Biomechanical Assessment of Femur Fracture in Pediatric Falls

儿童跌倒股骨骨折的生物力学评估

基本信息

批准号：
8838221
负责人：
GINA E. BERTOCCI
金额：
$ 7.47万
依托单位：
UNIVERSITY OF LOUISVILLE
依托单位国家：
美国
项目类别：
财政年份：
2014
资助国家：
美国
起止时间：
2014-04-14 至 2017-03-31
项目状态：
已结题

项目摘要

DESCRIPTION (provided by applicant): Child abuse is the leading cause of trauma-related fatalities in children less than four years of age. Children one year of age and younger are particularly at risk; approximately 1 out of every 48 children in this age group is a victim of abue or neglect. Cases of physical child abuse are commonly mistaken for accidental trauma. If the abuse goes unrecognized, the child is at risk for further, escalating injuries. An abused child returned to an unsafe home environment has up to an 80% risk for additional injury and up to a 30% risk of death. These repeat occurrences may be preventable through early detection of abuse. Fractures are early indicators of child abuse, but are also a common result of accidental trauma, such as household falls. Clinicians are often faced with the task of determining whether a child's injuries are the result of accidental causes or whether abuse should be suspected. Since household falls are a common false history given by caretakers to conceal abusive trauma, information regarding fracture potential in short-distance falls and specifically what type of fracture could result from different fall scenarios, may aid clinicians in distinguishing abusiv from accidental injuries, thus improving the accuracy of child abuse diagnoses. The purpose of this study is to provide objective, biomechanically-based information regarding femur fracture potential in short-distance falls. Three specific aims have been established to address this goal: (1) Describe femur loading (type and magnitude) associated with short-distance falls in young children, (2) Describe the likelihood of femur fractures in short-distance falls, (3) Develop an improved understanding of the influence of child-specific bone characteristics on fracture potential. This study will involve three primary methodological components. First, a CRABI 12-month-old anthropomorphic test device (ATD) will be modified to improve biofidelity of the lower extremities and instrumented to measure femur loads. Then, fall simulations will be conducted using the improved surrogate to determine femur loading characteristics. The final component involves development of a finite element model of a 12-month-old human child's femur. Femur loads from the ATD experiments will be reproduced in the finite element model. This will provide insight into fracture potential for the combined loading scenarios measured experimentally. Additionally, key parameters will be varied in the model as part of a sensitivity analysis to determine their effect on fracture potential. This will elucidate the effect of child-specific characteristics (such as bone density) on femur fracture potential. The outcomes from this study will provide an improved understanding of femur fracture potential in short-distance pediatric falls and lay the foundation for future work that will improve clinical assessments of injury and history compatibility. Additionally, though this study focuses on femur fracture potential, the approach used may serve as a model for future investigation of fracture potential in other bones.

描述（由申请人提供）：虐待儿童是导致四岁以下儿童创伤相关死亡的主要原因。一岁及以下的儿童尤其面临风险；该年龄组中大约每 48 名儿童中就有 1 名是虐待或忽视的受害者。虐待儿童的案例通常被误认为是意外创伤。如果虐待行为未被识别，孩子就有遭受进一步、不断升级伤害的风险。受虐待的儿童返回不安全的家庭环境后，遭受额外伤害的风险高达 80%，死亡风险高达 30%。通过及早发现滥用行为，这些重复发生是可以预防的。骨折是虐待儿童的早期迹象，但也是意外创伤（例如家庭跌倒）的常见结果。临床医生经常面临确定儿童受伤是否是意外原因或是否应怀疑虐待的任务。由于家庭跌倒是看护者为掩盖虐待创伤而提供的常见虚假历史，因此有关短距离跌倒的骨折可能性以及具体类型的信息骨折可能是由不同的跌倒情况引起的，可以帮助临床医生区分虐待和意外伤害，从而提高虐待儿童诊断的准确性。本研究的目的是提供有关短距离跌倒时股骨骨折可能性的客观的、基于生物力学的信息。为了实现这一目标，我们制定了三个具体目标：(1) 描述与幼儿短距离跌倒相关的股骨负荷（类型和强度），(2) 描述短距离跌倒时股骨骨折的可能性，(3)更好地了解儿童特定的骨骼特征对骨折可能性的影响。这项研究将涉及三个主要方法论组成部分。首先，将对 CRABI 12 个月大的拟人化测试装置 (ATD) 进行修改，以提高下肢的生物保真度，并配备仪器来测量股骨负荷。然后，将使用改进的替代品进行跌倒模拟，以确定股骨负载特征。最后一个部分涉及开发 12 个月大儿童股骨的有限元模型。 ATD 实验中的股骨载荷将在有限元模型中重现。这将有助于深入了解实验测量的组合载荷场景的断裂可能性。此外，作为敏感性分析的一部分，模型中的关键参数将发生变化，以确定它们对断裂可能性的影响。这将阐明儿童特定特征（例如骨密度）对股骨骨折可能性的影响。这项研究的结果将有助于更好地了解儿童短距离跌倒中股骨骨折的可能性，并为未来改善损伤和历史兼容性的临床评估工作奠定基础。此外，虽然这项研究的重点是股骨骨折可能性，但所使用的方法可以作为未来研究其他骨骼骨折可能性的模型。