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Exploring the stochastic intricacies of bone microstructure is a promising way to make progress on the practical issue of bone fracture. This study investigates the fracture of human complete ribs subjected to bending and using acoustic emission (AE) for microfailure detection. As the strain increases, the number of AE signals per unit of time rises until, beyond a certain threshold, an avalanche of signals occurs, indicating the aggregation of numerous microfailures into a macroscopic fracture. Since microfailures appear randomly throughout the bending test, and given the lack of a deterministic law and the random nature of microfailures during the bending test, we opted to develop a stochastic model to account for their occurrence within the irregular and random microstructure of the cortical bone. Notable discoveries encompass the significant correlation between adjusted parameters of the stochastic model and the total number of microfailures with anthropometric variables such as age and body mass index (BMI). The progression of microfailures with strain is significantly more pronounced with age and BMI, as measured by the rate of bone deterioration. In addition, the rate of microfailures is significantly impacted by BMI alone. It is also observed that the average energy of the identified AE events adheres to a precisely defined Pareto distribution for every specimen, with the principal exponent exhibiting a significant correlation with anthropometric variables. From a mathematical standpoint, the model can be described as a double Cox stochastic and explosive (coxplosive process) model. This further provides insight into the reason why the ribs of older individuals are considerably less resilient than those of younger individuals, breaking under a considerably lower maximum strain ( ε max ). [ABSTRACT FROM AUTHOR]

Most car occupant fatalities occur in frontal crashes and the thorax is the most frequently injured body region. The objectives of the study were, firstly, to quantify the relation between risk factors (such as speed and occupant age) and rib and sternum fracture injury probability in frontal car crashes, and, secondly, to evaluate whether rib fracture occurrence can predict sternum fractures. Weighted German data from 1999-2021 were used to create the injury risk curves to predict both, at least moderate and at least serious, rib and sternum fracture risks. A contingency table for rib and sternum fractures allowed the calculation of sensitivity, specificity, and precision, as well as testing for the association. Elderly occupants (≥65 years old) had increased rib and sternum fracture risk compared to mid aged occupants (18-64 years old). Besides occupant age, delta-V was always and sex sometimes a significant predictor for skeletal thoracic injury. Sternum fractures were more common than rib fractures and more likely to occur at any given delta-V. Sternum fractures occurred often in isolation. Female occupants were at higher risk than males to sustain at least moderate rib and sternum fractures together and sternum fractures in isolation. Rib and sternum fractures were associated, but low sensitivity and precision show that rib fractures do not predict sternum fractures well. Elderly and female occupants were at the highest risk and should be targeted by thoracic injury criteria and thresholds for frontal crash occupant protection. Rib and sternum fractures were not associated. Therefore, sternum fractures need to be predicted and evaluated separately from rib fractures. [ABSTRACT FROM AUTHOR]

Predicting and understanding thorax injury is fundamental for the assessment and development of safety systems to mitigate injury risk to the increasing and vulnerable aged population. While computational human models have contributed to the understanding of injury biomechanics, contemporary human body models have struggled to predict rib fractures and explain the increased incidence of injury in the aged population. The present study enhanced young and aged human body models (HBMs) by integrating a biofidelic cortical bone constitutive model and population-based bone material properties. The HBMs were evaluated using side impact sled tests assessed using chest compression and number of rib fractures. The increase in thoracic kyphosis and the associated change in rib angle with increasing age, led to increased rib torsional moment increasing the rib shear stress. Coupled with and improved cortical bone constitutive model and aged material properties, the higher resulting shear stress led to an increased number of rib fractures in the aged model. The importance of shear stress resulting from torsional load was further investigated using an isolated rib model. In contrast, HBM chest compression, a common thorax injury-associated metric, was insensitive to the aging factors studied. This study proposes an explanation for the increased incidence of thorax injury with increasing age reported in epidemiological data, and provides an enhanced understanding of human rib mechanics that will benefit assessment and design of future safety systems.

Thorax injury remains a primary contributor to mortality in car crash scenarios. Although human body models can be used to investigate thorax response to impact, isolated rib models have not been able to predict age- and sex-specific force-displacement response and fracture location simultaneously, which is a critical step towards developing human thorax models able to accurately predict injury response. Recent advancements in constitutive models and quantification of age- and sex-specific material properties, cross-sectional area, and cortical bone thickness distribution offer opportunities to improve rib computational models. In the present study, improved cortical and trabecular bone constitutive models populated with age-specific material properties, age- and sex-specific population data on rib cross-sectional area, and cortical bone thickness distribution were implemented into an isolated 6 th rib from a contemporary human body model. The enhanced rib model was simulated in anterior-posterior loading for comparison to experimental age- and sex-specific (twenty-three mid-size males, age range of 22- to 57-year-old) population force-displacement response and fracture location. The improved constitutive models, populated with age-specific material properties, proved critical to predict the rib failure force and displacement, while the improved cortical bone thickness distribution and cross-sectional area improved the fracture location prediction. The enhanced young mid-size male 6 th rib model was able to predict young mid-size male 6 th rib experimental force-displacement response and fracture location (overpredicted the displacement at failure by 35% and underpredicted the force at failure by 8% but within ±1 SD). The results of the present study can be integrated into full body models to potentially improve thorax injury prediction capabilities.

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient’s systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury.

The simplified point mass, flail-space model was introduced in 1981 and is currently used in the United States, Canadian, Australian, and New Zealand road safety barrier and fixtures standards as a method of assessing vehicle occupant injury risk in certification crash tests when an instrumented anthropomorphic crash test dummy is not used. Maximum and preferred flail-space threshold impact velocities and accelerations of an unrestrained occupant are specified for longitudinal (frontal) and lateral (side) impact in the standards. The longitudinal impact velocity component of the flail-space model has been compared with impact velocities from real-world frontal crash data. However, the lateral velocity component has yet to be compared with impact velocities from any side impact tests or real-world injury crash data. This current study assesses the relationship between injury severity and impact velocities from cadaveric lateral thoracic impact tests and relates this to the maximum and preferred lateral velocities as recommended in the flail-space model. The following data from previous thoracic lateral impact cadaver tests were collated: impact velocity, cadaver age, cadaver mass, impact wall padding thickness, impact test method, and resultant Abbreviated Injury Scale (AIS) level. Multiple logistic regression analysis was used to determine the significant variables in predicting AIS 3+ and AIS 4+ injuries. Single variable regression analysis was then performed to determine a relationship between lateral impact velocity and AIS 3+ and AIS 4+ injury level. From the results, the current flail-space model's preferred lateral velocity used in the road safety barrier standards was found to be high and a lower preferred threshold of 6.4 m s−1is proposed. [ABSTRACT FROM PUBLISHER]

Thoracic injuries from motor vehicle crashes (MVCs) are common in children and the elderly and are associated with a high rate of mortality for both groups. Rib fractures, in particular, are linked to high mortality rates which increase with the number of fractures sustained. Anthropomorphic test devices (ATDs) and computational models have been developed to improve vehicle safety, however these tools are constructed based on limited physical datasets. To-date, no study has explored variation of rib structural properties across the entire age spectrum with data obtained using the same experimental methodology to allow for comparison. One-hundred eighty-four ribs from 93 post mortem human subjects (PMHS) (70 male, 23 female; ages 4–99) were subjected to dynamic bending tests simulating a frontal impact to the thorax. Structural mechanical properties were calculated and a multi-level statistical model quantified the sample variance as explained by age and sex. Displacement ( δ X ), peak force ( F peak ), linear structural stiffness ( K ), energy absorption to fracture ( U tot ), and plastic properties including post-yield energy absorption ( U Pl ), plastic displacement (δ Pl ), and the ratio of elastic to secant stiffness ( K -ratio) all showed negative relationships with age, while only F peak , K , and U tot were dependent on sex. Despite these relationships being statistically significant, only 7–39% of variance is explained by age and only 3–17% of variance is explained by sex. This demonstrates that variability in bone properties is more complex than simply chronological age- and sex-dependence and should be explored in the context of biological mechanisms instead. [ABSTRACT FROM AUTHOR]

The cause of serious and fatal thoracic injuries in passenger vehicle rollover crashes is currently not well understood. Previous research on thoracic injuries resulting from rollover crashes have focused primarily on statistical analysis of crash data. This study seeks to develop a better understanding of where in the rollover sequence thoracic injuries may occur. To do this, a real-world passenger vehicle rollover crash where the driver sustained serious bilateral thoracic injuries was reconstructed. Multi-body analysis was used to determine the vehicle’s pre-trip trajectory and to obtain the vehicle’s position and kinematics at the point of trip. This information was then used to prescribe the motion of the vehicle in a finite element analysis. A finite element model of the EuroSID-2re anthropomorphic test device was placed in the driver’s seat. Four simulations, each with the anthropomorphic test device positioned in different postures, were performed. Rib deflection, spinal acceleration, and thoracic impact velocity were obtained from the anthropomorphic test device and compared to existing thoracic injury assessment reference values. From the analysis, lateral thoracic impact velocity indicates that a serious thoracic injury is likely to have occurred when the driver impacted the centre console during the vehicle’s fourth quarter-turn.

Side impact continues to be a significant source of vehicle occupant injuries and fatalities requiring an improved understanding of response sensitivity to occupant position and the potential for injury. The primary interaction between the occupant and vehicle in near-side impact is the intruding door and vehicle structure where contact with the intruding structures is observed to be the most frequent cause of injuries. Restraints and protective systems are tested for a specific driving position with a prescribed set of anthropometric test devices; however, studies have shown that the initial position and posture of the occupant within the vehicle may have an influence on occupant response. In this study, a finite-element human body model with a detailed representation of the thorax and an ES-2re anthropomorphic test device (ATD) model were integrated with a mid-sized sedan vehicle model to investigate occupant response from a moving deformable barrier side impact. All models were verified using established tests (pendulum, side sled) and physical test data available in the literature. A parametric study was undertaken to evaluate the effect of arm position and car door material properties on thoracic response, assessed using thoracic deflection and the viscous criterion. In the standard driving position, the human and ATD model responses were similar. The human body model demonstrated significant sensitivity, relative to the ATD, to different arm positions with a lesser sensitivity to the door interior properties. It was found that in side impact which has the characteristics of high energy and limited displacement, the arm aligned with the body can act as a significant source of load transmission to the thorax, increasing the potential for injury. This study demonstrates that the choice of occupant model, injury metric and occupant arm position plays an important role in evaluating side impact safety. [ABSTRACT FROM PUBLISHER]

Objective: To explore the relationship between the collision parameters of vehicle and the pedestrian thorax injury by establishing the chest simulation models in car-pedestrian collision at different velocities and angles.Methods: 87 cases of vehicle-to-pedestrian accidents, with detailed injury information and determined vehicle impact parameters, were included. The severity of injury was scaled in line with the Abbreviated Injury Scale (AIS). The chest biomechanical response parameters and change characteristics were obtained by using Hyperworks and LS-DYNA computing. Simulation analysis was applied to compare the characteristics of injuries.Results: When impact velocities at 25, 40 and 55 km/h, respectively, 1) the maximum values of thorax velocity criterion (VC) were for 0.29, 0.83 and 2.58 m/s; and at the same collision velocity, the thorax VC from the impact on pedestrian's front was successively greater than on his back and on his side; 2) the maximum values of peak stress on ribs were 154, 177 and 209 MPa; and at the same velocity, peak stress values on ribs from the impact on pedestrian's side were greater than on his front and his back.Conclusion: There is a positive correlation between the severity and risk of thorax injury and the collision velocity and angle of car-thorax crashes. At the same velocity, it is of greater damage risk when the soft tissue of thorax under a front impact; and there is also a greater risk of ribs fracture under a side impact of the thorax. This result is of vital significance for diagnosis and protection of thorax collision injuries. [ABSTRACT FROM AUTHOR]

Purpose: Respiratory support is the mainstay for the management of patients with pulmonary contusion following blunt chest trauma. In patients not requiring immediate intubation and ventilation, the optimal respiratory management strategy is not clear. This systematic review and meta-analysis aimed to determine the efficacy of non-invasive ventilation (NIV), as compared to traditional respiratory support strategies (i.e., high-flow facemask oxygen or pre-emptive intubation and ventilation), in adult patients with blunt chest trauma. Methods: We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing NIV to traditional forms of respiratory support (i.e., facemask oxygen or intubation and ventilation) in an adult trauma population. For each eligible trial, we extracted the outcomes of all-cause mortality, length of intensive care unit (ICU) stay, length of hospital stay, and pneumonia. Results: We identified 643 citations, selected 17 for full-text evaluation, and identified three eligible RCTs. Patients receiving NIV had a non-significant reduction in the risk of death (OR 0.55; 95 % CI 0.18-1.70; I = 0 %), but significant reductions in length of ICU stay (mean difference −2.45 days; 95 % CI −4.27 to −0.63; I = 66 %), length of hospital stay (mean difference −4.60 days; 95 % CI −8.81 to −0.39; I = 85 %), and risk of pneumonia (OR 0.20; 95 % CI 0.09-0.47; I = 0 %). Conclusion: This meta-analysis suggests that NIV is superior to both high-flow facemask oxygen or pre-emptive intubation and ventilation in patients with blunt chest trauma who have no contraindication to NIV. [ABSTRACT FROM AUTHOR]

Studies on the effectiveness of thoracic side airbags (tSABs) in preventing thoracic injuries is limited and conflicting. This retrospective observational study aims to evaluate the effectiveness of tSABs in side-impact crashes based on data for motor vehicle occupants (MVOs) who visited an emergency department in Korea. The data were obtained from the Korean In-Depth Accident Study (KIDAS) database for patients treated at Wonju Severance Christian Hospital between January 2011 and April 2020. Of the 3899 patients with road traffic injuries, data for 490 patients were used. The overall frequency of tSAB deployment in side-impact crashes was found to be 8.1%. In the multivariate analysis, elderly age, near-side impact, colliding with fixed objects, non-oblique force, and higher crush extent were found to be factors associated with higher thoracic injuries (Abbreviated Injury Scale ≥ 2). MVOs in crashes with tSAB deployment were at an increased risk of injury compared with MVOs in crashes with no deployment, but no statistical difference was observed [adjusted odds ratios (AORs): 1.65 (0.73-3.73)]. Further, the incidence of lung injury and rib fractures increased with tSAB activation ( p < 0.05). These results demonstrate the limited capability of tSABs in preventing thoracic injuries in motor vehicle crashes.

Our in-patient surgical department during the time period from January 2003 to December 2009 saw 28 patients who were hospitalised with an isolated fracture of the sternum. The purpose of observing these patients in the surgical ward was to exclude any possible complications of blunt cardiac trauma or injury to the large mediastinal vessels. According to numerous previous reports in the literature, sternal fractures may be related to the occurrence of such sequelae. All patients admitted to the surgical unit had routine chest x-ray pictures taken in the AP (anterior-poste- rior) and lateral views, specifically targeting the sternum, as well as a routine electrocardiogram (ECG). Some patients also had an echocardiograph (ECHO) performed and cardiac enzyme levels assessed. None of the patients at the time of admission, nor during their hospital stay, had any clinical, radiological, or electrocardiographic signs suggestive of a cardiac contusion or a traumatic injury to the thoracic aorta or other great vessels of the mediastinum. None of the hospitalised patients had any complications which required surgical intervention. The widespread use of safety belts in cars and the rapid growth of motorisation is associated with an increase in the number of isolated fractures of the sternum. Therefore, it is of increasing importance to develop appropriate standards of treatment in this type of trauma situation. Our experience, as well as a review of recently published reports has prompted us to introduce the following recommendations in our centre: patients with isolated sternal fractures, with no other abnormalities seen on the chest X-ray and with a normal electrocardiogram do not require routine observation in the surgical ward. Echocardiography or the evaluation of cardiac enzyme levels is not necessary with the routine diagnosis of uncomplicated fractures of the sternum. [ABSTRACT FROM AUTHOR]

Abstract: The Crash Injury Research Engineering Network (CIREN) database contains detailed medical and crash information on a large number of severely injured occupants in motor vehicle crashes. CIREN''s major limitation for stand-alone analyses to explore injury risk factors is that control subjects without a given injury type must have another severe injury to be included in the database. This leads to bias toward the null in the estimation of risk associations. One method to cope with this limitation is to obtain information about occupants without a given injury type from the National Automotive Sampling System''s Crashworthiness Data System (NASS-CDS), which is a probability sample of towaway crashes, containing similar crash information, but less medical detail. Combining CIREN and NASS-CDS in this manner takes advantage of the increased sample size when outcomes are available in both datasets; otherwise NASS-CDS can serve as a sample of controls to be combined with CIREN cases, possibly under a sensitivity analysis that includes and excludes NASS-CDS subjects whose status as a control is uncertain. Because CIREN is not a probability sample of crashes that meet its inclusion criteria, we develop a method to estimate the probability of selection for the CIREN cases using data from NASS-CDS. These estimated probabilities are then used to compute “pseudo-weights” for the CIREN cases. These pseudo-weights not only allow for reduced bias in the estimation of risk associations, they allow direct prevalence estimates to be made using medical outcome data available only in CIREN. We illustrate the use of these methods with both simulation studies and application to estimation of prevalence and predictors of AIS 3+ injury risk to head, thorax, and lower extremity regions, as well as prevalence and predictors of acetabular pelvic fractures. Results of these analyses demonstrate combining NASS and CIREN data can yield improvements in mean square error and nominal confidence interval coverage over analyses that use either the NASS-CDS or the CIREN sample alone. [Copyright &y& Elsevier]

Objective: To determine the usefulness of ultrasound in the detection of rib fractures. Patients and Methods: A prospective study was performed over a 3-month period. Patients presenting with a high clinical suspicion of rib fracture(s) to the Accident and Emergency Department were referred for radiological work-up with a PA chest radiograph, an oblique rib view and a chest ultrasound. Associated lesions, e.g. pleural effusion, splenic laceration and pneumothorax were recorded. Results: Fourteen patients were radiologically assessed. The mean patient age was 31 years (range 16-55 years) and the M:F ratio 3.7:1 (11 men and 3 women). Ten patients displayed a total of 15 broken ribs. Chest radiography detected 11, oblique rib views 13 and ultrasound 14 broken ribs. Ultrasound findings included discontinuity of cortical alignment in 12 fractures, an acoustic linear edge shadow in nine and a reverberation artifact in six. Concordance with plain film findings, and especially oblique rib views, was good, though better when the rib fractures fragments were markedly displaced. One splenic laceration was detected with an associated small pleural effusion. There were no pneumothoraces. The average time of ultrasound examination was 13 min. Conclusion: Ultrasound does not significantly increase the detection rate of rib fractures, may be uncomfortable for the patient and is too time-consuming to justify its routine use to detect rib fractures. [ABSTRACT FROM AUTHOR]

• Detailed analysis of motorcyclist AIS15 injuries beyond body regions. • Comprehensive injury prioritization lists with respect to impact types. • Most common were tibia, femur and rib cage fractures, brain and lung injuries. • Both, physical dummies and virtual human body models need further validation. Globally there are more than 350,000 PTW fatalities each year. Safety concepts to protect Powered Two-Wheeler (PTW) riders exist and are being developed further, but they need appropriate procedures and test tools (Anthropometric Test Devices (ATDs) for physical testing and Human Body Models (HBMs) for virtual testing) to direct and promote those developments. To aid further development of the tools, we aim to rank the frequency of specific injuries arising from the prevalent impact types, discuss how current ATDs and HBMs are equipped to assess these injuries, and suggest what further development should be prioritized. We analyzed a sample of injured riders from the German In-depth Accident Study (GIDAS) according to the Abbreviated Injury Scale (AIS) 2015 classification, using severity thresholds of at-least-moderate (AIS2+) and at-least-serious (AIS3+). PTW rider injuries were ranked by frequency for all crashes and also for sub-samples of specific impact types (impact with passenger cars, ground, and roadside furniture). The most frequent AIS3+ injuries were: femur fracture (17%), rib cage fracture (13%), lung injury (9%), tibia fracture (7%), and cerebrum injury (7%). In all impacts together and as for impacts with the road surface, injuries to the thorax were most frequent. In impacts with cars and road furniture, thorax injuries were also frequent, but outranked by lower extremity injuries. Considering both AIS2+ and AIS3+ injuries, the priorities for PTW rider safety interventions are: fracture of the rib cage, femur fracture, tibia fracture, radius fracture, cerebrum injury, and cerebral concussion. The ATD currently used most frequently, the Hybrid III, is unlikely to provide adequate rib fracture injury assessments, but HBMs are promising in this area. Rib injury assessment may also reasonably predict other injuries that were correlated or in proximity to rib fractures: clavicle, lung, and upper abdomen organ injury. Lower extremity, upper extremity, and head injuries are likely addressable to some extent with current ATDs while HBMs hold the promise of more detailed and mechanism-specific injury assessments. Both ATDs and HBMs need more validation for use in the PTW environment. [ABSTRACT FROM AUTHOR]

This study aims to define possible predictors of the need of invasive and non-invasive ventilatory support, in addition to predictors of mortality in patients with severe thoracic trauma. Data from 832 patients admitted to our trauma center were collected from 2010 to 2017 and retrospectively analyzed. Demographic data, type of respiratory assistance, chest injuries, trauma scores and outcome were considered. Univariate analysis was performed, and binary logistic regression was applied to significant data. The injury severity score (ISS) and the revised trauma score (RTS) were both found to be predictive factors for invasive ventilation. Multivariate analysis of the anatomical injuries revealed that the association of high-severity thoracic injuries with trauma in other districts is an indicator of the need for orotracheal intubation. From the analysis of physiological parameters, values of systolic blood pressure, lactate, and Glasgow coma scale (GCS) score indicate the need for invasive ventilatory support. Predictive factors for non-invasive ventilation include: RTS, ISS, number of rib fractures and presence of hemothorax. Risk factors for death were: age over 65, the presence of bilateral rib fractures, pulmonary contusion, hemothorax and associated head trauma. In conclusion, the need for invasive ventilatory support in thoracic trauma is associated to the patient's systemic severity. Non-invasive ventilation is a supportive treatment indicated in physiologically stable patients regardless of the severity of thoracic injury. [ABSTRACT FROM AUTHOR]

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Background and Aims: Trauma registry data are used for analyzing and improving patient care, comparison of different units, and for research and administrative purposes. Data should therefore be reliable. The aim of this study was to audit the quality of the Helsinki Trauma Registry internally. We describe how to conduct a validation of a regional or national trauma registry and how to report the results in a readily comprehensible form., Materials and Methods: Trauma registry database of Helsinki Trauma Registry from year 2013 was re-evaluated. We assessed data quality in three different parts of the data input process: the process of including patients in the trauma registry (case completeness); the process of calculating Abbreviated Injury Scale (AIS) codes; and entering the patient variables in the trauma registry (data completeness, accuracy, and correctness). We calculated the case completeness results using raw agreement percentage and Cohen's κ value. Percentage and descriptive methods were used for the remaining calculations., Results: In total, 862 patients were evaluated; 853 were rated the same in the audit process resulting in a raw agreement percentage of 99%. Nine cases were missing from the registry, yielding a case completeness of 97.1% for the Helsinki Trauma Registry. For AIS code data, we analyzed 107 patients with severe thorax injury with 941 AIS codes. Completeness of codes was 99.0% (932/941), accuracy was 90.0% (841/932), and correctness was 97.5% (909/932). The data completeness of patient variables was 93.4% (3899/4174). Data completeness was 100% for 16 of 32 categories. Data accuracy was 94.6% (3690/3899) and data correctness was 97.2% (3789/3899)., Conclusion: The case completeness, data completeness, data accuracy, and data correctness of the Helsinki Trauma Registry are excellent. We recommend that these should be the variables included in a trauma registry validation process, and that the quality of trauma registry data should be systematically and regularly reviewed and reported.

The pediatric cadaver impact experiments were reconstructed using the validated finite element(FE) models of the 3-year-old and 6-year-old children. The effect of parameters, such as hammer size, material parameters and thorax anatomical structure characteristics, on the impact mechanical responses of 3-year-old and 6-year-old pediatric thorax was discussed by designing reasonable finite element simulation experiments. The research results showed that the variation of thorax contact peak force for 3-year-old group was far larger than that of 6-year-old group when the child was impacted by hammers with different size, which meant that 3-year-old child was more sensitive to hammer size. The mechanical properties of thoracic organs had little influence on the thorax injury because of the small difference between 3-year-old and 6-year-old child in this research. During the impact, rib deformation led to different impact location and deformation of internal organs because the 3-year-old and 6-year-old children had different geometrical anatomical structures, such as different size of internal organs. Therefore, the injury of internal organs in the two groups was obviously different. It is of great significance to develop children finite element models with high biofidelity according to its real anatomical structures.

Traumatic injury from motor vehicle crashes is a major cause of morbidity and mortality in the United States. The thorax is particularly at risk in motor vehicle crashes and is studied extensively by the injury biomechanics community. Unfortunately, most samples used in such research generally do not include children or the very elderly, despite the common occurrence of thorax injuries at both ends of the age spectrum. Rib fractures in particular, are one of the most common injuries, especially in the elderly, and can greatly affect morbidity, mortality, and quality of life. As the proportion of older adults in the population increases, such age-related fragility fractures will continually grow as a worldwide problem. Additionally, the risk of rib fracture significantly increases with age with confounding deleterious effects. Studies on elderly ribs are not uncommon, however very few studies exist which explore the mechanical properties and behavior of immature human bone, especially of ribs. Previous research identifying rib properties has provided useful information for numerous applications. However, no study has included a comprehensive sample of all ages (pediatric through elderly) in which ribs are tested in the same repeatable set-up. The goal of this study is to characterize differences in rib structural response across the age spectrum. One-hundred forty excised ribs from 70 individuals were experimentally tested in a custom-built pendulum fixture simulating a dynamic frontal impact. The sample includes individuals of ages ranging from six to 99 years old and includes 58 males and 12 females. Reported data include fracture location, displacement in the X and Y directions at fracture (δX, δY), force at fracture (FX), and linear structural stiffness (K). δX and K exhibit a statistically significant linear decrease with age (p<0.0001). FX reveals a trend in which a peak is reached in the young adult years (25-40). Detailed mechanical property data, as provided here, will prove useful for application in computational modeling efforts, which are vital to help prevent injury and to understand injury mechanisms from childhood through old age., (Copyright © 2014 Elsevier Ltd. All rights reserved.)

Objective: Within the EC Seventh Framework project THORAX, the Mod-Kit THOR was upgraded with a new thorax and shoulder. The aim of this study was to investigate whether the THOR ATD met a set of prerequisites to a greater extent than Hybrid III and by that measure whether the dummy could serve as a potential tool for future evaluation of serious head and chest injuries in near-side oblique frontal impacts., Method: A small-overlap/oblique sled system was used to reflect occupant forces observed in oblique frontal crashes. The head and thoracic response from THOR was evaluated for 3 combinations: belt only with no deformation of the driver's side door (configuration A), belt only in combination with a predeformed door (configuration B), and prepretensioning belt and driver airbag (PPT+DAB) in combination with a predeformed door (configuration C). To evaluate head injury risk, the head injury criterion (HIC) and brain injury criteria (BrIC) were used. For evaluation of the thoracic injury risk, 3 injury criteria proposed by the THORAX project were evaluated: Dmax, DcTHOR, and strain (dummy rib fractures)., Results: Unlike Hybrid III, the THOR with SD3 shoulder interacted with the side structure in a near-side oblique frontal impact. HIC values for the 3 test configurations corresponded to a 90% (A) and 100% (B and C) risk of Abbreviated Injury Scale (AIS) 2+ head injury, and BrIC values resulted in a 100% risk of AIS 2+ head injury in configurations A and B. In C the risk was reduced to 75%. The AIS 2+ thoracic injury risks based on Dmax were similar (14-18%) for all tests. Based on DcTHOR, AIS 2+ injury risk increased from 29 to 53% as the predeformed door side was introduced (A to B), and the risk increased, to 64%, as a PPT+DAB was added (C). Considering the AIS 2+ injury risk based on strain, tests in A resulted in an average of 3 dummy rib fractures (17%). Introducing the predeformed door (B) increased the average of dummy fractures to 5 (39%), but in C the average number of dummy rib fractures decreased to 4 (28%)., Conclusions: THOR with an SD3 shoulder should be the preferred ATD rather than the Hybrid III for evaluating head and thorax injuries in oblique frontal impacts. Thoracic interaction with the predeformed door was not well captured by the 3D IR-Traccs; hence, use of deflection as an injury predictor in oblique loading is insufficient for evaluating injury risk in this load case. However, injury risk evaluation may be performed using the strain measurements, which characterize loading from seat belt and airbag as well as the lateral contribution of the structural impact in the loading condition used in this study.