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Human Foot-Ankle Injuries and Associated Risk Curves from Under Body Blast Loading Conditions
Technical Paper
2017-22-0006
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English
Abstract
Under body blast (UBB) loading to military transport vehicles is known to cause
foot-ankle fractures to occupants due to energy transfer from the vehicle floor
to the feet of the soldier. The soldier posture, the proximity of the event with
respect to the soldier, the personal protective equipment (PPE) and age/sex of
the soldier are some variables that can influence injury severity and injury
patterns. Recently conducted experiments to simulate the loading environment to
the human foot/ankle in UBB events (~5ms rise time) with variables such as
posture, age and PPE were used for the current study. The objective of this
study was to determine statistically if these variables affected the primary
injury predictors, and develop injury risk curves. Fifty below-knee post mortem
human surrogate (PMHS) legs were used for statistical analysis. Injuries to
specimens involved isolated and multiple fractures of varying severity. The
Sanders classification was used to grade calcaneus severity and the AO/OTA
classification for distal tibia fracture. Injury risk curves were developed
using survival regression analysis and covariates were included whenever
statistically significant (p<0.05). With peak force as the injury predictor
and age and boot as covariates, the model was statistically significant.
However, boot use changed the pattern of injury from predominately calcaneus to
predominantly tibia. Also, a severity based risk curve showed tolerance
differences between calcaneus (minor/major) and tibia (severity-I/ severity-II)
injuries. The tibia demonstrated higher tolerance as compared to either minor or
major calcaneus injury. These findings can play a vital role in development of
safety systems to mitigate injuries to the occupant.
Authors
Topic
Citation
Chirvi, S., Pintar, F., Yoganandan, N., Banerjee, A. et al., "Human Foot-Ankle Injuries and Associated Risk Curves from Under Body Blast Loading Conditions," SAE Technical Paper 2017-22-0006, 2017, https://doi.org/10.4271/2017-22-0006.Data Sets - Support Documents
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References
- Austin PC , Lee DS , Fine JP 2016 Introduction to the Analysis of Survival Data in the Presence of Competing Risks Circulation 133 6
- Austin PC , Steyerberg EW 2017 Events per variable (EPV) and the relative performance of different strategies for estimating the out-of-sample validity of logistic regression models Stat. Methods Med. Res. 26 2 796 808
- Babyak MA 2004 What you see may not be what you get: a brief, nontechnical introduction to overfitting in regression-type models Psychosom. Med. 66 3 411 421
- Bailey AM , Christopher JJ , Henderson K , Brozoski F Salzar RS (2013) Comparison of Hybrid-III and PMHS Response to Simulated Underbody Blast Loading Conditions IRCOBI Conf. 2013 7288 158 170
- Bailey AM , McMurry TL , Poplin GS , Salzar RS , Crandall JR 2015 Survival Model for Foot and Leg High Rate Axial Impact Injury Data Traffic Inj. Prev. 16 2 S96 S102
- Balazs GC , Polfer EM , Brelin AM , Gordon WT 2014 High Seas to High Explosives: The Evolution of Calcaneus Fracture Management in the Military Mil. Med. 179 11 1228 1235
- Bennett PM , Stevenson T , Sargeant ID , Mountain A , Penn-Barwell JG 2017
- Champion HR , Holcomb JB , Lawnick MM , Kelliher T , Spott MA , Galarneau MR , Jenkins DH , et al. 2010 Improved Characterization of Combat Injury J. Trauma Inj. Infect. Crit. Care 68 5 1139 1150
- Chirvi S , Pintar F , Yoganandan N 2016
- Conroy J , Agarwal M , Giannoudis P V ., Matthews SJE 2003 Early internal fixation and soft tissue cover of severe open tibial pilon fractures Int. Orthop. 27 6 343 347
- Daftary A , Haims AH , Baumgaertner MR 2005 Fractures of the Calcaneus: A Review with Emphasis on CT RadioGraphics 25 5 1215 1226
- Danelson KA , Kemper AR , Mason MJ , Tegtmeyer M , Swiatkowski SA 2015 Comparison of ATD to PMHS Response in the Under-Body Blast Environment Stapp Car Crash J. 59 445 520
- Danoff JR , Saifi C , Goodspeed DC , Reid JS 2015 Outcome of 28 open pilon fractures with injury severity-based fixation Eur. J. Orthop. Surg. Traumatol. 25 3 569 575
- De-las-Heras-Romero J , Lledo-Alvarez AM Lizaur-Utrilla A , Lopez-Prats FA 2017 Quality of life and prognostic factors after intra-articular tibial pilon fracture Injury 48 6 1258 1263
- Dischinger PC , Read KM , Kufera JA , Kerns TJ , Burch CA , Jawed N , Ho SM , Burgess AR 2004 Consequences and costs of lower extremity injuries Annu. proceedings. Assoc. Adv. Automot. Med. 48 339 353
- Eberius NL , Hall L , VanAmburg RL 2014 Quantifying the protective capability of body armor using M&S Ames RG , Boeka RD Ballist. 2014 28th Int. Symp. Ballist
- Folk B , Salzar R , Davis M , Harris R , Rountree MS , Gardner M , Harcke T , et al. 2004 Development of a Test Methodology to Evaluate Mine Protective Footwear Univ Virginia, Charlottesv
- Funk JR , Crandall JR , Tourret LJ , MacMahon CB , Bass CR , Patrie JT , Khaewpong N , Eppinger RH 2002 The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension J. Biomech. Eng. 124 6 750 757
- Gallenberger K , Yoganandan N , Pintar F 2013 Biomechanics of foot/ankle trauma with variable energy impacts Ann. Adv. Automot. Med. Assoc. Adv. Automot. Med. Annu. Sci. Conf. 57 123 132
- Gardner MJ , Mehta S , Barei DP , Nork SE 2008 Treatment Protocol for Open AO/OTA Type C3 Pilon Fractures With Segmental Bone Loss J. Orthop. Trauma 22 7 451 457
- Geiger S , McCormick F , Chou R , Wandel AG 2008 War Wounds: Lessons Learned from Operation Iraqi Freedom Plast. Reconstr. Surg. 122 1 146 153
- Gordon CC , Blackwell CL , Bradtmiller B , Parham JL , Barrientos P , Paquette SP , Corner BD , et al. 2014 2012 Anthropometric Survey of U.S. Army Personnel: Methods and Summary Statistics
- Grala , P. , Machyńska-Bućko , Z. , Kierzynka G 2007 Radiographic imaging of calcaneal fractures - The surgeons view point Polish J. Radiol. 72 2 88 91
- Henderson KA , Bailey AM , Christopher JJ , Brozoski F , Salzar RS 2013 Biomechanical response of the lower leg under high rate loading 2013 IRCOBI Conf. Proc. - Int. Res. Counc. Biomech. Inj. 145 157
- ISO 2014
- Jacob N , Amin A , Giotakis N , Narayan B , Nayagam S , Trompeter AJ 2015 Management of high-energy tibial pilon fractures Strategies Trauma Limb Reconstr. 10 3 137 147
- Klein JP , Rizzo JD , Zhang MJ , Keiding N 2001 Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part I: Unadjusted analysis Bone Marrow Transplant. 28 10 909 915
- Klein JP , Rizzo JD , Zhang MJ , Keiding N 2001 Statistical methods for the analysis and presentation of the results of bone marrow transplants. Part 2: Regression modeling Bone Marrow Transplant. 28 11 1001 1011
- Kline PW , Williams DSB 2015 Effects of normal aging on lower extremity loading and coordination during running in males and females Int. J. Sports Phys. Ther. 10 6 901 909
- Klopp GS , Crandall J , Hall GW , Pilkey WD , Hutwitz SR , Kuppa SM 1997 Mechanisms of injury and injury criteria for the human foot and ankle in dynamic axial impacts to the foot IRCOBI Conf. - Hannover
- Kragh JF , Kirby JM , Ficke JR 2012 Extremity Injury
- Lawnick MM , Champion HR , Gennarelli T , Galarneau MR , D’Souza E , Vickers RR , Wing V , et al. 2013 Combat injury coding J. Trauma Acute Care Surg. 75 4 573 581
- Manoli A , Prasad P , Levine RS 1997 Foot and Ankle Severity Scale (FASS) Foot Ankle Int. 18 9 598 602
- Marsh JL , Slongo TF , Agel J , Broderick JS , Creevey W , DeCoster TA , Prokuski L , et al. 2007 Fracture and dislocation classification compendium - 2007: Orthopaedic Trauma Association classification, database and outcomes committee J. Orthop. Trauma 21 10 Suppl S1 133
- McKay BJ , Bir C a 2009 Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events Stapp Car Crash J. 53 November 229 249
- NATO 2007 Test Methodology for Protection of Vehicle Occupants against Anti-Vehicular Landmine Effects. NATO, RTO, Res. Technol. Organ. TR-HFM-090. Neuilly-sur-Seine Cedex RTO/NATO
- Noordzij M , Leffondre K , van Stralen KJ , Zoccali C , Dekker FW , Jager KJ 2013 When do we need competing risks methods for survival analysis in nephrology? Nephrol. Dial. Transplant. 28 11 2670 2677
- Office of Deputy Assistant Secretary of Defense 2015 Demographics: Profile of the military community United States Department of Defense
- Owens BD , Kragh JF , Macaitis J , Svoboda SJ , Wenke JC 2007 Characterization of Extremity Wounds in Operation Iraqi Freedom and Operation Enduring Freedom J. Orthop. Trauma 21 4 254 257
- Peduzzi P , Concato J , Feinstein AR , Holford TR 1995 Importance of events per independent variable in proportional hazards regression analysis. II. Accuracy and precision of regression estimates J. Clin. Epidemiol. 48 12 1503 10
- Peduzzi P , Concato J Kemper E Feinstein AR 1996 A simulation study of the number of events per variable in logistic regression analysis J. Clin. Epidemiol. 49 12 1373 1379
- Petitjean A , Trosseille X , Yoganandan N , Pintar FA 2015 Normalization and Scaling for Human Response Corridors and Development of Injury Risk Curves. Accid. Inj. Springer New York New York, NY 769 792
- Pietsch HA , Bosch KE , Weyland DR , Spratley EM , Henderson KA , Salzar RS , Smith TA , et al. 2016 Evaluation of WIAMan Technology Demonstrator Biofidelity Relative to Sub-Injurious PMHS Response in Simulated Under-body Blast Events Stapp Car Crash J. 60 199 246
- Pintar FA , Schlick MB , Yoganandan N , Voo L , Merkle AC , Kleinberger M 2016 Biomechanical Response of Military Booted and Unbooted Foot-Ankle-Tibia from Vertical Loading Stapp Car Crash J. 60 247 285
- Pintar FA , Yoganandan N , Voo L 1998 Effect of age and loading rate on human cervical spine injury threshold. Spine (Phila. Pa. 1976) 23 18 1957 1962
- Quenneville CE , Dunning CE 2011 Evaluation of Energy Attenuating Floor Mats for Protection of Lower Limbs From Anti-Vehicular Landmines J. Battlef. Technol. 14 1 4
- Quenneville CE , Fraser GS , Dunning CE 2010 Development of an Apparatus to Produce Fractures From Short-Duration High-Impulse Loading With an Application in the Lower Leg J. Biomech. Eng. 132 1 14502
- Radoni V , Giunio L , Bioči M , Tripkovi A , Lukši B , Primorac D 2004 Injuries from Antitank Mines in Southern Croatia Mil. Med. 169 4
- Ramasamy A , Hill AM , Hepper AE , Bull AMJ , Clasper JC 2009 Blast mines: physics, injury mechanisms and vehicle protection J. R. Army Med. Corps 155 4 258 264
- Ramasamy A , Hill AM , Masouros S , Gibb I , Bull AMJ , Clasper JC 2011a Blast-related fracture patterns: a forensic biomechanical approach J. R. Soc. Interface 8 58 689 698
- Ramasamy A , Hill AM , Phillip R , Gibb I , Bull AMJ , Clasper JC 2011 The modern “deck-slap” injury— calcaneal blast fractures from vehicle explosions J. Trauma Inj. Infect. Crit. Care 71 6 1694 1698
- Rupp JD , Miller CS , Reed MP , Madura NH , Klinich KD , Schneider LW 2008 Characterization of knee-thigh-hip response in frontal impacts using biomechanical testing and computational simulations Stapp Car Crash J. 52 421 474
- Sanders R , Fortin P , DiPasquale T , Walling A 1993 Operative treatment in 120 displaced intraarticular calcaneal fractures. Results using a prognostic computed tomography scan classification Clin. Orthop. Relat. Res. 290 87 95
- Seipel RC , Pintar FA , Yoganandan N , Boynton MD 2001 Biomechanics of calcaneal fractures: a model for the motor vehicle Clin. Orthop. Relat. Res. 388 218 24
- Tableman M 2012 Survival Analysis Using S/R * Unterlagen für den Weiterbildungs−Lehrgang in angewandter Statistik an der ETH Zürich
- Therneau TM , Grambsch PM 2000 Modeling Survival Data: Extending the Cox Model Springer New York New York, NY
- Vittinghoff E , McCulloch CE 2007 Relaxing the Rule of Ten Events per Variable in Logistic and Cox Regression Am. J. Epidemiol. 165 6 710 718
- Wolbers M , Koller MT , Stel VS , Schaer B , Jager KJ , Leffondré K , Heinze G 2014 Competing risks analyses: objectives and approaches Eur. Heart J. 35 42 2936 2941
- Yoganandan N , Arun M , Pintar F , Banerjee A 2015a Lower Leg Injury Reference Values and Risk Curves from Survival Analysis for Male and Female Dummies: Meta-analysis of Postmortem Human Subject Tests Traffic Inj. Prev. 16 sup1 S100 S107
- Yoganandan N , Arun M , Pintar F , Szabo A 2014a Optimized lower leg injury probability curves from postmortem human subject tests under axial impacts Traffic Inj. Prev. 15 Suppl 1(0 1) S151 6
- Yoganandan N , Banerjee A , Hsu FC , Bass CR , Voo L , Pintar FA , Gayzik FS 2016a Deriving injury risk curves using survival analysis from biomechanical experiments J. Biomech. 49 14 3260 3267
- Yoganandan N , Chirvi S , Pintar FA , Uppal H , Schlick M , Banerjee A , Voo L , Merkle A , Kleinberger M 2016b Foot-Ankle Fractures and Injury Probability Curves from Post-mortem Human Surrogate Tests Ann. Biomed. Eng. 44 10 2937 2947
- Yoganandan N , Chirvi S , Voo L , DeVogel N , Pintar FA , Banerjee A 2017 Foot-ankle complex injury risk curves using calcaneus bone mineral density data J. Mech. Behav. Biomed. Mater. 72 246 251
- Yoganandan N , Pintar FA , Boynton M , Begeman P , Prasad P , Kuppa SM , Morgan RM , Eppinger RH 1996 Dynamic Axial Tolerance of the Human Foot-Ankle Complex Soc. Automot. Eng. Inc. 207 218
- Yoganandan N , Pintar FA , Gennarelli TA , Seipel R , Marks R 1999 Biomechanical Tolerance of Calcaneal Fractures Annu. Proc. / Assoc. Adv. Automot. Med. 43 345
- Yoganandan N , Pintar FA , Schlick M , Humm JR , Voo L , Merkle A , Kleinberger M 2015b Vertical accelerator device to apply loads simulating blast environments in the military to human surrogates J. Biomech. 48 12 3534 3538
- Yoganandan N , Pintar F , Banerjee A , Schlick M , Chirvi S , Uppal H , Merkle A , Voo L , Kleinberg M 2015 Hybrid III Lower Leg Injury Assessment Reference Curves Under Axial Impacts Using Matched-Pair Tests Biomed. Sci. Instrum. 51 230 237
- Yoganandan N , Schlick M , Arun MWJ , Pintar FA 2014b Military boot attenuates axial loading to the lower leg Annu. Rocky Mt. Bioeng. Symp. RMBS 2014 51st Int. ISA Biomed. Sci. Instrum. Symp. 2014