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Vertebral Body Fractures of the L-spine in Frontal Crashes
Transcript of Vertebral Body Fractures of the L-spine in Frontal Crashes
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Vertebral Body Fractures of the L-spine in Frontal Crashes Seattle CIREN University of WashingtonHarborview Injury Prevention and Research CenterRandy Ching PhD Rob Kaufman BS Chris Mack MSEileen Bulger MD
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L-Spine Major Compression Fractures (LSMC)
AIS – 650634.3
Vertebral Body fracture with >20% loss of height
Note: also included 6 of 10 cases coded as a spinal cord injury with fracture of the vertebral body.
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Compressive Lumbar Fractures
Wedge-Compression FxBurst Fracture
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National Automotive Sampling System Data (1993-2008) – LSMC
• 103 cases of LSMC over the period• Weighted
– 12,260 total cases, with over 800 annually• 53% (46) of cases identified as frontal
crashes and 26% as non-horizontal impacts
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National Automotive Sampling System Data (1993-2008) – LSMC
• Mean Model Year - 1993• Mean Delta V = 22mph/36kmph• Mean Age = 35 years• 50% Female, 50% Male• Mean Height/Weight = 5’7”, 160lbs.• 62% drivers, 25% front right position and
13% in second row• Belts used = 61%, 32% air bag deployed
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Compact Truck Large Pickup SUV Sedan/ HB Vans
National Automotive Sampling System Data (1993-2008) – LSMCVehicle Body Types
N = 103
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L-spine Major Compression CIREN Data
Identified 52 Total cases (1996-2009 CIREN)
Gender - 19 Males, 33 Females
Mean Age - 43 years old
Belts used - 43 yes, 9 none
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L-spine-Major Compression CIREN All-Crashes - Fractured locations
L-spine -Major compression fractures
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L1 L2 L3 L4 L5
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Sedan/HB Sport Utility Vehicle Compact Truck Minivan
L-spine-Major Compression CIREN All-Crashes – Body Types
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L-spine-Major Compression CIREN All-Crashes – Model Years
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Rollovers Nearside impacts Front - Non-Horiz Front-Unbelt 2nd seatocc.
Undercarriage - Non-Horiz.
Frontals
L-spine-Major Compression CIREN All-Crashes – Crash Types
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Frontal Non-Horizontals
If the frontal force angle was greater than 15 degrees, then the PDOF is coded as Non-Horizontal to Front plane.
Less than 15 degrees would be classified as Frontal
15 degrees
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Frontal – Non-HorizontalsUndercarriage – Non-Horizontals
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Frontal Non-HorizontalCIREN case example
2007 Compact Utility
- 70’s year old female
- Lap/shoulder belt, no airbag deployments
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Front Non-HorizontalCIREN case example
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Front Non-HorizontalCIREN case example
Frontal, undercarriage damage
Front right passenger location
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Front Non-HorizontalCIREN case example
Seat cushion deformity
L1 burst fracture occurred
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CIREN dataLSMC in Frontals
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CIREN Frontals -Demographics
• 14 cases identified as frontal impacts– Mean Age = 47 years– Gender: 10 of 14 are females– Mean height/weight : 5’6”, 153 lbs– 12 drivers, 2 front right passengers– ALL were lap/shoulder belted
• 11 of 14 equipped with retractor type pretensioners and all actuated
– ALL had frontal impact air bag deployment
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CIREN data Frontals only – Body Types
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Sedan/HB Compact Truck Sport Utility Vehicle Minivan
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CIREN Data - Frontals only• Models Years, 11 of 14 are 2004 & later• Mean Delta V = 26 mph (13/14 coded)
– Range (10-50mph)
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CIREN data - Frontals only LSMC location, fracture types
10 – Burst types ( compression )
4 – Wedge Compression ( flexion, compression/flexion )
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Wedge
Burst
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Frontal – Wedge Comp. Type
2004 Sedan
Head on with Semi Truck
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Deformation of seat cushion noted
Elderly female
Lap/shoulder belt with retractor pretensioner
L4 body wedge compression fracture
Flexion/Compression
Frontal – Wedge Comp. Type
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Frontal – LSMC Burst Type
2008 Compact sport utility vehicle
Delta V = 47 mph
20’s year old female
Lap/shoulder belt with pretensionerwith front air bag deployment
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Frontal – LSMC Burst Type
L5 burst fracture occurred
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Frontal – LSMC Burst Type
2006 Two door hatchback
Delta V = 30mph/48kmph
70 year old, male, 5’7”, 141lbs
Lap/shoulder w/ pretensioner
Frontal and Knee bags deployed
L4 burst fracture occurred
L4 fracture
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Frontal – LCMC Burst TypeFrontal into Tree
2006 Sedan
Delta V = 50 mph
40’s year old female
Major intrusion with some buckling to floor with some seat cushion deformity.
This case occupant had an L2 LSMC burst type fracture
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Frontal – LSMC Burst Type
Frontal impact to guard rail
2001 Two door hatchback
Barrier equivalent = 10 mph
Driver – 40 yrs, Female5’ 7”, 145lbsLap/shoulder belt used
L1 Burst fracture occurred
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Frontal – Burst Type LSMC2007 Sedan
Frontal sideswipe pole and impact to guard rail
Barrier equiv. = 14mph
Driver – 60’s year old female 5’4”,180lbs.
Lap/shoulder belt with pretensioner
L1 burst fracture occurred
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LSMC “Burst Types” involving compression in Frontal Crashes
- Possible Contributing Factors to Examine
I. Some vertical lift of vehicle during impactII. Seat cushion angle, anti-submarine barIII. Some involve high Delta VIV. Belt pretensioners, majority actuatedV. Combination of above
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Front or Rear Lift in Frontals
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Seat Cushion Angle
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Seat Cushion Angle and Deformation
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Seat Cushion Angle and Deformation
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Exterior Views of Frontal Crash Test
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Driver position Pre and Post
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Seat cushion deformation during frontal crash tests
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Conclusions from All Crashes
• Crashes that involved some non-horizontal force were most common in producing a major LSMC fractures
• More than half occurred at L1 in CIREN • More than half involved sedans and
hatchbacks • Address new photo guidelines for CIREN
teams to document seat cushions
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Conclusions on Frontal only group• The frontal only group had a mean age of
45 years old and majority were females with many who were short stature, and lighter in weight
• Most vehicles were late models (2004 - on)• Majority were sedans and hatchbacks• More than half occurred at L1
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Potential Contributing Factors in Frontal Crashes Producing Major Compression L-spine Fractures
• Belt pretensioners actuated in almost all the cases
• The seat cushion angle and deformity were documented in most cases
• Some lift upward of the front or rear of the vehicle may be occurring during the crash to provide some vertical force
• High Delta V crashes, significant intrusion• Combination of the above
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Biomechanical Study
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Biomechanical Study
What is the difference in loading associated with these two fracture types?
Wedge-Compression FxBurst Fracture
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Biomechanical Study
[Q]: Assuming similar loading rates and compression forces (magnitude), will the location of the force vector determine the fracture type?
Wedge-Compression FxBurst Fracture
X
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Biomechanical Study
Methods- Human lumbar segments:
T12-L1-L2 and L3-L4-L5
- High-rate MTS: 0.5-1.0 m/s
- X-Y Stage
- 6-Axis load cell
- “Tipping Point”
- Normalize X (% V.B. width)
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Biomechanical Study
Burst
Wedge-Comp
- Failure load (forces/moments)
- Injury type: Burst / Wedge-Compression
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Thank You