Injuries of the head from backface deformation of ballistic protective helmets under ballistic impact.

Modern ballistic helmets defeat penetrating bullets by energy transfer from the projectile to the helmet, producing helmet deformation. This deformation may cause severe injuries without completely perforating the helmet, termed "behind armor blunt trauma" (BABT). As helmets become lighter, the likelihood of larger helmet backface deformation under ballistic impact increases. To characterize the potential for BABT, seven postmortem human head/neck specimens wearing a ballistic protective helmet were exposed to nonperforating impact, using a 9 mm, full metal jacket, 124 grain bullet with velocities of 400-460 m/s. An increasing trend of injury severity was observed, ranging from simple linear fractures to combinations of linear and depressed fractures. Overall, the ability to identify skull fractures resulting from BABT can be used in forensic investigations. Our results demonstrate a high risk of skull fracture due to BABT and necessitate the prevention of BABT as a design factor in future generations of protective gear.

Brain injury risk from primary blast.

BACKGROUND: Military service members are often exposed to at least one explosive event, and many blast-exposed veterans present with symptoms of traumatic brain injury. However, there is little information on the intensity and duration of blast necessary to cause brain injury. METHODS: Varying intensity shock tube blasts were focused on the head of anesthetized ferrets, whose thorax and abdomen were protected. Injury evaluations included physiologic consequences, gross necropsy, and histologic diagnosis. The resulting apnea, meningeal bleeding, and fatality were analyzed using logistic regressions to determine injury risk functions. RESULTS: Increasing severity of blast exposure demonstrated increasing apnea immediately after the blast. Gross necropsy revealed hemorrhages, frequently near the brain stem, at the highest blast intensities. Apnea, bleeding, and fatality risk functions from blast exposure to the head were determined for peak overpressure and positive-phase duration. The 50% risk of apnea and moderate hemorrhage were similar, whereas the 50% risk of mild hemorrhage was independent of duration and required lower overpressures (144 kPa). Another fatality risk function was determined with existing data for scaled positive-phase durations from 1 millisecond to 20 milliseconds. CONCLUSION: The first primary blast brain injury risk assessments for mild and moderate/severe injuries in a gyrencephalic animal model were determined. The blast level needed to cause a mild/moderate brain injury may be similar to or less than that needed for pulmonary injury. The risk functions can be used in future research for blast brain injury by providing realistic injury risks to guide the design of protection or evaluate injury.

Primary blast survival and injury risk assessment for repeated blast exposures.

BACKGROUND: The widespread use of explosives by modern insurgents and terrorists has increased the potential frequency of blast exposure in soldiers and civilians. This growing threat highlights the importance of understanding and evaluating blast injury risk and the increase of injury risk from exposure to repeated blast effects. METHODS: Data from more than 3,250 large animal experiments were collected from studies focusing on the effects of blast exposure. The current study uses 2,349 experiments from the data collection for analysis of the primary blast injury and survival risk for both long- and short-duration blasts, including the effects from repeated exposures. A piecewise linear logistic regression was performed on the data to develop survival and injury risk assessment curves. RESULTS: New injury risk assessment curves uniting long- and short-duration blasts were developed for incident and reflected pressure measures and were used to evaluate the risk of injury based on blast over pressure, positive-phase duration, and the number of repeated exposures. The risk assessments were derived for three levels of injury severity: nonauditory, pulmonary, and fatality. The analysis showed a marked initial decrease in injury tolerance with each subsequent blast exposure. This effect decreases with increasing number of blast exposures. CONCLUSIONS: The new injury risk functions showed good agreement with the existing experimental data and provided a simplified model for primary blast injury risk. This model can be used to predict blast injury or fatality risk for single exposure and repeated exposure cases and has application in modern combat scenarios or in setting occupational health limits.

Pulmonary injury risk assessment for long-duration blasts: a meta-analysis.

BACKGROUND: Long-duration blasts are an increasing threat with the expanded use of thermobaric and other novel explosives. Other potential long-duration threats include large explosions from improvised explosive devices, weapons caches, and other explosives including nuclear explosives. However, there are very few long-duration pulmonary blast injury assessments, and use of short-duration exposure injury metrics is inappropriate as the injury mechanism for long-duration exposures is likely different from that of short-duration exposures. METHODS: This study develops an injury model for long-duration (>10 milliseconds positive overpressure phase) blasts with sharp rising overpressures. For this study, data on more than 2,730 large animal experiments were collected from more than 55 experimental studies on blast. From this dataset, nearly 850 large animal experiments were selected with positive phase overpressure durations of 10 milliseconds or more. Various models were evaluated to determine the best fit of injury risk as a function of pressure and duration. A linear logistic regression was performed on the experimental data for threshold injury and lethality in terms of pressure and duration. The effects of mass, pressure, and duration scaling were all evaluated, and two goodness-of-fit indicators were used to assess the different models. RESULTS AND CONCLUSIONS: New injury risk assessment curves were determined for both incident and reflected pressure conditions for reflecting surface and free-field exposures. Position dependent injury risk curves were also determined. The resulting curves are an improvement to existing assessments, because they use actual data to demonstrate theoretical assumptions on the injury risk.

Drosophila melanogaster larvae as a model for blast lung injury.

BACKGROUND: Primary blast injuries, specifically lung injuries, resulting from blast overpressure exposures are a major source of mortality for victims of blast events. However, existing pulmonary injury criteria are inappropriate for common exposure environments. This study uses Drosophila melanogaster larvae to develop a simple phenomenological model for human pulmonary injury from primary blast exposure. METHODS: Drosophila larvae were exposed to blast overpressures generated by a 5.1-cm internal diameter shock tube and their mortality was observed after the exposure. To establish mortality thresholds, a survival analysis was conducted using survival data and peak incident pressures. In addition, a histologic analysis was performed on the larvae to establish the mechanisms of blast injury. RESULTS: The results of the survival analysis suggest that blast overpressure for 50% Drosophila survival is greater than human threshold lung injury and is similar to human 50% survival levels, in the range of overpressure durations tested (1-5 ms). A "parallel" analysis of the Bass et al. 50% human survival curves indicates that 50% Drosophila survival is equivalent to a human injury resulting in a 69% chance of survival. Histologic analysis of the blast-exposed larvae failed to demonstrate damage to the dorsal trunk of the tracheal system; however, the presence of flocculent material in the larvae body cavities and tracheas suggests tissue damage. CONCLUSIONS: This study shows that D. melanogaster survival can be correlated with large animal injury models to approximate a human blast lung injury tolerance. Within the range of durations tested, Drosophila larvae may be used as a simple model for blast injury.

Pulmonary injury risk assessment for short-duration blasts.

BACKGROUND: Blast injuries are becoming more common in modern war and terrorist action. This increasing threat underscores the importance of understanding and evaluating blast effects. METHODS: For this study, data on more than 2,550 large animal experiments were collected from more than 50 experimental studies on blast. From this dataset, over 1,100 large animal experiments were selected with positive phase overpressure durations of 30 milliseconds or less. A two variable nonlinear logistic regression was performed on the experimental data for threshold injury and lethality in terms of pressure and duration. The effects of mass, pressure, and duration scaling were all evaluated. RESULTS: New injury risk assessment curves were analyzed for both incident and reflected pressure conditions. Position dependent injury risk curves were also analyzed and were found to be unnecessary, at least for prone and side on conditions. CONCLUSIONS: The injury risk assessment showed good correlation to some of the existing injury assessments. It also showed good correspondence to a reported human case of blast exposure. Pressure scaling was analyzed to be unnecessary for these short duration exposures. Recommended injury assessments for various orientations relative to the incoming blast wave are included.

Thoracic and lumbar spinal impact tolerance.

INTRODUCTION: Thoracolumbar injuries resulting from motor vehicle accidents, falls, and assaults have a high risk of morbidity and mortality. However, there are no biomechanically based standards that address this problem. METHODS: This study used four cadaveric porcine specimens as a model for direct spinal impact injuries to humans to determine an appropriate injury tolerance value. The anthropometric parameters of these specimens are compared with values found in a large human cadaveric dataset. Each specimen was subjected to five impacts on the dorsal surface of the lower thorax and abdomen. RESULTS: The injuries ranged from mild spinous process fractures to endplate fractures with anterior longitudinal ligament (ALL) transactions with a maximum AIS=3. The average peak reaction force for the thoracic failure tests was 4720+/-1340 N, and the average peak reaction force for the lumbar failure tests was 4650+/-1590 N. DISCUSSION: When scaled to human values using anthropometric parameters determined in this study, the force at which there is a 50% risk of injury is 10,200+/-3900 N. This value favorably compares to that found in the existing literature on isolated vertebral segments. SUMMARY: After demonstrating that the porcine model can be used as a spinal impact model for the human, the resulting injury risk value can be used in determining new standards for human injury risk or in guiding the design of safety equipment for the back.

The temperature-dependent viscoelasticity of porcine lumbar spine ligaments.

STUDY DESIGN: A uniaxial tensile loading study of 13 lumbar porcine ligaments under varying environmental temperature conditions. OBJECTIVES: To investigate a possible temperature dependence of the material behavior of porcine lumbar anterior longitudinal ligaments. SUMMARY OF BACKGROUND DATA: Temperature dependence of the mechanical material properties of ligament has not been conclusively established. METHODS: The anterior longitudinal ligaments (ALLs) from domestic pigs (n = 5) were loaded in tension to 20% strain using a protocol that included fast ramp/hold and sinusoidal tests. These ligaments were tested at temperatures of 37.8 degrees C, 29.4 degrees C, 21.1 degrees C, 12.8 degrees C, and 4.4 degrees C. The temperatures were controlled to within 0.6 degrees C, and ligament hydration was maintained with a humidifier inside the test chamber and by spraying 0.9% saline onto the ligament. A viscoelastic model was used to characterize the force response of the ligaments. RESULTS: The testing indicated that the ALL has strong temperature dependence. As temperature decreased, the peak forces increased for similar input peak strains and strain rates. The relaxation of the ligaments was similar at each temperature and showed only weak temperature dependence. Predicted behavior using the viscoelastic model compared well with the actual data (R2 values ranging from 0.89 to 0.99). A regression analysis performed on the viscoelastic model coefficients confirmed that relaxation coefficients were only weakly temperature dependent while the instantaneous elastic function coefficients were strongly temperature dependent. CONCLUSIONS: The experiment demonstrated that the viscoelastic mechanical response of the porcine ligament is dependent on the temperature at which it is tested; the force response of the ligament increased as the temperature decreased. This conclusion also applies to human ligaments owing to material and structural similarity. This result settles a controversy on the temperature dependence of ligament in the available literature. The ligament viscoelastic model shows a significant temperature dependence on the material properties; instantaneous elastic force was clearly temperature dependent while the relaxation response was only weakly temperature dependent. This result suggests that temperature dependence should be considered when testing ligaments and developing material models for in vivo force response, and further suggests that previously published material property values derived from room temperature testing may not adequately represent in vivo response. These findings have clinical relevance in the increased susceptibility of ligamentous injury in the cold and in assessing the mechanical behavior of cold extremities and extremities with limited vascular perfusion such as those of the elderly.