult.

The present report is an analysis of the course of peripheral vascular disease (PVD) in 619 patients with non-insulin-dependent diabetes (NIDDM) recruited within 1 yr of diagnosis and followed quarterly for up to 14 yr (X = 10.5 yr). At 13 yr duration, the actuarially determined cumulative risks for intermittent claudication (IC), nonpalpable dorsalis pedis pulse (NPUL), and arterial calcification (CALC) were, respectively, 37.9%, 34.5%, and 60.9% for men and 24.3%, 37.6%, and 32.2% for women. Major amputations (AMP) occurred in only 1.3% of the patients, equivalent to approximately one case per 1000 patients per year. The corresponding incidences of IC, NPUL, and CALC were, respectively, 29, 27, and 47 per 1000 men and 19, 27, and 25 per 1000 women per year. CALC and NPUL were strongly related to mortality. Baseline risk factors with probability levels that suggest a relationship to PVD were, in women, age versus CALC (P less than 0.01), age versus NPUL (P less than 0.05), weight versus NPUL (P less than 0.05), systolic BP versus CALC (P less than 0.01), summed glucose tolerance test versus CALC (P less than 0.01), and triglyceride level versus CALC (P less than 0.05). In men, the only significant risk factors were diminished vibration perception, which was related to NPUL (P less than 0.05), and the serum triglyceride level, which was related to IC (P less than 0.05). In patients who are carefully followed prospectively, IC is far more common, but AMP is far less common than has been generally appreciated. Further studies are needed to clarify the roles of the diverse risk factors that are possibly related.