Risk Of Skull Fracture Research Articles

How Well Do Popular Bicycle Helmets Protect from Different Types of Head Injury?

Bicycle helmets are designed to protect against skull fractures and associated focal brain injuries, driven by helmet standards. Another type of head injury seen in injured cyclists is diffuse brain injuries, but little is known about the protection provided by bicycle helmets against these injuries. Here, we examine the performance of modern bicycle helmets in preventing diffuse injuries and skull fractures under impact conditions that represent a range of real-world incidents. We also investigate the effects of helmet technology, price, and mass on protection against these pathologies. 30 most popular helmets among UK cyclists were purchased within 9.99-135.00 GBP price range. Helmets were tested under oblique impacts onto a 45° anvil at 6.5m/s impact speed and four locations, front, rear, side, and front-side. A new headform, which better represents the average human head's mass, moments of inertia and coefficient of friction than any other available headforms, was used. We determined peak linear acceleration (PLA), peak rotational acceleration (PRA), peak rotational velocity (PRV), and BrIC. We also determined the risk of skull fractures based on PLA (linear risk), risk of diffuse brain injuries based on BrIC (rotational risk), and their mean (overall risk). Our results show large variation in head kinematics: PLA (80-213g), PRV (8.5-29.9rad/s), PRA (1.6-9.7 krad/s2), and BrIC (0.17-0.65). The overall risk varied considerably with a 2.25 ratio between the least and most protective helmet. This ratio was 1.76 for the linear and 4.21 for the rotational risk. Nine best performing helmets were equipped with the rotation management technology MIPS, but not all helmets equipped with MIPS were among the best performing helmets. Our comparison of three tested helmets which have MIPS and no-MIPS versions showed that MIPS reduced rotational kinematics, but not linear kinematics. We found no significant effect of helmet price on exposure-adjusted injury risks. We found that larger helmet mass was associated with higher linear risk. This study highlights the need for a holistic approach, including both rotational and linear head injury metrics and risks, in helmet design and testing. It also highlights the need for providing information about helmet safety to consumers to help them make an informed choice.

Lattice use in rugby headguards

This project is related to the design of rugby headguards. The World Rugby regulations limit the ability of headguards to reduce impact force. As such, World Rugby approved headguards are not intended to reduce the risk of serious injuries, like concussion or skull fracture. Rather, current headguards only limit the risk of superficial injuries to the soft tissue, like lacerations and contusions. With concussions linked to CTE (Chronic traumatic encephalopathy), an improvement in headguards could lead to an increased quality of life for all rugby players. With about a quarter of all rugby union injuries being concussion in the 2021/2022 season, there is justification to explore new headguard designs with potential to reduce the risk of such injuries. With World Rugby and the RFL recently introducing new rules for tackle height to try to reduce concussion rates, headguards that offer more protection could also help to reduce concussion rates. A lattice is a structure made from connected cells. When used within protective devices, lattices have potential advantages over the materials traditionally used, such as foams, from reducing the overall mass to allowing forces to be spread more evenly throughout the structure. The aim of this study was to design and comparatively impact test a lattice against foam in relation to rugby headguards. Prior data was limited as most studies on lattices focused on combining materials to have either a hollow lattice or a filled lattice which is not applicable to this study due to World Rugby regulations on protective equipment which states no sandwich material. The FEA results show that the force is more equally distributed through the lattice then it is foam allowing a lower force to hit the base.

Finite Element Analysis of Energy-Absorbing Floors for Reducing Head Injury Risk during Fall Accidents

Energy-absorbing floor (EAF) has been proposed as one of several biomechanically effective strategies to mitigate the risk of fall-related injuries by decreasing peak loads and enhancing system energy absorption. This study aims to compare the protective capacity of four commercially available EAF products (Igelkott Floor, Kradal, SmartCells, and OmniSports) in terms of head impacts using the finite element (FE) method. The stress–strain curves acquired from mechanical tests were applied to material models in LS-Dyna. The established FE models were then validated using Hybrid III or hemispheric drop tests to compare the acceleration–time curves between experiments and simulations. Finally, the validated FE models were utilized to simulate a typical pedestrian fall accident scenario. It was demonstrated that EAFs can substantially reduce the peak forces, acceleration, and velocity changes during fall-related head impacts. Specifically, in the accident reconstruction scenario, SmartCells provided the largest reduction in peak linear acceleration and skull fracture risk, while Igelkott Floor provided the largest reduction in peak angular velocity and concussion risk. This performance was caused by different energy absorption mechanisms. Consequently, the results can contribute to supporting the implementation of EAFs and determine the effectiveness of various protective strategies for fall-related head injury prevention.

Numerical Reconstruction of Cyclist Impact Accidents: Can Helmets Protect the Head-Neck of Cyclists?

Cyclists are vulnerable road users and often suffer head-neck injuries in car-cyclist accidents. Wearing a helmet is currently the most prevalent protection method against such injuries. Today, there is an ongoing debate about the ability of helmets to protect the cyclists' head-neck from injury. In the current study, we numerically reconstructed five real-world car-cyclist impact accidents, incorporating previously developed finite element models of four cyclist helmets to evaluate their protective performances. We made comparative head-neck injury predictions for unhelmeted and helmeted cyclists. The results show that helmets could clearly lower the risk of severe (AIS 4+) brain injury and skull fracture, as assessed by the predicted head injury criterion (HIC), while a relatively limited decrease in AIS 4+ brain injury risk can be achieved in terms of the analysis of CSDM0.25. Assessment using the maximum principal strain (MPS0.98) and head impact power (HIP) criteria suggests that helmets could lower the risk of diffuse axonal injury and subdural hematoma of the cyclist. The helmet efficacy in neck protection depends on the impact scenario. Therefore, wearing a helmet does not seem to cause a significant neck injury risk level increase to the cyclist. Our work presents important insights into the helmet's efficacy in protecting the head-neck of cyclists and motivates further optimization of protective equipment.

Holistic pedestrian safety assessment for average males and females.

An integrated assessment framework that enables holistic safety evaluations addressing vulnerable road users (VRU) is introduced and applied in the current study. The developed method enables consideration of both active and passive safety measures and distributions of real-world crash scenario parameters. The likelihood of a specific virtual testing scenario occurring in real life has been derived from accident databases scaled to European level. Based on pre-crash simulations, it is determined how likely it is that scenarios could be avoided by a specific Autonomous Emergency Braking (AEB) system. For the unavoidable cases, probabilities for specific collision scenarios are determined, and the injury risk for these is determined, subsequently, from in-crash simulations with the VIVA+ Human Body Models combined with the created metamodel for an average male and female model. The integrated assessment framework was applied for the holistic assessment of car-related pedestrian protection using a generic car model to assess the safety benefits of a generic AEB system combined with current passive safety structures. In total, 61,914 virtual testing scenarios have been derived from the different car-pedestrian cases based on real-world crash scenario parameters. Considering the occurrence probability of the virtual testing scenarios, by implementing an AEB, a total crash risk reduction of 81.70% was achieved based on pre-crash simulations. It was shown that 50 in-crash simulations per load case are sufficient to create a metamodel for injury prediction. For the in-crash simulations with the generic vehicle, it was also shown that the injury risk can be reduced by implementing an AEB, as compared to the baseline scenarios. Moreover, as seen in the unavoidable cases, the injury risk for the average male and female is the same for brain injuries and femoral shaft fractures. The average male has a higher risk of skull fractures and fractures of more than three ribs compared to the average female. The average female has a higher risk of proximal femoral fractures than the average male. A novel methodology was developed which allows for movement away from the exclusive use of standard-load case assessments, thus helping to bridge the gap between active and passive safety evaluations.

Comparing rates of skull fractures in female versus male geriatric patients who sustain head injuries

BackgroundHead trauma is the leading cause of serious injury in the older adult population with skull fractures as a serious reported outcome. This study aims to evaluate the role of sex in the risk of skull fracture in patients over the age of 65. MethodsA prospective cohort study was conducted at two level-one trauma centers, serving a population of 360,000 geriatric residents. Over a year-long period, consecutive patients aged 65 years and older who presented with blunt head injury were included. Patients who did not receive head CT imaging were excluded. The primary outcome was rate of skull fracture due to the acute trauma, compared by sex. Additional factors examined included patient race/ethnicity and mechanism of injury. ResultsAmong 5402 patients enrolled, 3010 (56%) were female and 2392 (44%) were male. 4612 (85%) of the head injuries sustained were due to falls, and 4536 (90%) of all subjects were Caucasian. Overall, 199 patients (3.7%) sustained skull fractures. Males had a significantly greater rate of skull fracture when compared to females (4.6% vs 3.0%, OR 1.5, 95% CI: 1.2–2.1, p = 0.002). This trend was also seen across race/ethnicity and mechanism of injury. ConclusionsOlder males were found to have a higher rate of skull fractures compared to females after sustaining blunt head trauma, mostly due to falls.

A rubberized impact absorbing pavement can reduce the head injury risk in vulnerable road users: A bicycle and a pedestrian accident case study

Objective Vulnerable Road Users (VRU), including pedestrians and cyclists, are generally the least protected road users and are frequently missed in the planning process of preventive measures. Rubberized asphalt mixtures were originally developed as a possible environmentally friendly solution to recycle the End-of-Life Tires while making the pavements more durable. The objective of the current study was to explore the effects of increasing the rubber content of the common rubberized asphalt mixtures in reducing the head injuries risk for VRUs. Method To achieve this purpose, four different sample series with 0, 14, 28, and 33 weight percent rubber in each were tested. A compressive test without permanent deformation and one with failure were performed on each sample series. The mechanical behavior of each set was modeled using a MAT_SIMPLIFIED_RUBBER material model in LS-Dyna and validated against a standard Head Injury Criterion (HIC) drop test. Ultimately, previously low-speed accident reconstructed cases, a bicycle and a pedestrian one, were used to assess the effect of varying the rubber content on reducing the head injury risk. Results In the bicycle accident case, the risk of skull fracture was reduced from 0.99 to 0.29 when comparing the non-rubberized asphalt mixture with the 33% rubber mixture. In the same accident case, the risk of concussion, evaluated using the logistic regression method, was reduced from 0.97 in the non-rubberized mixture to 0.81 in the 33% rubber mixture. The initial conditions, linear and rotational velocities, were lower for the pedestrian case compared to the bicycle case (the bicycle case was more severe compared to the pedestrian case), which led to lower strains in the pedestrian case. In the pedestrian accident case, the risk of skull fracture was reduced from 1.00 in the non-rubberized mixture to 0.63 in the 33% rubber mixture, while the risk of concussion was reduced from 0.64 to 0.07. Conclusion The rubberized asphalt mixtures could reduce the head injury risk for the studied cases when the rubber content in the asphalt mixture increases.

Basilar, skull and facial fractures in 2nd row occupants by crash type with a focus on side and rear impacts

Objective Field data was analyzed to assess the risk of basilar, skull and facial fractures in 2nd row occupants by crash type. The study determined the rate of fractures in seriously injured (MAIS 3 + F) occupants to establish priorities for 2nd row occupant safety. Methods Field accident data on seriously injured (MAIS 3+) occupants was determined using 1993-2015 NASS-CDS and 2017-19 CISS by crash type identified with damage area variables for non-ejected occupants in the 2nd row. Occupants with serious head and face injuries (AIS 3+) were subdivided by fractures to the skull, basilar skull and face. Moderate-to serious (AIS 2+) orbit fractures were included. The rate of injury was determined. Individual electronic cases were analyzed for occupants with basilar fracture in rear and side impacts. Results The proportion of 2nd row occupants with AIS 3+ head and face injury was highest at 73.7% in rear impacts followed by side impacts at 54.2% for those with MAIS 3 + F injury. Basilar fractures (AIS 3+) occurred in 53.9% of 2nd row occupants with skull fracture in rear impacts but only 20.3% in side impacts. Overall, basilar fractures occurred in 10.8% of 2nd row occupants with serious injury (MAIS 3 + F) in rear impacts and 2.7% in side impacts. The frequency of AIS 3+ facial fractures was highest in side impacts (40.2%) and lowest (7.6%) in rear impacts. Conclusions While basilar skull fractures are rare in 2nd row occupants, at 0.083% in rear and 0.044% in side impacts, they represent 53.9% of 2nd row occupants with a skull fracture and serious injury in rear impacts and 20.3% in side impacts. The mechanism of injury is different in rear and side impacts, but frequently involves multi-impact crashes, severe impacts, intrusion into the seating area and head impact on hard surfaces.

Effect of different helmets against ground impact based on the in-depth reconstruction of electric two-wheeler accidents

Skull fracture and brain injury are frequent head injuries in electric two-wheeler (ETW) accidents, and the type of helmet and impact conditions affect the effectiveness of the helmet in protecting the rider’s head. The purpose of this study was to conduct in-depth reconstructions of rider’s head-to-ground impacts in ten ETW accidents by using a multi-body system combined with a finite element approach and to evaluate the effect of two typical full-face helmets (FFH) and one half-coverage helmet (HCH) through head accelerations and intracranial biomechanics injury metrics in ground impacts. The results showed that all three helmets reduced the risk of skull fracture in most cases, however, FFH performed better due to its wider protection area. In addition, three helmets showed varying degrees of overall reduction in measuring all indicators of brain injury. Although the effectiveness of the helmets on angular acceleration was largely influenced by the angle and location of impact, it was certain that wearing an FFH was more likely to reduce rotational head movements than an HCH, and that the FFH also offered the better advantage in reducing diffuse axonal injury (DAI) risk due to its better resistance to ejection in a crash.

Evaluation of the head protection effectiveness of cyclist helmets using full-scale computational biomechanics modelling of cycling accidents

Introduction: Cycling is a popular choice for urban transportation. Helmets are important and the most popular means of head protection for cyclists. However, a debate about the effectiveness of helmets in protecting a cyclist’s head from injury continues. Method: We employed computational biomechanics methods to analyze the head protection effectiveness of nine off-the-shelf-helmets for two typical impact scenarios that occur in cycling accidents: cyclist’s head impacting a kerb (kerb-impact) and cyclist skidding (skidding impact) on the road surface. We conducted drop tests for all nine analyzed helmets, and used the test data for validation of the corresponding helmet finite element (FE) models created in this study. The validated helmet models were then used in the full-scale computer simulations (FE analysis for the skull, brain and helmet, and multibody dynamics for the remaining segments of the cyclist’s body) of the cycling accidents for cyclists wearing a helmet and without a helmet. Results: The results indicate that helmets can reduce both the peak linear acceleration of the cyclist head center of gravity (COG) and the risk of cyclist skull fracture. However, higher rotational acceleration of the head COG was predicted for cyclists wearing helmets. The results obtained using the injury criteria that rely on the brain deformations (maximum shear strain MPS and cumulative strain damage measure CSDM) suggest that helmets may offer protection in all the analyzed cyclist impact scenarios. However, the predicted level of protection varies for different helmets and impact scenarios with appreciable variations in the predictions obtained using different injury criteria. Reduction in the maximum principal strain (MPS0.98) for helmeted cyclists was predicted for both impact scenarios. In contrast, wearing the helmet reduced the CSDM only for the skidding impact scenario. For the kerb-impact scenario, no clear influence of the helmet on the predicted CSDM was observed.

Parameterized Analysis of Craniocerebral Injury Caused by Fist.

Objective Based on the theory of biomechanics, the finite element method was used to study the injury characteristics of different parts of brain hit by fist with different force and to predict the risk of craniocerebral injury, in order to provide reference for actual medical protection and forensic identification. Methods The finite element model of fist was constructed by using DICOM data modeling method and related software, and the effective mass and speed of fist were used to represent the kinetic energy of fist, and combined with human finite element model THUMS 4.02, the characteristics of craniocerebral injury caused by frontal and lateral blows were parametrically simulated. Results The probability of direct death from a blow to the head was low, but as fist power increased, so did the risk of craniocerebral injury. The characteristics of craniocerebral injury were also significantly different with the different fist hitting head locations. When the frontal area was attacked, the maximum equivalent stress of skull was 122.40 MPa, while that of brain tissue was 4.31 kPa. When the temporal area was attacked, the maximum equivalent stress of skull was 71.53 MPa, while that of brain tissue was 7.09 kPa. Conclusion The characteristics and risks of skull fracture and brain tissue injury are different when different parts of the brain are hit by fist. When the frontal area is hit, the risk of skull fracture is significantly higher than when the temporal area is hit. The risk of brain tissue injury is the opposite. The position with the highest probability of skull fracture is generally the place where the skull is directly impacted, and with the conduction of stress waves, it will spread to other parts of the skull, while the position with the highest risk of brain tissue injury is not the place where the brain is directly impacted.

Evaluation of Protective Properties of Commercially Available Medical Helmets: Are Medical Helmets Protective?

The aims of the study were to evaluate and to compare protective properties of commercially available medical helmets for a set of standardized head injury risk measures. Eleven helmet types were evaluated to represent the variety of commercially available medical helmet designs and manufacturers. A test mannequin and sensor apparatus were used to simulate a backward-standing fall. The head/neck size, mass, and "standing" height of the mannequin (5'9″) were representative of a 50th percentile male. A triaxial array was placed at the head center of mass to position 3 linear accelerometers and 3 angular rate sensors. Data were collected for 5 single trials for each helmet, as well as 5 repeated trials. Five trials were also collected with no helmet scenarios. Three head injury risk measures were examined (linear acceleration, angular acceleration, and head injury criterion). Data were analyzed by clinical cutoff thresholds and continuous values. Helmets varied in their performance across head injury risk measures. All helmets provided higher levels of protection compared with no helmet scenarios. No helmets were protective for subdural hematoma (measured by angular acceleration). All helmets lost protective properties with repeated falls. Results for skull fracture risk were inconsistent between linear acceleration and head injury criterion injury risk measures. No helmets were protective across all head injury risk measures. Medical helmets may reduce some fall injury severity but may not prevent all types of head injury. All helmets exhibited worsening of protective properties with repeated falls. We recommend medical helmets be replaced after each fall incident where the helmet impacts another surface.

Automobile injury trends in the contemporary fleet: Belted occupants in frontal collisions

Objective: As vehicle safety technologies and evaluation procedures advance, it is pertinent to periodically evaluate injury trends to identify continuing and emerging priorities for intervention. This study examined detailed injury distributions and injury risk trends in belted occupants in frontal automobile collisions (10 o’clock to 2 o’clock) using NASS-CDS (1998–2015).Methods: Injury distributions were examined by occupant age and vehicle model year (stratified at pre- and post-2009). Logistic regression models were developed to examine the effects of various factors on injury risk (by body region), controlling for delta-V, sex, age, height, body mass index (BMI), vehicle model year (again stratified at 2009).Results: Among other observations, these analyses indicate that newer model year vehicles (model year [MY] 2009 and later) carry less risk of Abbreviated Injury Scale (AIS) 2+ and AIS 3+ injury compared to older model year vehicles, with odds ratios of 0.69 (AIS 2+) and 0.45 (AIS 3+). The largest reductions in risk between newer model year vehicles and older model year vehicles occur in the lower extremities and in the risk of skull fracture. There is no statistically significant change in risk of AIS 3+ rib fracture or sternum injury between model year categories. Females are at greater risk of AIS 2+ and AIS 3+ injury compared to males, with increased risk across most injury types.Conclusions: For belted occupants in frontal collisions, substantial reductions in injury risk have been realized in many body regions in recent years. Risk reduction in the thorax has lagged other body regions, resulting in increasing prevalence among skeletal injuries in newer model year vehicles (especially in the elderly). Injuries also remain common in the arm and hand/wrist for all age ranges studied. These results provide insight into where advances in the field have made gains in occupant protection and what injury types remain to be addressed.

Helmet protective performance via reconstruction of electric two-wheeler rider’s head-to-ground impact accidents

Numerous studies, including epidemiological, experimental and simulation studies, have shown that helmets can provide good protection for the two-wheeler (TW) rider’s head and reduce the casualty rate due to head injuries during an accident. The objective of this current study was to evaluate the protective performance of a helmet based on in-depth accident reconstructions of electric two-wheel (ETW) rider’s head-to-ground impact validated by the video information that provide clear and complete kinematics of ETW rider. Furthermore, validated finite element (FE) models of the helmet and human head were used. Three real-world accident cases (Cases A, B and C) were evaluated, in which, the riders’ head were injured by ground impact after collided by the vehicles. In Case A and Case B, the helmet could effectively reduce the risk of skull fracture to 46% and 4%, respectively; whereas the risk of a skull fracture was up to 94% in Case C. In addition, the helmet can slightly reduce the risk of DAI injuries to 39% in Case C, while the risk of concussion cannot be reduced in three cases. In the violent impact condition such as in Case C, the bottoming out of the liner foam makes helmet lose effective protection against skull fracture. The connection between the shell and liner foam largely affects the helmet's protection against the brain injuries such as DAIs and concussions. The findings point out the lack of protective performance of the helmet and further provide more comprehensive guidance on the safety design of the helmet.

Characteristics of pedestrian head injuries observed from real world collision data

Head injury is one of the most common injury types in vehicle-to-pedestrian collisions, which leads to death and long-term disabilities. However, detailed analysis of pedestrian head injuries in real world collisions is scarce. Thus the current study used two samples of 120 cases and 184 cases extracted from 1060 pedestrian collision cases captured during 2000–2015 from the GIDAS (German In-Depth-Accident Study) database to investigate the detailed characteristics of AIS2+ pedestrian head injuries. Firstly, the interrelationship between different head injury types (skull fracture, focal brain injury, concussion and diffuse axonal injury (DAI)) was analysed using the sample of 120 cases which each had at least one AIS2+ head injury. Then the influences of impact speed, pedestrian age and car front shape parameters on the injury risk of skull fracture, focal brain injury and concussion were assessed using the logistic regression method, based on the sample of 184 AIS1+ cases where the primary head contact location was within the windscreen glass area. The results show that: skull fractures and focal brain injuries dominate for AIS3+ head injuries and are generally associated with each other; concussion is the most important injury type for AIS2 head injuries and usually occurs in isolation. Further, for head impacts to the windscreen glass area a higher bonnet leading edge helps to reduce concussion odds, and none of the selected car front shape parameters are significant for the odds of skull fracture and focal brain injury, and vehicle impact speed and pedestrian age are insignificant for concussion. These detailed characteristics of pedestrian head injuries provide a basis for future pedestrian head injury prevention strategies with skull fractures and focal brain injuries being the most important injuries to address.

Evaluation of a novel bicycle helmet concept in oblique impact testing

BackgroundA novel bicycle helmet concept has been developed to mitigate rotational head acceleration, which is a predominant mechanism of traumatic brain injury (TBI). This WAVECEL concept employs a collapsible cellular structure that is recessed within the helmet to provide a rotational suspension. This cellular concept differs from other bicycle helmet technologies for mitigation of rotational head acceleration, such as the commercially available Multi-Directional Impact Protection System (MIPS) technology which employs a slip liner to permit sliding between the helmet and the head during impact. This study quantified the efficacy of both, the WAVECEL cellular concept, and a MIPS helmet, in direct comparison to a traditional bicycle helmet made of rigid expanded polystyrene (EPS). MethodsThree bicycle helmet types were subjected to oblique impacts in guided vertical drop tests onto an angled anvil: traditional EPS helmets (CONTROL group); helmets with a MIPS slip liner (SLIP group); and helmets with a WAVECEL cellular structure (CELL group). Helmet performance was evaluated using 4.8 m/s impacts onto anvils angled at 30°, 45°, and 60° from the horizontal plane. In addition, helmet performance was tested at a faster speed of 6.2 m/s onto the 45° anvil. Five helmets were tested under each of the four impact conditions for each of the three groups, requiring a total of 60 helmets. Headform kinematics were acquired and used to calculate an injury risk criterion for Abbreviated Injury Score (AIS) 2 brain injury. ResultsLinear acceleration of the headform remained below 90 g and was not associated with the risk of skull fracture in any impact scenario and helmet type. Headform rotational acceleration in the CONTROL group was highest for 6.2 m/s impacts onto the 45° anvil (7.2 ± 0.6 krad/s2). In this impact scenario, SLIP helmets and CELL helmets reduced rotational acceleration by 22% (p = 0003) and 73% (p < 0.001), respectively, compared to CONTROL helmets. The CONTROL group had the highest AIS 2 brain injury risk of 59 ± 8% for 6.2 m/s impacts onto the 45° anvil. In this impact scenario, SLIP helmets and CELL helmets reduced the AIS 2 brain injury risk to 34.2% (p = 0.001) and 1.2% (p < 0.001), respectively, compared to CONTROL helmets. DiscussionResults of this study are limited to a narrow range of impact conditions, but demonstrated the potential that rotational acceleration and the associated brain injury risk can be significantly reduced by the cellular WAVECEL concept or a MIPS slip liner. Results obtained under specific impact angles and impact velocities indicated performance differences between these mechanisms. These differences emphasize the need for continued research and development efforts toward helmet technologies that further improve protection from brain injury over a wide range a realistic impact parameters.

Improved safety standards are needed to better protect younger children at playgrounds

Playground-related traumatic brain injuries (TBIs) in children remain a considerable problem world-wide and current safety standards are being questioned due to historical reasons where the injury thresholds had been perpetuated from automobile industry. Here we investigated head injury mechanisms due to falls on playgrounds using a previously developed and validated age-scalable and positionable whole body child model impacted at front, back and side of the head simulating head-first falls from 1.59 meters (m). The results show that a playground material passing the current testing standards (HIC < 1000 and resultant linear acceleration <200 g) resulted in maximum strain in the brain higher than known injury thresholds, thus not offering sufficient protection especially for younger children. The analysis highlights the age dependence of head injuries in children due to playground falls and the youngest have a higher risk of brain injury and skull fracture. Further, the results provide the first biomechanical evidence guiding age-dependent injury thresholds for playground testing standards. The results also have direct implications for novel designs of playground materials for a better protection of children from TBIs. Only making the playground material thicker and more compliant is not sufficient. This study represents the first initiative of using full body human body models of children as a new tool to improve playground testing standards and to better protect the children at playgrounds.

Effectiveness of wearing a bicycle helmet for impacts against the front of a vehicle and the road surface

Objective: To assess the effect of wearing a bicycle helmet using an adult headform in terms of the head injury criterion (HIC) when the frontal and lateral parts of the helmet impact a vehicle body and also when the frontal part of the helmet impacts the road surface.Methods: The adult headform was made to impact the hood, windscreen, roof top, and roof side rail of a vehicle body at an impact velocity of 35 km/h, which is a common head-to-vehicle impact velocity in real-world cyclist–vehicle collisions, in which the vehicle impacts the cyclist at 40 km/h. For the road surface impact experiments, we set a drop height of 1.5 m (impact velocity of 20 km/h).Results: Helmet usage helped to reduce the HIC when the frontal and lateral parts of the helmet impacted vehicle parts other than the hood. The HIC reduction for the frontal impact was greater than that for the lateral impact. Moreover, the higher the stiffness index of the vehicle structure, the greater was the HIC reduction. However, helmet usage was ineffective for reducing skull fracture risk (HIC 2558) when the lateral part of the helmet impacted stiffer parts of the vehicle, such as the roof side rail close to the B-pillar. Helmet usage helped to reduce the HIC by 91% when the frontal part of the helmet impacted the road surface.Conclusions: Wearing a helmet reduces skull fracture risk when the frontal and lateral parts of the helmet impact vehicle parts (excluding the hood) at 35 km/h and the road surface at 20 km/h. However, when the lateral part of the helmet impacts the B-pillar, the helmet cannot effectively reduce the skull fracture risk at these real-world velocities.

Infant skull fracture risk for low height falls

Skull fractures are common injuries in young children, typically caused by accidental falls and child abuse. The paucity of detailed biomechanical data from real-world trauma in children has hampered development of biomechanical thresholds for skull fracture in infants. The objectives of this study were to identify biomechanical metrics to predict skull fracture, determine threshold values associated with fracture, and develop skull fracture risk curves for low-height falls in infants. To achieve these objectives, we utilized an integrated approach consisting of case evaluation, anthropomorphic reconstruction, and finite element simulation. Four biomechanical candidates for predicting skull fracture were identified (first principal stress, first principal strain, shear stress, and von Mises stress) and evaluated against well-witnessed falls in infants (0–6 months). Among the predictor candidates, first principal stress and strain correlated best with the occurrence of parietal skull fracture. The principal stress and strain thresholds associated with 50 and 95% probability of parietal skull fracture were 25.229 and 36.015 MPa and 0.0464 and 0.0699, respectively. Risk curves using these predictors determined that infant falls from 0.3 m had a low probability (0–54%) to result in parietal skull fracture, particularly with carpet impact (0–1%). Head-first falls from 0.9 m had a high probability of fracture (86–100%) for concrete impact and a moderate probability (34–81%) for carpet impact. Probabilities of fracture in 0.6 m falls were dependent on impact surface. Occipital impacts from 0.9 m onto the concrete also had the potential (27–90% probability) to generate parietal skull fracture. These data represent a multi-faceted biomechanical assessment of infant skull fracture risk and can assist in the differential diagnosis for head trauma in children.

Chapter 5 - Concussive and subconcussive brain trauma: the complexity of impact biomechanics and injury risk in contact sport

Head impacts that transfer mechanical energy to the skull and create brain injuries have unique dynamic responses and brain tissue trauma characteristics. The magnitude of the impact energy and how it is transmitted creates three-dimensional linear and rotational accelerations of the head, resulting in unique strains on brain tissue. Biomechanical investigations of head injuries in contact sports have historically focused on attenuating energy transfer to the skull and brain. Typically, severe life-threatening events are caused by high-energy impact events that result in anatomic damage. Protective equipment attenuates energy transmission to neural tissues to decrease the risk of structural damage. In addition to reducing risk of skull fracture, helmets work by increasing impact compliance, to decrease the magnitude of the head's dynamic response and increase the duration of the event. This strategy helps prevent severe traumatic brain injuries and shifts the risk to concussion and repetitive head impact exposure. Metabolic, cellular, and physiologic responses characterize cumulative brain trauma that may manifest years later. Relying on the presence of symptoms to establish injury is subjective and limited in capturing the risks associated with neural tissue trauma. To more effectively capture brain injury risks in contact sports, we present the concept of brain trauma profiling, involving impact magnitude, frequency, interval, and duration of exposure. Brain trauma profiling captures and describes the cumulative and acute trauma-associated injury risks unique to each sport, level of play, and player position.