The Biomechanics of Thoracic Trauma

  • John M. Cavanaugh

Abstract

During impact with an automobile, the thorax can interact with various components of the automobile interior and with several types of restraint. The types of interactions include unrestrained driver or passenger with steering wheel or instrument panel, and interactions with active or passive restaints, including three-point lap/shoulder belts, two-point shoulder belts, knee bolsters, and air bags. Injury to the thorax commonly occurs in frontal and side impacts and in impact directions intermediate to these two. In automotive accidents chest injury ranks only second to head injury in overall number of fatalities and serious injuries. It ranks second to head injury in overall economic cost using the Harm concept of Malliaris et al. (1982, 1985) as shown in Table 15.1.

Keywords

Chest Compression Abbreviate Injury Scale Thoracic Trauma Side Impact Flail Chest 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. 49.
    CFR Part 571. Federal Motor Vehicle Safety Standards; Side Impact Protection. Federal Register, Docket No. 88-C6, Notice 8, RIN 2127AB86, Vol 55(210), Oct. 30, 1990, pp 4572145780, 1990.Google Scholar
  2. Abbreviated Injury Scale (AIS)-1980 Revision Association for the Advancement of Automotive Medicine, Morton Grove, IL.Google Scholar
  3. Abbreviated Injury Scale (AIS)-1985 Revision Association for the Advancement of Automotive Medicine, Morton Grove, IL.Google Scholar
  4. Abbreviated Injury Scale (AIS)-1990 revision Association for the Advancement of Automotive Medicine, Morton Grove, IL.Google Scholar
  5. Aldman B, Anderson A, Sexmark O.: Possible effects of air bag inflation on a standing child. Proc 18th Conference of the American Association for Automotive Medicine, 1974.Google Scholar
  6. Anderson JE.: Grant’s Atlas of Anatomy, 8th edition. Williams and Wilkins, Baltimore, 1983.Google Scholar
  7. Backaitis SH, St. Laurent A. Chest deflection characteristics of volunteers and HYBRID III dummies. Proc 30th Stapp Car Crash Conference. SAE 861884, pp 157–166, 1986.Google Scholar
  8. Baker SP, O’Neill B, Haddon W, Long WB.: The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma 14: 187–196, 1974.PubMedCrossRefGoogle Scholar
  9. Beebe MS. What is BIOSID? SAE 900377, 1990.Google Scholar
  10. Bierman HR, Wilder RM, Hellems HK. The physiological effects of compressive forces on the torso. Report No. 8, Naval Medical Research Institute Project X-630, Bethseda, MD, 1946.Google Scholar
  11. Campbell KL, Wasko RJ, Henson SE.: Analysis of side impact test data comparing SID and BIOSID. Proc 34th Stapp Car Crash Conference. SAE 902319, pp 185–205, 1990.Google Scholar
  12. Carsten O. Relationship of accident type to occupant injuries. Report No. UMTRI-86–15, General Motors Research Laboratories, 1986.Google Scholar
  13. Carsten O, O’Day J. Injury priority analysis. Report No. UMTRI-84–24, NHTSA, 1984.Google Scholar
  14. Cavanaugh JM, Walilko TJ, Malhotra A, Zhu Y, King AI.: Biomechanical response and injury tolerance of the thorax in twelve sled side impacts. Proc 34th Stapp Car Crash Conference. SAE 902307, pp 23–38, 1990.Google Scholar
  15. Cheng R, Yang KH, Levine RS, King AI, Morgan R.: Injuries to the cervical spine caused by a distributed frontal load to the chest. Proc 26th Stapp Car Crash Conference. SAE 821155, pp 1–40, 1982.Google Scholar
  16. Cheng R, Yang KH, Levine RS, King AI.: Dynamic impact loading of the femur under passive restrained condition. Proc 28th Stapp Car Crash Conference. SAE 841661, pp 101–118, 1984.Google Scholar
  17. Code of Federal Regulations, 571.208, FMVSS 208, Occupant Crash Protection.Google Scholar
  18. Cohen DS.: The safety problem for passengers in frontal impacts: analysis of accidents, laboratory and model simulation data. Presented at the 11th International Technical Conference on Experimental Safety Vehicles, Washington, DC, 12–15 May, 1987.Google Scholar
  19. Cooper GJ, Pearce BP, Stainer MC, Maynard RL.: The biomechanical response of the thorax to non-penetrating trauma with particular reference to cardiac injuries. J Trauma 22 (12): 994–1008, 1982.PubMedCrossRefGoogle Scholar
  20. Dalmotas DJ. Mechanism of injury to vehicle occupants restrained by three-point seat belts. Proc 24th Stapp Car Crash Conference. SAE 801311, pp 439–476, 1980.Google Scholar
  21. Deng YC. Design considerations for occupant protection in side impact—a modeling approach. Proc 32nd Stapp Car Crash Conference. SAE 881713, pp 71–79, 1988.Google Scholar
  22. Eiband AM. Human tolerance to rapidly applied acceleration. A survey of the literature. National Aeronautics and Space Administration, Washington, DC. NASA Memo No. 5–19–59E, 1959.Google Scholar
  23. Eppinger RH. Prediction of thoracic injury using measurable experimental parameters. Report 6th International Technical Conference on Experimental Safety Vehicles, pp 770–779. National Highway Traffic Safety Administration, Washington, DC, 1976.Google Scholar
  24. Eppinger RH, Augustyn K, Robbins DH. Development of a promising universal thoracic trauma prediction methodology. Proc 22nd Stapp Conference. SAE 780891, pp 211–268, 1978.Google Scholar
  25. Eppinger RH, Marcus JH. Prediction of injury in blunt frontal impact. Tenth International Conference on Experimental Safety Vehicles, Oxford, England, pp 90–104, 1985.Google Scholar
  26. Eppinger RH, Marcus JH, Morgan RM. Development of dummy and injury index for NHTSA’s thoracic side impact protection research program. Government/Industry Meeting and Exposition, Washington, DC. SAE 840885, 1984.Google Scholar
  27. Eppinger RH, Morgan RM, Morgan RM. Side impact data analysis. Ninth International Conference on Experimental Safety Vehicles, 1982.Google Scholar
  28. Fayon A, Tarriere C, Walfisch G, Got C, Patel A.: Thorax of three-point-belt wearers during a crash (experiments with cadavers). Proc 19th Stapp Car Crash Conference. SAE 751148, pp 195–223, 1975.Google Scholar
  29. Foster JK, Kortge JO, Wolanin MJ. Hybrid III—a biomechanically-based crash test dummy. Stapp Car Crash Conference Proceedings. Warrendale, PA, SAE 770938, pp 975–1014, 1977.Google Scholar
  30. Fung YC, Yen MR. Experimental investigation of lung injury mechanisms. Topical Report, U.S. Army Medical Research and Development Command. Contract No. DAMD 17–82-C-2062, 1984.Google Scholar
  31. Gadd CW, Patrick LM. Systems versus laboratory impact tests for estimating injury hazard. Society of Automotive Engineers, New York, SAE 680053, 1968.Google Scholar
  32. Hirsch A, Eppinger R, Shams T, Nguten T, Levine R, Mackenzie J, Marks M, Ommaya A. Impairment scaling from the Abbreviated Injury Scale. Report No. DOT HS 806 648, NHTSA, 1983.Google Scholar
  33. Horsch J, Lau I, Andrzejak D, Viano D, Melvin J, Pearson J, Cok D, Miller G. Assessment of air bag deployment loads. Proc 34th Stapp Car Crash Conference. SAE 902324, pp 267–288, 1990.Google Scholar
  34. Kallieris D, Mattem R, Schmidt G, Eppinger R. Quantification of side impact responses and injuries. Proc 25th Stapp Car Crash Conference. SAE 811009, pp 329–366, 1981.Google Scholar
  35. King AI, Huang Y, Cavanaugh JM. Protection of occupants against side impact. Thirteenth International Conference on Experimental Safety Vehicles, Paris, France, Nov. 4–7, 1991.Google Scholar
  36. Kroell CK, Allen SD, Warner CY, Perl TR. Interrelationship of velocity and chest compression in blunt thoracic impact to swine II. Proc 30th Stapp Car Crash Conference. SAE 861881, pp 99–121, 1986.Google Scholar
  37. Kroell CK, Pope ME, Viano DC, Warner CY, Allen SD. Interrelationship of velocity and chest compression in blunt thoracic impact. Proc 25th Stapp Car Crash Conference. SAE 811016, pp 549–579, 1981.Google Scholar
  38. Kroell CK, Schneider DC, Nahum AM. Impact tolerance and response to the human thorax. Proc 15th Stapp Car Crash Conference. SAE 710851, pp 84–134, 1971.Google Scholar
  39. Kroell CK, Schneider DC, Nahum AM. Impact tolerance and response to the human thorax II. Proc 18th Stapp Car Crash Conference. SAE 741187, pp 383–457, 1974.Google Scholar
  40. L’Abbe RJ, Dainty DA, Newman JA. An experimental analysis of thoracic deflection response to belt loading. Seventh International IRCOBI Conference on the Biomechanics of Impacts, Bron, France, pp 184–194, 1982.Google Scholar
  41. Lasky II, Siegel AW, Nahum AM. Automotive cardio-thoracic injuries: a medical-engineering analysis. Automotive Engineering Congress, Detroit, MI, SAE 680052, January 8–12, 1968.Google Scholar
  42. Lau IV, Viano DC.: Influence of impact velocity on the severity of nonpenetrating hepatic injury. J Trauma 21: 115–123, 1981a.PubMedCrossRefGoogle Scholar
  43. Lau IV, Viano DC.: Influence of impact velocity and chest compression on experimental pulmonary injury severity in an animal model. J Trauma 21: 1022–1028, 1981b.PubMedCrossRefGoogle Scholar
  44. Lau IV, Viano DC. The viscous criterion—bases and applications of an injury severity index for soft tissues. Proc 30th Stapp Car Crash Conference. SAE 861882, pp 123–142, 1986.Google Scholar
  45. Lobdell TE, Kroell CK, Schneider DC, Hering WE, Nahum AM. Impact response of the human thorax. In King WF, Mertz HJ (eds) Human impact response measurement and simulation. Plenum Press, New York, pp 201–245, 1973.Google Scholar
  46. Malliaris AC, Hitchock R, Hedlund J. A search for priorities in crash protection. SAE 820242, 1982.Google Scholar
  47. Malliaris AC, et al. Harm causation and ranking in car crashes. SAE 850090, 1985.Google Scholar
  48. Marcus JH, Blodgett R. Priorities of automobile crash safety based on impairment. Proc 11th International Technical Conference on Experimental Safety Vehicles, R.port No. DOT HS 807223, NHTSA, pp 257–269, 1988.Google Scholar
  49. Marcus JH, Morgan RM, Eppinger RH, Kallieris D, Mattem R, Schmidt G. Human response to injury from lateral impact. Proc 27th Stapp Crash Conference. SAE 831634, pp 419–432, 1983.Google Scholar
  50. Melvin JW, King AI, Alem NM. AATD system technical characteristics, design concepts, and trauma assessment criteria. AATD Task E-F Final Report in DOT-HS-807–224 U.S. Department of Transportation, National Highway Traffic Safety Administration, Washington, DC, 1988.Google Scholar
  51. Melvin JW, Mohan D, Stalnaker RL. Occupant injury assessment criteria. SAE 750914, 1975.Google Scholar
  52. Melvin JW, Weber K (eds). Review of bio-mechanical response and injury in the automotive environment. AATD Task B Final Report in DOT-HS-807–224 U.S. Department of Transportation, National Highway Traffic Safety Administration, Washington, DC, 1988.Google Scholar
  53. Mertz HJ, Kroell CK. Tolerance of thorax and abdomen. In Impact injury and crash protection. Charles C. Thomas, Springfield, IL, pp 372–401, 1970.Google Scholar
  54. Mohan D, Melvin JW.: Failure properties of passive human aortic tissue II: biaxial tension tests. J Trauma 16: 31–44.Google Scholar
  55. Morgan RM, Marcus JH, Eppinger RH. Side impact—the biofidelity of NHTSA’s proposed ATD and efficacy of TTI. 30th Stapp Car Crash Conference. SAE 861877, 1986.Google Scholar
  56. Nahum AM, Gadd CW, Schneider DC, Kroell CK. Deflection of the human thorax under sternal impact. 1970 International Automobile Safety Conference Compendium, SAE, pp 797–807, 1970.Google Scholar
  57. Nahum AM, Gadd CW, Schneider DC, Kroell CK.: The biomechanical basis for chest impact protection: I. Force-deflection characteristics of the thorax. J Trauma 11 (10): 874–882, 1971.PubMedCrossRefGoogle Scholar
  58. Nahum AM, Schneider DC, Kroell CK. Cadaver skeletal response to blunt thoracic impact. Proc 19th Stapp Car Crash Conference. SAE 751150, pp 259–293, 1975.Google Scholar
  59. Neathery RF. Analysis of chest impact response data and scaled performance specifications. Proc 18th Stapp Crash Conference. SAE 741188, pp 459–493, 1974.Google Scholar
  60. Neathery RF, Kroell CK, Mertz HJ. Prediction of thoracic injury from dummy responses. 19th Stapp Car Crash Conference. SAE 751151, pp 295–316, 1975.Google Scholar
  61. Newman RJ, Rastogi S.: Rupture of the thoracic aorta and its relationship to road traffic accident characteristics. Injury 296: 296–299.Google Scholar
  62. Patrick LM. Impact force-deflection of the human thorax. Proc 25th Stapp Car Crash Conference. SAE 811014, pp 471–496, 1981.Google Scholar
  63. Patrick LM, Bohlin NI, Anderson A. Three-point harness accident and laboratory data comparison. Proc 18th Stapp Car Crash Conference. SAE 741181, pp 201–282, 1974.Google Scholar
  64. Patrick LM, Kroell CK, Mertz HJ. Forces on the human body in simulated crashes. Proc Ninth Stapp Car Crash Conference. University of Minnesota, pp 237–260, 1965.Google Scholar
  65. Patrick LM, Mertz HJ, Kroell CK. Cadaver knee, chest and head impact loads. Proc Eleventh Stapp Car Crash Conference. Society of Automotive Engineers, New York, SAE 670913, pp 168–182, 1969.Google Scholar
  66. Robbins DH, Melvin JW, Stalnaker RL. The prediction of thoracic impact injuries. Proc 20th Stapp Car Crash Conference. SAE 760822, pp 699–729, 1976.Google Scholar
  67. Sacreste J, Brun-Cassan F, Fayon A, Tarriere C, Got C, Patel A. Proposal for a thorax tolerance level in side impacts based on 62 tests performed with cadavers having known bone condition. Proc 26th Stapp Car Crash Conference. SAE 821157, pp 155–171, 1982.Google Scholar
  68. Schmidt G, Kallieris D, Barz J, Mattem R. Results of 49 cadaver tests simulating frontal collision of front seat passengers. Proc 18th Stapp Car Crash Conference. SAE 741182, pp 283–291, 1974.Google Scholar
  69. Schneider LW, King AI, Beebe MS. Design requirements and specifications; thorax-abdomen development task. Interim report: trauma assessment device development program. Report No. DOTHS-807–511, 1990.Google Scholar
  70. Somers RL. New ways to use the 1980 Abbreviated Injury Scale. Accident Analysis Group, Laboratory for Public Health and Health Economics, Odense University Hospital, Odense, Denmark, 1982.Google Scholar
  71. Somers RL.: The probability of death score: an improvement of the injury severity score. Accid Anal Prey 15: 247–257, 1983.CrossRefGoogle Scholar
  72. Stalnaker RL, McElhaney JH, Roberts VL, Trollope ML. Human torso response to blunt trauma. In King WF, Mertz HJ (eds) Human impact response measurement and simulation. Plenum Press, New York, pp 181–199, 1973.Google Scholar
  73. Stalnaker RL, Mohan D. Human chest impact protection criteria. Proc 3rd International Conference on Occupant Protection. Society of Automotive Engineers, New York, pp 384–393, 1974.Google Scholar
  74. Stalnaker RL, Tarriere C, Fayon A, Walfisch G, Balthazard M, Masset J, Got C, Patel A. Modification of part 572 dummy for lateral impact according to biomechanical data. Proc 23rd Stapp Car Crash Conference. SAE 791031, pp 843–872, 1979.Google Scholar
  75. Stapp JP. Human exposure to linear decelerations. Part 2. The forward-facing position and the development of a crash harness. AFTR 5915, pt. 2. Wright-Patterson AFB, Dayton, Ohio, 1951.Google Scholar
  76. Stapp JP. Voluntary human tolerance levels. In Gurdjian ES, Lange WA, Patrick LM, Thomas LM (eds) Impact injury and crash protection. Charles C. Thomas, Springfield, IL, pp 308–349, 1970.Google Scholar
  77. Takeda H, Kobayashi S. Injuries to children from airbag deployment. Proc 8th International Technical Conference on Experimental Safety Vehicles. SAE 806030, 1980.Google Scholar
  78. Tarriere C, Walfisch G, Fayon A, Rosey JP, Got C, Patel A, Delmus A. Synthesis of human tolerances obtained from lateral impact simulations. 7th International Conference on Experimental Safety Vehicles, Paris, France, pp 359–373, 1979.Google Scholar
  79. Tsitlik JE, Weisfeldt ML, Chandra N, Effron MB, Halperin HR, Levin HR.: Elastic properties of the human chest during cardiopulmonary resuscitation. Crit Care Med 11 (9): 685–692, 1983.PubMedCrossRefGoogle Scholar
  80. Viano DC.: Evaluation of biomechanical response and potential injury from thoracic impact. Aviat Space Environ Med 49 (1): 125–135, 1978a.PubMedGoogle Scholar
  81. Viano DC. Thoracic injury potential. Proc 3rd International Meeting on Simulation and Reconstruction of Impacts in Collisions, IRCOBI, Bron, France, pp 142–156, 1978b.Google Scholar
  82. Viano DC. Biomechanics of non-penetrating aortic trauma: a review. Proc 27th Stapp Car Crash Conference. SAE 831608, pp 109–114, 1983.Google Scholar
  83. Viano DC. Evaluation of the benefit of energy-absorbing material in side impact protection: part I. Proc 31st Stapp Car Crash Conference. SAE 872212, 1987a.Google Scholar
  84. Viano DC. Evaluation of the benefit of energy-absorbing material in side impact protection: part II. Proc 31st Stapp Car Crash Conference. SAE 872213, 1987b.Google Scholar
  85. Viano DC. Biomechanical responses and injuries in blunt lateral impact. Proc 33rd Stapp Car Crash Conference. SAE 892432, pp 113–142, 1989.Google Scholar
  86. Viano DC, Culver CC, Evans L, Frick M, Scott R. Involvement of older drivers in multi-vehicle side impact crashes. Proc 33rd Annual Proc AAAM, 1989.Google Scholar
  87. Viano DC, Lau IV.: Role of impact velocity and chest compression in thoracic injury. Aviat Space Environ Med 54: 16–21, 1983.PubMedGoogle Scholar
  88. Viano DC, Lau IV. Thoracic impact: a viscous tolerance criterion. Tenth International Conference on Experimental Safety Vehicles, Oxford, England, pp 104–114, 1985.Google Scholar
  89. Walfisch G, Chamouard F, Lesrelin, Fayon A, Tarriere C, Got C, Guillon F, Patel A, Hureau J. Tolerance limits and mechanical characteristics of the human thorax in frontal and side impact and transposition of these characteristics into protection criteria. Proc 7th International Conference on the Biomechanics of Impacts, IRCOBI, Bron, France, pp 122–139, 1982.Google Scholar
  90. Weisfeldt ML. Compliance characteristics of the human chest during cardiopulmonary resuscitation. Final Report No. DOT-HS-805–800, 1979.Google Scholar

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  • John M. Cavanaugh

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