Real-World Rib Fracture Patterns in Frontal Crashes in Different Restraint Conditions.

OBJECTIVE: The purpose of this study was to use the detailed medical injury information in the Crash Injury Research and Engineering Network (CIREN) to evaluate patterns of rib fractures in real-world crash occupants in both belted and unbelted restraint conditions. Fracture patterns binned into rib regional levels were examined to determine normative trends associated with belt use and other possible contributing factors. METHODS: Front row adult occupants with Abbreviated Injury Scale (AIS) 3+ rib fractures, in frontal crashes with a deployed frontal airbag, were selected from the CIREN database. The circumferential location of each rib fracture (with respect to the sternum) was documented using a previously published method (Ritchie et al. 2006) and digital computed tomography scans. Fracture patterns for different crash and occupant parameters (restraint use, involved physical component, occupant kinematics, crash principal direction of force, and occupant age) were compared qualitatively and quantitatively. RESULTS: There were 158 belted and 44 unbelted occupants included in this study. For belted occupants, fractures were mainly located near the path of the shoulder belt, with the majority of fractures occurring on the inboard (with respect to the vehicle) side of the thorax. For unbelted occupants, fractures were approximately symmetric and distributed across both sides of the thorax. There were negligible differences in fracture patterns between occupants with frontal (0°) and near side (330° to 350° for drivers; 10° to 30° for passengers) crash principal directions of force but substantial differences between groups when occupant kinematics (and contacts within the vehicle) were considered. Age also affected fracture pattern, with fractures tending to occur more anteriorly in older occupants and more laterally in younger occupants (both belted and unbelted). CONCLUSIONS: Results of this study confirmed with real-world data that rib fracture patterns in unbelted occupants were more distributed and symmetric across the thorax compared to belted occupants in crashes with a deployed frontal airbag. Other factors, such as occupant kinematics and occupant age, also produced differing patterns of fractures. Normative data on rib fracture patterns in real-world occupants can contribute to understanding injury mechanisms and the role of different causation factors, which can ultimately help prevent fractures and improve vehicle safety.

Occupant accelerations and injury potential during an ambulance-to-curb impact.

This paper presents real world acceleration data for an ambulance driving up and over a curb. A full scale reenactment was performed for a litigated case in which a patient on a gurney in an ambulance claimed a variety of bodily injuries after the ambulance struck a curb. A height and weight matched surrogate rode on the gurney during the tests. Results demonstrated that peak vehicle and occupant accelerations never exceeded 1.1g's. To address the claimed injuries, the accelerations likely sustained by the patient were compared to those experienced during daily life. Since ambulances are wide vehicles that travel fast on potentially narrow arterial, collector or local roadways, curb or median impacts may occur during the normal course of driving. Thus, these results may be useful for forensic experts in dealing with similar cases involving claimed injuries following curb impacts.

The ratio of thoracic to lumbar compression force is posture dependent.

Despite the evidence suggesting that between 8% and 55% of manual labourers experience thoracic pain, research on spinal loading during occupational tasks has been almost invariably limited to the lumbar spine. In this study, we determined the ratio of thoracic to lumbar compression force and the relative risk of injury to each region in various postures. Compressive forces on the spine were calculated based on previously reported thoracic and lumbar intradiscal pressures and disc cross-sectional areas. Flexion postures were associated with an approximate doubling in lumbar compression force but only small increases (or even decreases) in thoracic compression. The ratio of thoracic to lumbar compression was above the tolerance ratio (i.e. the ratio of thoracic to lumbar compressive strength) during upright postures and below the tolerance ratio during flexion postures, indicating that upright postures may pose a greater relative risk of injury to the thoracic spine than to the lumbar spine. Practitioner summary: Previously reported thoracic and lumbar in vivo disc pressures during various postures were compared. The ratio of thoracic and lumbar compression increased during upright postures and decreased in flexed postures, indicating that upright postures may pose a greater risk of injury to the thoracic spine than to the lumbar spine.