CHARACTERIZATION OF LEG INJURIES FROM MOTOR VEHICLE IMPACTS

Tyler A. Kress, Ph.D.

Engineering Institute for Trauma & Injury Prevention
The University of Tennessee, U.S.A.
David J. Porta, Ph.D.
Bellarmine College, U.S.A.
Paper number 443

ABSTRACT of test procedures which assess the injury potential

of vehicle structures is needed.
The objective of this investigation was to The injury potential in a motor vehicle
understand relationships among loading collision with a pedestrian is high because of the
characteristics as they affect the kinematics and great difference between the mass of a vehicle and
injury of a pedestrian’s lower extremity. Real-life that of a pedestrian. Since the mass of a vehicle is so
pedestrian and motor vehicle collision scenarios were much greater than that of a pedestrian, the velocity of
modeled by impacting 604 human cadaver intact legs can be very low and still have very significant injury-
and long bones with a cart/guide rail impacting causing potential. A vehicle does not need to achieve
system designed to simulate the front end of an high velocity in order to severely damage
automobile. A parametric study was conducted that pedestrians. Approximately 80% of pedestrian
varied the boundary conditions on the foot as well as impacts occur with vehicles moving less than 35 mph
test parameters such as loading direction, impact (NHTSA 1993a, NHTSA 1994b). A report issued by
velocity, and impactor geometry. The series of tests NHTSA in late 1999 (NHTSA 1999) titled
can be categorized as follows: (1) Fracture “Literature Review on Vehicle Travel Speeds and
Characterization, (2) Threshold Velocity, (3) Pedestrian Injuries” states that approximately 5% of
Friction versus Inertial Constraint, (4) Anterior and pedestrians die when struck by a vehicle traveling at
Lateral Thigh Impacts, and (5) Embalmed vs. 20 miles per hour or less. This is compared to
Unembalmed. Documented data for various fatality rates of 40, 80, and nearly 100 percent for
specimens include, but are not limited to, specimen impacting speeds of 30, 40, and 50 (or more) miles
anthropometrics, fracture patterns, failure force per hour respectively.
levels, and calculated bending moments. The kinematics associated with vehicle-
Representative values include averages as follows: pedestrian impacts are often governed more by the
Failure forces for the tibia ranged from 1.19 to 7.07 shape of the impacting vehicle than its mass or
kN. Failure forces for the femur ranged 1.31 to 8.37 velocity. Buses, trucks, and vans tend to have broad,
kN. Bending moments averaged from approximately flat leading edges that enable them to strike a larger
100 to 500 Nm. These values varied depending on portion of a pedestrian including at a height at their
the speed of impact, impactor geometry, direction of center of gravity. When this is the case, the body is
impact, gender of specimen, etc. The results and generally thrown forward. There tends to be less
observations may be helpful as an aid for evaluating sever injuries under these circumstances if blows to
the effectiveness of any protective or mitigative the head are avoided. With most cars, the hood and
devices or strategies. bumper design are lower and more pointed for
reasons of aerodynamics and style. Therefore, cars
INTRODUCTION tend to strike below the center of gravity of a
pedestrian such that the pedestrian is undercut and
Pedestrians account for approximately one lands on the hood or roof of the vehicle (Aldman
out of seven of all traffic fatalities. The number of 1984a).
pedestrian injuries every year from motor vehicles is The first car was manufactured by Henry
at least a factor of ten greater than the number of Ford in 1893 (Grun 1982). Soon thereafter
deaths. Statistics indicate that head injury is the pedestrian-automobile impacts were so common that
leading cause of fatalities among pedestrians. The specific injuries were attributed to them. The term
most common injury is to the leg. The United States “bumper fracture” was used in the medical literature
National Traffic Highway Safety Administration at least as early as 1929 by Cotton and Berg to
recently stated that the development and evaluation identify fractures of the proximal tibia (Hendrix

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1972; Levine 1994). This type of injury is indicative PURPOSE
of the normal sequence of events when a pedestrian
is struck by an automobile. The episode usually Reduction or prevention of impact injury
begins with initial contact at the lower limb by the through design of protective devices/safer
bumper (Manoli 1986). This may result in a variety environments requires certain biomechanical
of injuries to the lower extremity including fractures, information. This information includes a
lacerations, avulsions, and occasionally, hip characterization of how the body region of interest
dislocations (McClelland et al. 1987). Often, a responds to impact forces in terms of mechanical
bumper (approximately 17-23" above the ground can parameters such as force-time histories of impact,
impact the leg crushing the common fibular nerve. accelerations/decelerations, and deformations in the
This causes a condition known as "foot drop" in tissue structures. Also, mechanisms by which the
which the extensor muscles of the foot do not tissues fail, mechanical parameters by which they
function properly (Huelke 1986). In a study of respond, and the values of the injury criteria are
pedestrian victims, the incidence of fracture was important results of impact biomechanics research. These
observed to steadily increase with age such that the "biomechanical behaviors" and "injury characterizations" for
over-65 group had the highest incidence (3.5) of a pedestrian’s lower extremities are the essence of the
fractures per patient. (O’Malley et al. 1985). efforts discussed in this paper. In order to keep this paper
Breaking strength and fracture patterns of to a reasonable length, not all data could be included. A
long bones have been studied quite extensively with list of several observations near the end of the paper
good documentation dating as far back as the 19th is an attempt to provide succinct information
century. Messerer (1880) tested 500 bones from 90 regarding some of the results.
cadavers of both sexes and various ages. He found
that the cracking or tearing of the bone generally GENERAL METHODOLOGY
occurred on the convex (tension) side of the bone.
For bones exhibiting significant bend there was Injuries to the human leg and fractures of
crushing on the concave (compression) side, at the the diaphyseal portion of long bones were
point of application of the load, before a tearing or investigated by conducting dynamic impact tests of
tension fracture occurred. The significance of tensile 604 geriatric human cadaver lower extremity
stresses as the cause for bone failure was further components. The majority of the tests involved the
emphasized by Evans and Lissner (1948) through use of a horizontal pneumatic-based accelerator
stresscoat studies. Mechanical property studies over which propelled a 50-kg cart along a railway at 7.5
the years have shown that bone is weaker in tension m/s. The cart was headed by varying striking
than in compression. Rauber (1876) was one of the surfaces (pipe, plate, bumper sections, and padded
first researchers to discover that when a bone is plate) instrumented with force transducers. Impactor
subjected to increasing amounts of equal tensile and speed was slower for many tests, and some
compressive forces it fails in tension first. Kress and comparative studies were made between embalmed
Porta (1993) have found that the human femur seems and unembalmed bare bones and intact legs.
to be approximately 1.5 times stronger in Impactor leading edge geometry was also varied
compression than tension, even during dynamic during some of the tests. Intact lower extremities
loading conditions. and bare long bones were impacted under various
Nyquist et al. (1985) and Kress et al. (1990) conditions, including anterior and lateral impacts at
have probably provided the most thorough studies approximately 7.5 m/s; as well as anterior, posterior,
but there is still room for improvement in the lateral and medial midshaft impacts at
analyses of anthropometry and injury, especially with approximately 5.0 m/s. Specifically, the series of
respect to fracture patterns. Although Kallieris and tests can be categorized as follows (number of
Schmidt (1988) presented a considerable amount of specimens dedicated to each test series is also
anatomic data, theirs is the exception to the rule. specified): (1) Fracture Characterization – 558 long
Most previous publications fail to even mention age, bones and intact legs, (2) Threshold Velocity – 8
sex, causes of death, or specific sites of impact and embalmed legs, (3) Friction versus Inertial
the resultant injuries to the cadavers. Therefore, one Constraint – 8 embalmed legs (4 matched pairs), (4)
emphasis of the work reported on in this paper is to Anterior and Lateral Thigh Impacts – 12 embalmed
provide detailed anatomic data alongside basic legs (6 matched pairs), and (5) Embalmed vs.
engineering findings. Attempts are made to Unembalmed – 12 embalmed and unembalmed legs,
investigate any correlation between the two. (6 matched pairs).

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 a photovoltaic cell/timer apparatus permitting the
SPECIFIC METHODOLOGY, DATA calculation of the velocity before impact.
SOURCES, & RESULTS Heading the cart for most of the tests was an
instrumented 10-cm long steel impactor pipe with an
Documented data for various specimens outside diameter of 4.13 cm. It was mounted to the
include, but are not limited to, specimen front of the cart via slide pins. When contacting a
anthropometrics, fracture patterns, failure force specimen, the pipe was freely able to impinge on a
levels, and calculated bending moments. piezoelectric quartz force transducer (PCB
Representative values include averages as follows: Piezotronics model 208A03), thereby producing a
Failure forces for the tibia ranged from 1.19 to 7.07 measured force equal to that which is delivered to the
kN. Failure forces for the femur ranged 1.31 to 8.37 specimen. The transducer signal was recorded on a
kN. Bending moments averaged from approximately Hewlett Packard 3562A signal analyzer allowing
100 to 500 Nm. These values varied depending on storage of a force vs. time plot for each impact.
the speed of impact, impactor geometry, direction of
impact, gender of specimen, etc. All of the Test Series 2 – Threshold Velocity
documented data cannot be included in this short
paper, therefore some representative results are As part of an attempt to validate a fuzzy
presented, and observations and conclusions are logic computer model developed at The University of
summarized. For an extremely thorough and Tennessee Engineering Institute for Trauma and
comprehensive breakdown and discussion of the Injury Prevention and to further understand threshold
data, refer to the Ph.D. dissertation titled “The velocity at which legs fracture, different test
Anatomy and Biomechanics of Experimentally scenarios were utilized for each of eight embalmed
Traumatized Human Cadaver Lower Extremity cadaver leg impacts. Some of tests of individual
Components” by Porta (1997). specimens were rather interesting. As can be seen in
Table 1, all but one of the eight specimens were
Test Series 1 – Fracture Characterization impacted multiple times. The protocol called for the
first impact of a specimen to occur below 5.0 m/s
A total of 558 bone fracture tests were performed to and subsequent impacts were made at gradually
gain knowledge with regard to pedestrian leg fracture higher velocities until fracture. A skin flap was cut
characteristics and behavior. All bare bones were in each specimen in order to aid with the inspection
tested in a pin-pin setup and the intact leg tests were of the bone between tests. As might be expected, the
mostly pin-inertial (foot hanging freely) or pin- most resilient bone was that of the youngest male (55
friction (shoed foot on concrete block). The pin-pin years old). The leg was impacted 19 times with
setup supported the bare bones at their ends fracture finally achieved at a velocity of 8.0 m/s and
(epiphyseal aspects) which were impacted at a peak force of 6.24 kN. Surprisingly, the second
midshaft. strongest specimen was that of a 92 year-old female.
The testing apparatus consists of a Her limb failed on the ninth impact which was made
pneumatic-based accelerator which propels a at 7.9 m/s with a peak force of 3.29 kN recorded.
wheeled cart toward the mounted specimen. The Figure 1 shows the second and last impacts for this
accelerator consists of a piston assembly inside of a specimen. Notice that the leg maintains its structural
pneumatic chamber that is pressurized in order to integrity in the top photo (and each of the first eight
achieve target velocities. For most tests the pressure impacts) but the last impact photo shows the limb
was 0.34 MPa (50 psi) yielding a cart velocity of wrapping around the impacting plate as the bone
approximately 7.5 m/s. A ram connected to the fails. At the top of the picture a special rigging is
piston pushed an aluminum and steel impact cart (50 visible, a portion of the weight system utilized to
kgs) throughout its stroke of approximately 1.5 apply a 20 kg downward force vector through a rod
meters. Then the cart separated from the ram and that was passed transversely through a drilled hole in
traveled along a railway for less than a meter before the femoral condyles.
striking the specimen. In that stretch, it was timed by

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 Table 1.
Leg Tests for Threshold Velocity Analysis

Velocity Test Conditions

Leg # Age Site of # of @ Peak (all legs had a 20 kg weight
& Impact Impacts Fracture Force applied downward)
Sex (m/s) (kN)

755-L 56 f Anterior 8 6.3 1.49 VPSAF

991-L 92 f Anterior 9 7.9 3.29 VPSA

009-L 55 m Anterior 19 8.0 6.24 VqS

070-L 81 f Anterior 3 5.2 1.14 VP

949-L 84 f Anterior 2 4.9 1.67 VPS

070-R 81 f Posterio 3 2.8 1.14 VP A

r

961-R 80 f Posterio 1 5.1 1.34 VPSA

r

949-R 84 f Posterio 5 6.3 2.06 VPSA

r

*
Legend for Test Conditions: V- 20 kg mass exerting an downward force vector on the specimen; P- Impact surface was a 10
cm wide steel plate; q- Impact surface was a 4 cm wide plate; S- Shoed foot placed on concrete block; A- Air springs
positioned between cart and impact plate; F- Foam placed on face of plate

Figure 1. Impacts of a leg resulting in no fracture and fracture.

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All of the limbs were thoroughly dissected and, as noted that a bumper force of 4 kN may fracture an
expected, there was little soft tissue damage in these unloaded tibia, but with body weight it may be only 1
embalmed specimens. Nerves were typically observed kN. A simple controlled study was designed in an
to be grossly unaffected. It was noted that posterior effort to examine the effects of simulated body weight
impacts resulted in more distal fractures than the and frictional forces on peak impact forces. Matched
anterior strikes. pairs of embalmed legs from four cadavers were
collected for this study. The right legs were each
Test Series 3 – Friction vs. Inertia suspended by a rod passed through a drilled hole in the
femoral condyles. The foot did not contact the ground.
The application of a frictional component was The inertial mass effects of the foot and ankle were the
one aspect of the variety of conditions employed in the only distal constraints on these limbs. When the left
“threshold velocity” tests that appeared particularly legs were tested, they were positioned either precisely
amenable to this next series of tests. According to like those of the previous study (Figure 2) or in a
Aldman (1984a), during walking, the leg supports vertically oriented rigging.
between 80 and 120% of the static body weight. He

Figure 2. Set-up for tests for inertial and frictional constraints.

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 All specimens were impacted on the anterior desired. It should be noted that there was no significant
surface of the mid-leg. Test results are presented in difference in cortex thicknesses between the groups
Table 2. It appears that the results of this small study (average thickness of bones in friction set = 5.51 mm (
conflict with the statement by Aldman (1984a) = 0.86 mm); average thickness of bones in inertial set =
regarding differences in forces for loaded versus 5.21 mm ( = 0.68 mm). Nor were there any
unloaded legs since 3 of the 4 peak forces recorded for significant differences (p = 0.9100) between the mean
the limbs in the frictional set-up were higher than their velocity of impact for the friction (7.89 m/s with =
inertially constrained counterparts. Student’s T-test 1.01 m/s) versus the inertial constraint (7.97 m/s with
was performed in order to identify the significance level = 0.90 m/s). Although this is a small study, there
for the force and constraint data. The average peak appears to be a trend towards slightly greater damage in
force for the friction study was 7.20 kN (standard the limbs with the frictional constraint. Major muscular
deviation = = 1.97 kN) while the inertially supported damage and severed blood vessels were observed in 3
limbs were of the 4 friction limbs and only 1 of the 4 inertially
subjected to an average peak force of 5.94 kN ( = 0.70 constrained limbs. In addition, one of the only impacts
kN). There was not a statistically significant difference to result in a severed nerve occurred to a limb in the
between the two groups when a 5% confidence level is friction set up.

Table 2.
Results of Friction vs. Inertia Series

Age Set-up1 Velocity Peak Fracture Avg.

# & (m/s) Force Pattern Cortex
Sex (kN) (mm)

L - Frxn 7.51 8.23 Segmental 4.77

110 71 m
R- Inert 7.49 6.27 Segmental 5.14

L- Frxn 7.26 7.55 Comminuted 6.36

1242 74 f
R- Inert 7.42 6.73 Transverse 5.98

L- Frxn 9.40 8.93 Transverse 6.13

1663 64 m
R- Inert 9.31 5.63 Compression Wedge 5.37

R- Frxn 7.37 4.33 Comminuted 4.78

051 85 m
L- Inert 7.64 5.14 Comminuted 4.35
1
Limb side: L-Left; R-Right; Frxn- Friction constraint; Inert- Inertial constraint
2
A prosthetic knee was found in Leg 124-R.
3
The left & right legs had to be impacted 5 and 2 times respectively until fracture.

Test Series 4 – Anterior and Lateral Thigh Impacts

same cart impactor the specimens were inverted and
Additional tests were performed in the suspended against a large steel elbow plate in the test
investigation of injury from perpendicular impacts to zone by a rod passing through the tibial plateau such
the mid-thigh. Matched pairs of thighs from six that impact occurred on the anterior or lateral surface.
embalmed cadavers were studied. In order to use the Testing results are shown in Table 3.

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 Table 3.
Results of Anterior vs. Lateral Thigh Impacts at 7.3 m/s
(all thighs were inverted and simply supported)

Age Impact1 Peak Fracture Avg.

# & Force Pattern Cortex
Sex (kN) (mm)

L – Ant na Oblique 7.17

919 79 m
R – Lat 4.61 Jagged Transverse 7.61

L- Ant 8.23 Jagged Transverse 6.92

901 86 m
R- Lat 7.36 Jagged Oblique 6.76

L- Ant na Segmental 7.76

8793 79 m
R- Lat 8.96 Oblique 7.32

R- Ant 5.29 Oblique4 6.90

860 95 f
L- Lat 4.85 Comminuted Oblique 5.43

R2- Ant 5.75 Comminuted Tension Wedge 5.61

846 88 f
L- Lat 4.52 Oblique4 6.38

R- Ant 3.96 Oblique 7.14

810 78 f
L- Lat 6.74 Comminuted Segment 5.68

1
Limb side and Impact Site: L-Left; R-Right; Ant- Anterior; Lat- Lateral
2
A prosthetic plate was found in Thigh 846-R.
3
The left and right legs had to be impacted 5 and 2 times respectively until fracture
4
Additional fractures were found in the hip- due to interaction with the support system

Analysis of the dissection data from these were amputated later and pre-test radiographs were
embalmed thighs was very similar to that from the made. For testing, a rod was inserted in the upright leg
embalmed legs. There was very little superficial such that simulated upper body mass could be applied.
damage and precious few vessels and nerves were A 50 kg cart propelled by a pneumatic accelerator to 7.5
grossly injured. Muscular damage was generally m/s struck the anterior leg midway between the knee
observed to be greater in the compartment opposite the and ankle. The cart was headed by an instrumented
site of impact. A prosthetic device in specimen 846R steel pipe (4.75 cm dia.) coupled to a transducer which
appears to have acted as a stress riser since fractures relayed impact force data to a Hewlett Packard 3562A
emanated from the screw hole closest to the impact signal analyzer. Testing was captured on standard VHS
area. video (30 frames/s) and 16 mm Color High Speed Film
(1,000 frames/s). Post-test analyses included
Test Series 5 – Embalmed vs. Unembalmed radiographs and thorough dissection. Peak forces were
comparable for matched pairs.
Intact legs from six geriatric cadavers were Figure 3 shows impact tests of two legs, one
fractured in a controlled study aimed at documenting embalmed and the other unembalmed.. Note the
the effects of embalming on both the soft and hard increased wrapping of the unembalmed leg around the
tissues of cadaver specimens subjected to impacting pipe after fracture has occurred. The foot is
biomechanical impact research. Upon bequeathal, one still in its original orientation with respect to the
leg was removed and frozen while the other remained vertical plane. A portion of the tibia can be seen
with the cadaver for embalming. The embalmed legs protruding from the posterior aspect of the leg.

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 Figure 3. Comparison of embalmed leg impact (top)
to that of an unembalmed leg impact (bottom)..

The matched pair of legs from a cadaver were the leg was placed upright in the impact zone of the test
subjected to identical test conditions with the only machine. A weight of over 50 kgs was applied to the
difference being the fact that one leg was embalmed. rod in an effort to simulate the upper body mass. The
Therefore, age, sex and overall physical condition could foot of the specimen was placed in an athletic shoe and
essentially be "factored out" allowing for a more set on a concrete surface. Additionally, for most tests,
meaningful comparison of the collected fracture and an attempt was made to pressurize the vasculature by
soft tissue damage. using a crude embalming machine to infuse the vessels
Every effort was made to make the cadaver with a sugar water solution via cannulation of the
specimens and test scenario as "life-like" as possible in popliteal or femoral artery. The machine registered a
hopes that the dynamic response would be similar to pressure of 2 to 3 psi (Resting systolic blood pressure
that of a pedestrian struck in the leg by a vehicle. of 120 mm Hg equals roughly 16 KPa or 2.3 psi.). Two
Testing conditions attempted to account for: 1) the of the legs could not be pressurized due to the presence
constraints of the upper body mass, 2) friction between of fixed blood in the vessels (3L) and an abnormal
the foot and the pavement, and 3) pressurization of the branching pattern of the femoral artery that resulted in
vasculature. vessels too small to accept the cannula (5L).
The frozen specimens were allowed to thaw Data collected regarding cadaver
for at least twenty-four hours. Immediately prior to demographics, specimen embalming, mid-shaft tibial
testing, the specimens were removed from their plastic cortex thickness, cart velocity and peak force are listed
bags and a hole was drilled from side-to-side in the for each test in Table 4.
distal femur. A rod was passed through the hole and

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 Table 4.
Test Data for Embalmed vs. Unembalmed Series

Cadaver Age, Sex & Leg & Embalmed? Avg. / Smallest Cart Velocity Peak Force
Cause of Death* Cortex Thickness (mm) (m/s) (kN)

1. 74 year-old Female, Right yes 4.33 / 1.97 7.08 No Trigger

Lung Cancer
Left no 4.93 / 2.10 7.94 5.95

2. 92 year-old Male Right yes 6.74 / 4.33 7.15 6.80

Cardiac Arrest,
Diabetes
Left no 6.56 / 3.53 7.62 7.80

3. 94 year-old Female, Left yes 6.24 / 3.36 7.30 4.78

Pneumonia
Right no 4.13 / 2.90 7.87 4.18

4. 75 year-old Male, Left y7.79 / 4.61 7.30 8.46

Lung Cancer
Right n7.49 / 4.81 7.84 6.21

5. 79 year-old Male, Left yes 7.89 / 4.25 7.71 8.46

Myocardial Infarction
Right no 7.74 / 4.79 7.69 7.43

6. 91 year-old Female, Right yes 4.15 / 2.48 7.48 5.03

Urosepsis
Left no 5.34 / 3.05 7.84 3.75

*
Cadaver 2 was African-American, all others were Caucasian.

Dissection results indicating damage to skin, important to note that no microscopic analysis was
muscles, vessels and bone are summarized in Table 5. performed. Since nerve components are often injured
The fractured unembalmed specimens showed by "stretching" or "pinching," it is quite probable that
considerably more soft tissue damage than their damage was present but went undetected. The
fractured embalmed matches. Lacerations to the skin comparison of the osteologic data is more complex.
and superficial fascia were judged to be greater in five The damage was similar in half of the matched pairs,
of the six pairs. Muscle damage was greater for the but the other half appeared to show greater
unembalmed leg in all six cases and vessel damage was comminution of the embalmed legs. Further review of
greater in four of the six. Oddly enough, the nervous the post-test radiographs may lead to a more clear
system appeared to escape serious injury as there was picture regarding bone damage.
virtually no gross damage to any of the nerves. It is

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 Table 5.
Damage Summary for Embalmed vs. Unembalmed Series

Leg1 Laceration2 Muscles Damaged3 Vessels4 Bone Fractures5

1Re 4 20.5 5% TA Fib V Bad Comm >15 pieces

1Lu 2 34.0 60% Gas & Sol, 100% EHL & None Bad Comm >6 Pieces
TP, 50% FDL, 50% FHL, and with Protrusion
10% FibB
2Re 1 1.5 10% FDL None Mild Comm Transverse

2Lu 1 7.5 50% FDL, 20% TA, 20% Gas, P. Tib A Mild Comm Oblique
30% Sol, 50% FHL, and 5% & Vs
FibB
3Le 6 13.5 50% Gas, 40% Sol, 33% FHL, Part of Bad Comm >15 pieces
and 50% FDL Saph V with Protrusion
3Ru 2 19.5 50% Gas, 50% Sol, 30% FHL, Fib A & Mild Comm Transverse
and 90% TP Vs
4Le 0 0 <5% TA A. Tib. Mild Comm Transverse
A
4Ru 1 1.5 10% TA, 10% Gas,, 10% FHL, Fib Vs Mild Comm Transverse
and 5% TP
5Le 2 3.5 2 cm vertical tear in Gas None Mild Comm Transverse

5Ru 1 1.5 10% Gas & Sol, 30% FHL, P. Tib A Mild Comm Segmental
50% FDL,
and 5% FiB
6Re 1 13.0 10% FDL, 10% TP, 75% FHL, None Comm >6 Pieces
and 5% TA with Protrusion
6Lu 2 13.5 30% FDL, 10% TP, 75% FHL, Fib A & Mild Comm Oblique
30% Gas Vs with Protrusion
and 30% Sol

1
The specimen test number is listed followed by a designation for left (L) or right (R) and embalmed (e) or unembalmed (u).
2
The number of skin lacerations is listed, followed by the total linear distance those cuts travel (cm).
3
The percent values represent an estimate of the horizontal tear length as it relates to total width of the particular muscle.
Muscle key: Gas= Gastrocnemius, Sol= Soleus, T= Tibialis, Fib= Fibularis, A= Anterior, P= Posterior, F= Flexor,
E= Extensor, D= Digitorum, H=Hallucis, L=Longus, B= Brevis.
4
Key for name of lacerated artery (A) or vein (V): P.= Posterior, A.= Anterior, Tib= Tibial, Fib= Fibular, Saph= Saphenous
5
Comm = Comminuted.

Dissection data clearly indicate that soft tissue laceration may be explained by several mechanisms: a)
damage to fractured embalmed legs was much less than The anatomy of the lower limb may afford nerves a
that seen in fractured unembalmed legs. Specifically, tremendous amount of protection from anterior impacts
damage was greater to the skin, the superficial fascia, to the mid-leg. Most of the large nerves are situated
muscles and blood vessels; however, the nerves were an posterior to the bones of the leg; therefore, fractures
exception. In some cases, blood vessels were would absorb much of the energy of impact prior to
punctured and large muscle masses were torn for involvement of the nerves. b) Transection may not be
several centimeters; however, to the naked eye, nerves the most common mechanism of injury. Stretching is
remained intact. The immediate question is whether often cited as the cause of central nervous system
this accurately models the live human response to injuries such as diffuse axonal injury. Compression of
anterior leg trauma. This question is addressed in the the brain is the primary cause of concussions. Maybe
following two paragraphs. peripheral nerves of the leg are most often injured in
Perhaps live nerves are rarely transected in similar manners without being grossly torn.
mid-leg anterior impacts and the lack of damage seen in If nerve transection is commonly seen after
this study is appropriate. If so, then the resistance to "real-world" anterior mid-leg impacts then there may be

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factors which were not, or could not be accounted for: knee impact or those that were crushed between two
a) Live nerves may simply be more fragile than those hard surfaces). 13) Many oblique fractures also have
of a cadaver. b) Perhaps when all of the components tensile wedge patterns that are not detected by x-ray.
of the leg have their normal turgor, the nerves are put in 14) Fractures resulting from 7.5 m/s impacts can be
a more precarious position. c) Nerve transection may quite serious, that is they cause significant injury. This
occur secondary to the impact. This would include conjecture is also supported by research pertaining to
violent motion of the fractured limb immediately after pedestrian injury and vehicle design by Pritz and
impact or improper splinting/transport, etc. It may also Hassler (1975). 15) Pritz and Hassler also reported no
include the human body’s post-traumatic responses. noticeable differences in injury severity associated with
Transection may occur during contraction of the cylindrical impactor radius changes from 1-inch to 4-
musculature immediately after impact. This could inches. This is consistent with the findings in this
result in laceration of the nerves as they are pinched study. 16) Comminuted fractures can occur without
between sharp bone fragments. entrapment (crushing injury). For 7.5 m/s impacts of
intact legs, the inertial restraint of the tibia from the
OBSERVATIONS AND CONCLUSIONS upper thigh and foot is sufficient enough to result in
comminuted fractures without any additional support.
1) Resultant fracture types for perpendicular 17) Age changes in bone can exist, although these
loading (anterior-to-posterior, posterior-to-anterior, changes do not seem to significantly affect fracture
lateral-to-medial, and medial-to-lateral) do not differ patterns (except when compared to babies or small
with respect to impact direction. 2) It is reasonable to infants). Such changes can include changes to mineral
assume that transverse, oblique, segmental and tension mass, volume, density, and mechanical properties.
wedge fractures are all just manifestations of tensile During dynamic loading situations when ultimate
failure. 3) The most common fracture pattern is tension strength is exceeded, bone basically fails as a brittle
butterfly wedge and is followed closely by the oblique material (young or old). So, the fractured patterns do
fracture. 4) The tension wedge fracture pattern can not vary too much, unless severe osteoporitic changes
definitively be used as an indicator of the direction of have occurred. Such osteoporosis can increase the
impact. 5) The fracture patterns at low speed impacts incidence of high comminution (shatter). 18) For
(1.2 m/s) are very similar to those of high speed (7.5 impact loading of the long bone shaft, arthritic changes
m/s). This is somewhat of a unique observation did not seem to affect the resultant fracture pattern of
because it has been commonly thought that the butterfly the entire bone. In other words, a fair supposition
wedge results only from high speed impacts. 6) Spiral would be that arthritis only affects failure patterns when
fractures only appear when bones are subjected to they involve joints. 19) The use of embalmed tissue in
torsional loads. 7) Embalmed intact leg fractures the study of the biomechanics of trauma will likely lead
exhibit greater comminution than unembalmed. The to a reasonable determination of impact forces;
embalment process causes significant increase in however, soft tissue damage may be understated and
stiffness of the soft tissue containment. 8) Although the fracture patterns may show greater fragmentation than
femur is stronger and has a different cross-sectional unembalmed specimens.
geometric shape, its fracture patterns as a result of
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