Annals of Biomedical Engineering

, Volume 41, Issue 9, pp 1957–1967 | Cite as

Design of a Traumatic Injury Simulator for Assessing Lower Limb Response to High Loading Rates

  • Spyros D. MasourosEmail author
  • Nicolas Newell
  • Arul Ramasamy
  • Timothy J. Bonner
  • Andrew T. H. West
  • Adam M. Hill
  • Jon C. Clasper
  • Anthony M. J. Bull


Current military conflicts are characterized by the use of the improvised explosive device. Improvements in personal protection, medical care, and evacuation logistics have resulted in increasing numbers of casualties surviving with complex musculoskeletal injuries, often leading to life-long disability. Thus, there exists an urgent requirement to investigate the mechanism of extremity injury caused by these devices in order to develop mitigation strategies. In addition, the wounds of war are no longer restricted to the battlefield; similar injuries can be witnessed in civilian centers following a terrorist attack. Key to understanding such mechanisms of injury is the ability to deconstruct the complexities of an explosive event into a controlled, laboratory-based environment. In this article, a traumatic injury simulator, designed to recreate in the laboratory the impulse that is transferred to the lower extremity from an anti-vehicle explosion, is presented and characterized experimentally and numerically. Tests with instrumented cadaveric limbs were then conducted to assess the simulator’s ability to interact with the human in two mounting conditions, simulating typical seated and standing vehicle passengers. This experimental device will now allow us to (a) gain comprehensive understanding of the load-transfer mechanisms through the lower limb, (b) characterize the dissipating capacity of mitigation technologies, and (c) assess the bio-fidelity of surrogates.


Blast injury Anti-vehicle mine Biomechanics Cadaveric Finite element modeling Impact testing Foot and ankle Surgical amputation Military medicine 



The authors would like to express their appreciation to Northern Hydraulic Cylinder Engineers Ltd. for the construction of AnUBIS, and Warrant Officer Rachel Mackenzie MBE in Queen Elizabeth Hospital, Birmingham for operating the CT scanner out of office hours. The costs for the construction and design of the rig were covered by the Army Benevolent Fund (ABF)—The Soldiers’ Charity; the Soldiers, Sailors, Airmen and Families Association (SSAFA) Forces Help; the FH Muirhead Charitable Trust; the Drummond Foundation; and the Defence, Science and Technology Laboratory (Dstl). The financial support of the Defence Medical Services (DMS) for AR, TJB, AMH, ATHW, and JCC, of the Royal Centre for Defence Medicine (RCDM) for the acquisition of equipment and consumables, of BBSRC for NN, and of Dstl and ABF—The Soldiers’ Charity for SDM are kindly acknowledged.

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  1. 1.
    Bir, C., A. Barbir, F. Dosquet, M. Wilhelm, M. van der Horst, and G. Wolfe. Validation of lower limb surrogates as injury assessment tools in floor impacts due to anti-vehicular land mines. Mil. Med. 173:1180–1184, 2008.PubMedGoogle Scholar
  2. 2.
    Bird, R. Protection of vehicles against landmines. J. Battlefield Technol. 4:14–17, 2001.Google Scholar
  3. 3.
    Cartner, J. L., Z. M. Hartsell, W. M. Ricci, and P. I. Tornetta. Can we trust ex vivo mechanical testing of fresh-frozen cadaveric specimens? The effect of postfreezing delays. J. Orthop. Trauma 25:459–461, 2011.PubMedCrossRefGoogle Scholar
  4. 4.
    Crandall, J. R., D. Bose, J. Forman, C. D. Untaroiu, C. Arregui-Dalmases, C. G. Shaw, and J. R. Kerrigan. Human surrogates for injury biomechanics research. Clin. Anat. 24:362–371, 2011.PubMedCrossRefGoogle Scholar
  5. 5.
    Funk, J. R., J. R. Crandall, L. J. Tourret, C. B. MacMahon, C. R. Bass, J. T. Patrie, N. Khaewpong, and R. H. Eppinger. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. J. Biomech. Eng. 124:750–757, 2002.PubMedCrossRefGoogle Scholar
  6. 6.
    Ludema, K. Friction, Wear, Lubrication: A Textbook in Tribology. New York, NY: CRC Press, 1996.CrossRefGoogle Scholar
  7. 7.
    Manoli, A., P. Prasad, and R. Levine. Foot and Ankle Severity Scale (FASS). Foot Ankle Int. 18:598–602, 1997.PubMedCrossRefGoogle Scholar
  8. 8.
    McKay, B., and C. Bir. Lower extremity injury criteria for evaluating military vehicle occupant injury in underbelly blast events. Stapp Car Crash J. 53:229–249, 2009.PubMedGoogle Scholar
  9. 9.
    McMaster, J., M. Parry, W. Wallace, L. Wheeler, C. Owen, R. Lowne, C. Oakley, and A. Roberts. Biomechanics of ankle and hindfoot injuries in dynamic axial loading. Stapp Car Crash J. 44:357–377, 2000.PubMedGoogle Scholar
  10. 10.
    Peleg, K., L. Aharonson-Daniel, M. Stein, M. Michaelson, Y. Kluger, D. Simon, Israeli Trauma Group (ITG), and E. K. Noji. Gunshot and explosion injuries: characteristics, outcomes, and implications for care of terror-related injuries in Israel. Ann. Surg. 239:311–318, 2004.PubMedCrossRefGoogle Scholar
  11. 11.
    Ramasamy, A., S. E. Harrisson, J. C. Clasper, and M. P. M. Stewart. Injuries from roadside improvised explosive devices. J. Trauma 65:910–914, 2008.PubMedCrossRefGoogle Scholar
  12. 12.
    Ramasamy, A., A. M. Hill, A. E. Hepper, A. M. J. Bull, and J. C. Clasper. Blast mines: physics, injury mechanisms and vehicle protection. J. R. Army Med. Corps 155:258–264, 2009.PubMedCrossRefGoogle Scholar
  13. 13.
    Ramasamy, A., A. M. Hill, S. Masouros, I. Gibb, A. M. J. Bull, and J. C. Clasper. Blast-related fracture patterns: a forensic biomechanical approach. J. R. Soc. Interface 8:689–698, 2011.PubMedCrossRefGoogle Scholar
  14. 14.
    Ramasamy, A., A. M. Hill, R. Phillip, I. Gibb, A. M. J. Bull, and J. C. Clasper. The modern “deck-slap” injury—calcaneal blast fractures from vehicle explosions. J. Trauma 71:1684–1688, 2011.CrossRefGoogle Scholar
  15. 15.
    Turegano-Fuentes, F., P. Caba-Doussoux, J. Jover-Navalon, E. Martin-Perez, D. Fernandez-Luengas, L. Diez-Valladares, D. Perez-Diaz, P. Yuste-Garcia, H. Guadalajara Labajo, R. Rios-Blanco, F. Hernando-Trancho, F. Garcia-Moreno Nisa, M. Sanz-Sanchez, C. Garcia-Fuentes, A. Martinez-Virto, J. Leon-Baltasar, and J. Vazquez-Estevez. Injury patterns from major urban terrorist bombings in trains: the Madrid experience. World J Surg. 32:1168–1175, 2008.PubMedCrossRefGoogle Scholar
  16. 16.
    van der Horst, M. J., C. K. Simms, R. Maasdam, and P.-J. C. Leerdam. Occupant lower leg injury assessment in landmine detonations under a vehicle. In: IUTAM Symposium on Impact Biomechanics: From Fundamental Insights to Applications, Edn 124, edited by M. D. Gilchrist. The Netherlands: Springer, 2005, pp. 41–49.Google Scholar
  17. 17.
    Wang, J. J., R. Bird, B. Swinton, and A. Krstic. Protection of lower limbs against floor impact in army vehicles experiencing landmine explosion. J. Battlefield Technol. 4:8–12, 2001.Google Scholar
  18. 18.
    Yoganandan, N., F. A. Pintar, M. Boyton, and P. Begeman. Dynamic axial tolerance of the human foot–ankle complex. In: 40th Stapp Car Crash Conference Proceedings, 1996, pp. 207–218.Google Scholar

Copyright information

© Biomedical Engineering Society 2013

Authors and Affiliations

  • Spyros D. Masouros
    • 1
    Email author
  • Nicolas Newell
    • 1
  • Arul Ramasamy
    • 1
    • 2
  • Timothy J. Bonner
    • 1
    • 2
  • Andrew T. H. West
    • 3
  • Adam M. Hill
    • 1
    • 2
  • Jon C. Clasper
    • 1
    • 2
  • Anthony M. J. Bull
    • 1
  1. 1.Department of BioengineeringImperial College LondonLondonUK
  2. 2.Academic Department of Military Surgery and TraumaRoyal Centre for Defence MedicineBirminghamUK
  3. 3.Centre of Defence ImagingRoyal Centre for Defence MedicineBirminghamUK

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