Abstract
Over 80% of wounded Service Members sustain at least one extremity injury. The ‘deck-slap’ foot, a product of the vehicle’s floor rising rapidly when attacked by a mine to injure the limb, has been a signature injury in recent conflicts. Given the frequency and severity of these combat-related extremity injuries, they require the greatest utilisation of resources for treatment, and have caused the greatest number of disabled soldiers during recent conflicts. Most research efforts focus on occupants seated with both tibia-to-femur and tibia-to-foot angles set at 90°; it is unknown whether results obtained from these tests are applicable when alternative seated postures are adopted. To investigate this, lower limbs from anthropometric testing devices (ATDs) and post mortem human subjects (PMHSs) were loaded in three different seated postures using an under-body blast injury simulator. Using metrics that are commonly used for assessing injury, such as the axial force and the revised tibia index, the lower limb of ATDs were found to be insensitive to posture variations while the injuries sustained by the PMHS lower limbs differed in type and severity between postures. This suggests that the mechanism of injury depends on the posture and that this cannot be captured by the current injury criteria. Therefore, great care should be taken when interpreting and extrapolating results, especially in vehicle qualification tests, when postures other than the 90°–90° are of interest.
Highlights
Improvised explosive devices (IEDs) have been identified as the most prevalent cause of injury in modern warfare.[10,32,33,34] Mounted victims of IED attacks sustain severe, difficult-to-treat injuries that result in high rates of amputation.[35]
Using the results reported by Yoganandan et al.[44] from matched-pair tests between the Hybrid III (H-III) anthropometric test devices (ATDs) and post mortem human surrogates (PMHSs), the mean peak axial tibial forces from the lower load cell of the H-III ATD measured in this study correspond to a mean probability of an AIS2+ injury of 36, 51, and 35% for postures 90°– 90°, 120°–90°, and 120°–120°, respectively
This study showed that the posture of the lower limb, and the angles of the knee and ankle joints in the sagittal plane, affect the injury mechanism in underbody blast (UBB)
Summary
Improvised explosive devices (IEDs) have been identified as the most prevalent cause of injury in modern warfare.[10,32,33,34] Mounted victims of IED attacks sustain severe, difficult-to-treat injuries that result in high rates of amputation.[35]. Various platforms have been developed previously to replicate underbody blast (UBB)—that is, the attack of the underside of a vehicle by explosives—in the laboratory and used to test surrogate lower limbs such as post mortem human surrogates (PMHSs) and anthropometric test devices (ATDs).[1,7,12,13,15,19,21,23,31,46,47] To assess injury, the results from these tests have been analysed to develop injury risk functions (IRFs), which relate the probability of injury with the axial force transmitted to the lower limb.[2,3,23,24,43,45] parameters such as age, gender, and bone mineral density,[12,45] as well as loading rates and location of measurements have been taken into account when developing IRFs,[2] the effect of the posture of the occupant at the time of the attack on the injurious outcome has not
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