Lateral head impacts and protection of the temporal area by bicycle safety helmets.

BACKGROUND: The protective effectiveness of bicycle helmets has been demonstrated in several epidemiologic studies. However, the temple region is only minimally covered by most helmet models. Impact tests were performed on human cadavers to investigate whether current bicycle helmets are capable of preventing direct contact on the temporal area in side impacts. METHODS: Lateral head impacts, corresponding to a force load of 15,000 N on an nonhelmeted head, were applied on 11 helmeted cadavers by a steel pendulum with a flat impact surface, and the contact between the impactor plate and the temporal and zygomatic area was investigated by means of paint transfer. In eight tests, a common design bicycle helmet was used, whereas in three tests the helmets provided larger temporal coverage (temporal helmet edge <10 mm above Frankfort plane). The skulls were inspected for fractures. RESULTS: In seven of the eight tests with common design bicycle helmets, contact had occurred and in one of these a skull fracture was seen. The helmets with a larger temporal coverage consistently prevented such contact loading. CONCLUSIONS: The common designs of commercially available bicycle helmets do not prevent direct contact loading on the temporal and zygomatic arch region and this contact loading is potentially harmful. The present preliminary study strongly questions the effectiveness of these helmets in providing accurate protection of the temporal and zygomatic area.

Mechanics of acute subdural hematomas resulting from bridging vein rupture.

OBJECT: Based on data from primate experiments it is known that rotational acceleration in the sagittal plane and in a forward direction is most likely to produce acute subdural hematomas due to bridging vein rupture. For protection against these lesions, knowledge of rotational acceleration tolerance levels in humans is required. In the present study the authors analyze human tolerance levels for bridging vein rupture by performing head impact tests in cadavers. METHODS: Ten unembalmed cadavers were subjected to 18 occipital impacts producing head rotation in the sagittal plane with varying rotational acceleration magnitudes and pulse durations. Rotational acceleration was calculated from the linear acceleration histories recorded by three uniaxial accelerometers mounted on the side of the head. Bridging vein ruptures were detected by injecting contrast dye into the superior sagittal sinus under fluoroscopy and by autopsy procedures. Bridging vein ruptures were produced in six head impact tests: one test with a pulse duration of 5.2 msec and a peak rotational acceleration of 13,411 rad/second2; three tests with a pulse duration between 7 and 8 msec and a peak rotational acceleration of 12,558, 10,607, and 8567 rad/second2; and two tests with a pulse duration longer than 10 msec and a peak rotational acceleration as low as 5267 rad/second2. CONCLUSIONS: This is the only cadaveric study of bridging vein rupture focused on short pulse durations, which are usually associated with falls. The data suggest a tolerance level of approximately 10,000 rad/second2 for pulse durations shorter than 10 msec, which seems to decrease for longer pulse durations.

Bicycle-related head injury: a study of 86 cases.

Within the framework of a bicycle helmet research program, we have set up a database of bicycle accident victims, containing both accident and clinical data. The database consists of a consecutive series of 86 victims of bicycle accidents who underwent a neurosurgical intervention in our hospital between 1990 and 2000. Data were obtained from police files, medical records, computed tomography head scans and a patient questionnaire. In only three victims, the wearing of a helmet was documented. In this study, the head injuries are analysed and the relation between the different types of head injuries and outcome is assessed. Forty-four accidents were collisions with a motor vehicle and 42 accidents were falls. Most impacts occurred at the side (57%) or at the front (27%) of the head. The most frequent injuries were skull fractures (86%) and cerebral contusions (73%). Age was negatively correlated with outcome (P = 0.0002 ) and positively correlated with the number (P = 0.00002) and volume (P = 0.00005) of contusions and the presence of subdural haematomas (P = 0.000001). The injuries with the strongest negative effect on outcome were: subarachnoid haemorrhage (P = 0.000001), multiple (P = 0.000005) or large ( P 0.0007) contusions, subdural haematoma (P = 0.001) and brain swelling (P = 0.002). A significant coexistence of these four injuries was found. We hypothesise that in many patients the contusions may have been the primary injuries of this complex and should therefore be considered as a main injury determining outcome in this study. We believe that such findings may support a rational approach to optimising pedal cyclist head protection.