Development of structural and material clavicle response corridors under axial compression and three point bending loading for clavicle finite element model validation

The I-PREDICT 50th Percentile Male Finite Element Model: Development and Validation of the Torso

Behind Armor Blunt Trauma (BABT) is a phenomenon that occurs when energy is transferred from Personal Protective Equipment (PPE) to the human body and can range from minor to fatal injuries. The current standard to evaluate PPE uses Roma Plastilina No. 1 clay and has a poor correlation to human injuries. To provide a more suitable human surrogate for evaluating risk of injury and functional incapacitation due to BABT, the Incapacitation Prediction for Readiness in Expeditionary Domains: an Integrated Computational Tool (I-PREDICT) has developed a 50th percentile male human body model (HBM) to better understand injury mechanisms in the BABT environment. The model was developed using a hierarchical validation approach including component, regional, and whole torso level tests. Material properties were sourced from literature and I-PREDICT experimental test data, and the model was simulated in 25 different validation cases ranging from component level quasi-static tests to high-rate BABT impacts. The model was stable in all 25 simulations. CORrelation and Analysis (CORA) and BioRank were used to objectively quantify the model response. The average CORA and BioRank across all validation cases were 0.78 ± 0.18 and 0.68 ± 0.27, respectively, indicating 'good' agreement by CORA standards and 'excellent' by BioRank standards. When compared to high-rate BABT experimental impacts on post-mortem human subjects, the I-PREDICT HBM accurately predicted rib fracture probability. The ultimate goal of the I-PREDICT model is to predict injury and functional incapacitation for various in theater military applications. This study highlights the development and validation of the I-PREDICT torso and highlights initial BABT use cases.

Isolated Rib Response and Fracture Prediction for Young Mid-Size Male, Enabled by Population Specific Material Models and Rib Cross-Sectional Geometry

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 6th 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 6th rib model was able to predict young mid-size male 6th 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.

Evaluation and Validation of Thorax Model Responses: A Hierarchical Approach to Achieve High Biofidelity for Thoracic Musculoskeletal System

As one of the most frequently occurring injuries, thoracic trauma is a significant public health burden occurring in road traffic crashes, sports accidents, and military events. The biomechanics of the human thorax under impact loading can be investigated by computational finite element (FE) models, which are capable of predicting complex thoracic responses and injury outcomes quantitatively. One of the key challenges for developing a biofidelic FE model involves model evaluation and validation. In this work, the biofidelity of a mid-sized male thorax model has been evaluated and enhanced by a multi-level, hierarchical strategy of validation, focusing on injury characteristics, and model improvement of the thoracic musculoskeletal system. At the component level, the biomechanical responses of several major thoracic load-bearing structures were validated against different relevant experimental cases in the literature, including the thoracic intervertebral joints, costovertebral joints, clavicle, sternum, and costal cartilages. As an example, the thoracic spine was improved by accurate representation of the components, material properties, and ligament failure features at tissue level then validated based on the quasi-static response at the segment level, flexion bending response at the functional spinal unit level, and extension angle of the whole thoracic spine. At ribcage and full thorax levels, the thorax model with validated bony components was evaluated by a series of experimental testing cases. The validation responses were rated above 0.76, as assessed by the CORA evaluation system, indicating the model exhibited overall good biofidelity. At both component and full thorax levels, the model showed good computational stability, and reasonable agreement with the experimental data both qualitatively and quantitatively. It is expected that our validated thorax model can predict thorax behavior with high biofidelity to assess injury risk and investigate injury mechanisms of the thoracic musculoskeletal system in various impact scenarios. The relevant validation cases established in this study shall be directly used for future evaluation of other thorax models, and the validation approach and process presented here may provide an insightful framework toward multi-level validating of human body models.

Surgical fixation of midshaft clavicle fractures: A systematic review of biomechanical studies

PURPOSE

Surgical treatment of displaced midshaft clavicle fractures requires a decision between plate fixation and intramedullary (IM) fixation. Numerous studies report on the biomechanical properties of various repair constructs. The goal of this systematic review was to provide an overview of studies describing the biomechanical properties of the most commonly used surgical fixations of midshaft clavicle fractures. Additionally, we aimed to translate these biomechanical results into clinically relevant conclusions.

METHODS

A computer-aided search of the EMBASE and PudMed/MEDLINE databases was conducted. Studies included for review compared biomechanical properties of plate fixation with IM fixation and superiorly positioned plates with anteroinferiorly positioned plates for midshaft clavicle fractures.

RESULTS

Fifteen studies were eligible for inclusion. Plate fixation seemed to form a more robust construct than IM fixation in terms of stiffness and failure loading. The remaining clavicle was stronger after removal of the IM device than after removal of the plate. Superior plating of transverse fractures generally seemed to provide greater stiffness and strength during bending loads than anteroinferior plating did. The absence of cortical alignment in wedge and comminuted fractures directly influenced the fixation stability for both IM fixation and plate fixation, regardless of location.

CONCLUSION

Each type of fracture fixation has biomechanical advantages and disadvantages. However, exact thresholds of stiffness for inducing healing and failure strength to withstand refractures are unknown. The clinical relevance of the biomechanical studies may be arguable. Since none of the studies investigate the effect of tissue adaptation over time they should be interpreted with caution.