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Foot–Ankle Fractures and Injury Probability Curves from Post-mortem Human Surrogate Tests

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Abstract

This purpose of this study was to replicate foot–ankle injuries seen in the military and derive human injury probability curves using the human cadaver model. Lower legs were isolated below knee from seventeen unembalmed human cadavers and they were aligned in a 90–90 posture (plantar surface orthogonal to leg). The specimens were loaded along the tibia axis by applying short-time duration pulses, using a repeated testing protocol. Injuries were documented using pre- and post-test X-rays, computed tomography scans, and dissection. Peak force-based risk curves were derived using survival analysis and accounted for data censoring. Fractures were grouped into all foot–ankle (A), any calcaneus (B), and any tibia injuries (C), respectively. Calcaneus and/or distal tibia/pilon fractures occurred in fourteen tests. Axial forces were the greatest and least for groups C and B, respectively. Times attainments of forces for all groups were within ten milliseconds. The Weibull function was the optimal probability distribution for all groups. Age was significant (p < 0.05) for groups A and C. Survival analysis-based probability curves were derived for all groups. Data are given in the body of paper. Age-based, risk-specific, and continuous distribution probability curves/responses guide in the creation of an injury assessment capability for military blast environments.

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Acknowledgments

This research was supported in part by the Cooperative Agreements W81XWH-10-2-0065 and W81XWH-12-0041 (Warrior Injury Assessment Manikin study), Department of Veterans Affairs Medical Research and Department of Neurosurgery at the Medical College of Wisconsin. This material is the result of work supported with resources and use of facilities at the Zablocki VA Medical Center, Milwaukee, Wisconsin and Medical College of Wisconsin. The first, second, fourth and fifth authors are part-time employees of the Zablocki VA Medical Center, Milwaukee, Wisconsin. Any views expressed in this article are those of the authors and not necessarily representative of the funding organizations. Further, all authors do not have any sources of conflict of interest for this work.

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None of the authors of this paper have any conflicts of interest.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Narayan Yoganandan & Harmeeth Uppal

  2. Department of Neurosurgery, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Narayan Yoganandan, Sajal Chirvi, Frank A. Pintar & Michael Schlick

  3. Division of Biostatistics, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI, 53226, USA

    Anjishnu Banerjee

  4. Applied Physics Laboratory, Johns Hopkins University, Laurel, MD, USA

    Liming Voo & Andrew Merkle

  5. US Army Research Laboratory, Aberdeen Proving Ground, MD, USA

    Michael Kleinberger

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  1. Narayan Yoganandan
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Correspondence to Narayan Yoganandan.

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Associate Editor Stefan M Duma oversaw the review of this article.

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Yoganandan, N., Chirvi, S., Pintar, F.A. et al. Foot–Ankle Fractures and Injury Probability Curves from Post-mortem Human Surrogate Tests. Ann Biomed Eng 44, 2937–2947 (2016). https://doi.org/10.1007/s10439-016-1598-2

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  • DOI: https://doi.org/10.1007/s10439-016-1598-2

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