Experimental model for civilian ballistic brain injury biomechanics quantification

[Orbital firearm injuries]

BACKGROUND

Injuries caused by firearms are fortunately rare in the field of ophthalmology. The treatment of an affected patient is a special challenge both ophthalmologically and emotionally.

METHODS

We report on seven consecutive cases of patients with an orbital gunshot injury who presented in a university hospital over a period of 11 years. The course of events leading to the injury with the weapon involved, the type of projectile, the injury pattern, cranial imaging, treatment and course were evaluated.

RESULTS

A total of seven cases of injuries caused by firearms could be documented and evaluated in the period 2007-2018. All seven patients were male. The average age was 44 ± 27.5 years. Of the injuries five were caused by a suicide attempt and two by an accident. Firearms were used except for one injury caused by a crossbow. There was a retained projectile in four of the cases, the bullet went through the body in two cases and one of the cases presented with a ricochet shot. The final visual acuity was unilateral amaurosis in 1 case and bilateral amaurosis in another case, 1/35 (measured at 1 m) in 1 case, while it varied between 0.2 and 0.7 in the other 4 cases. No patient died as a direct consequence of the firearm injury.

CONCLUSION

Injuries caused by firearms are relatively rare in Germany and mostly have a suicidal background. The pattern of the injury of the ocular structures is very variable. A reconstruction attempt is principally recommended. In the care of patients interdisciplinary cooperation between ophthalmologists and neurosurgeons, orofacial surgeons, ear nose and throat (ENT) surgeons and psychiatrists is necessary.

Ten years of molecular ballistics-a review and a field guide

Molecular ballistics combines molecular biological, forensic ballistic, and wound ballistic insights and approaches in the description, collection, objective investigation, and contextualization of the complex patterns of biological evidence that are generated by gunshots at biological targets. Setting out in 2010 with two seminal publications proving the principle that DNA from backspatter collected from inside surfaces of firearms can be retreived and successfully be analyzed, molecular ballistics covered a lot of ground until today. In this review, 10 years later, we begin with a comprehensive description and brief history of the field and lay out its intersections with other forensic disciplines like wound ballistics, forensic molecular biology, blood pattern analysis, and crime scene investigation. In an application guide section, we aim to raise consciousness to backspatter traces and the inside surfaces of firearms as sources of forensic evidence. Covering crime scene practical as well as forensic genetic aspects, we introduce operational requirements and lay out possible procedures, including forensic RNA analysis, when searching for, collecting, analyzing, and contextualizing such trace material. We discuss the intricacies and rationales of ballistic model building, employing different tissue, skin, and bone simulants and the advantages of the “triple-contrast” method in molecular ballistics and give advice on how to stage experimental shootings in molecular ballistic research. Finally, we take a look at future applications and prospects of molecular ballistics.

Mathematical modeling and computer simulation of needle insertion into soft tissue

In this study we present a kinematic approach for modeling needle insertion into soft tissues. The kinematic approach allows the presentation of the problem as Dirichlet-type (i.e. driven by enforced motion of boundaries) and therefore weakly sensitive to unknown properties of the tissues and needle-tissue interaction. The parameters used in the kinematic approach are straightforward to determine from images. Our method uses Meshless Total Lagrangian Explicit Dynamics (MTLED) method to compute soft tissue deformations. The proposed scheme was validated against experiments of needle insertion into silicone gel samples. We also present a simulation of needle insertion into the brain demonstrating the method's insensitivity to assumed mechanical properties of tissue.

Human Pelvis Bayesian Injury Probability Curves From Whole Body Lateral Impact Experiments

Injury criteria are used in military, automotive, and aviation environments to advance human safety. While injury risk curves (IRCs) for the human pelvis are published under vertical loading, there is a paucity of analysis that describe IRCs under lateral impact. The objective of the present study is to derive IRCs under this mode. Published data were used from 60 whole-body postmortem human surrogate (PMHS) tests that used repeated testing protocols. In the first analysis, from single impact tests, all injury data points were considered as left censored and noninjury points were considered as right censored, while repeated testing results were treated as interval censored data. In the second analysis, injury data were treated uncensored. Peak force was used as the response variable. Age, total body mass, gender, and body mass index (BMI) were used as covariates in different combinations. Bayesian survival analysis model was used to derive the IRCs. Plus-minus 95% credible intervals (CI) and their normalized CI sizes (NCIS) were obtained. This is the first study to develop IRCs in whole body PMHS tests to describe the human pelvic tolerance under lateral impact using Bayesian models.

Ballistic gelatine-what we see and what we get

Since decades, 10% gelatine is used to visualize and estimate the energy transfer of projectiles. The study performed investigates the correlation of the temporary cavity (TC) recorded by high-speed video (HSV) and the cracks in gelatine slices. A total of 36 shots were performed from distance using form-stable bullets (FMJ), 12 using deforming bullets (HP) in the calibres .32 auto, .38 special and 9 mm Luger. The target models were prepared according to Fackler's standard as 10% gelatine cubes with 12 cm edge length doped with a paint pad beneath the front cover ("reference cube"). Scaled images of the TC were recorded with 40.000 fps. The cubes were cut into 1-cm-thick gelatine cross sections, which were scanned. The evaluation of the destruction (cracks) was performed by the mean of image analysis measuring the longest crack, the wound profile according to Fackler and applying the polygon method. The height of the TC was measured each cm along the bullet path. The energy deposited ranged between 54 and 269 J. FMJ caused tubular, HP provoked pear-like TC. The tubular aspect was consistent with the quasi-constant deceleration of FMJ; however, the pear-like TC did not metrically represent the deceleration of HP. The profiles of destruction parameters were convex for both projectile types and did not match the profile of bullet deceleration. The maximum of TC stretching observed in HSV did not coincide with maximum gelatine destruction (crack lengths). The total energy transfer correlated with all considered destruction parameters in their sum; however, the cross-sectional parameters did not reflect the energy transfer per centimetre bullet path. The sum of the TC's heights correlated with the energy deposited, but differently for FMJ and HP. Obviously, the 12-cm reference cube reflects the energy transfer by a bullet as a whole.

[Update on gunshot wounds to extremities]

Due to recent rampage and terror attacks in Europe, gunshot wounds have become a focus of attention even though they are still rare in Europe. Approximately 50% of gunshot wounds affect the extremities and to understand the sequelae, a basic knowledge of wound ballistics is indispensable. The energy transmitted from the bullet to the tissue is responsible for the severity of the injury and is dependent on the type of weapon and ammunition. A differentiation is made between low-energy injuries caused, e.g. by pistols and high-energy injuries mostly caused by rifles. The higher energy transfer to the tissue in high-energy injuries, results in a temporary wound cavity in addition to the permanent wound channel with extensive soft tissue damage. High-energy gunshot fractures are also more extensive compared to those of low energy injuries. Debridement seems to be necessary for almost all gunshot wounds. Fractures should be temporarily stabilized with an external fixator due to contamination.

Cavitation nucleation in gelatin: Experiment and mechanism

Dynamic cavitation in soft materials is becoming increasingly relevant due to emerging medical implications such as the potential of cavitation-induced brain injury or cavitation created by therapeutic medical devices. However, the current understanding of dynamic cavitation in soft materials is still very limited, mainly due to lack of robust experimental techniques. To experimentally characterize cavitation nucleation under dynamic loading, we utilize a recently developed experimental instrument, the integrated drop tower system. This technique allows quantitative measurements of the critical acceleration (a_cr) that corresponds to cavitation nucleation while concurrently visualizing time evolution of cavitation. Our experimental results reveal that a_cr increases with increasing concentration of gelatin in pure water. Interestingly, we have observed the distinctive transition from a sharp increase (pure water to 1% gelatin) to a much slower rate of increase (∼10× slower) between 1% and 7.5% gelatin. Theoretical cavitation criterion predicts the general trend of increasing a_cr, but fails to explain the transition rates. As a likely mechanism, we consider concentration-dependent material properties and non-spherical cavitation nucleation sites, represented by pre-existing bubbles in gels, due to possible interplay between gelatin molecules and nucleation sites. This analysis shows that cavitation nucleation is very sensitive to the initial configuration of a bubble, i.e., a non-spherical bubble can significantly increase a_cr. This conclusion matches well with the experimentally observed liquid-to-gel transition in the critical acceleration for cavitation nucleation.

STATEMENT OF SIGNIFICANCE

From a medical standpoint, understanding dynamic cavitation within soft materials, i.e., tissues, is important as there are both potential injury implications (blast-induced cavitation within the brain) as well as treatments utilizing the phenomena (lithotripsy). In this regard, the main results of the present work are (1) quantitative characterization of cavitation nucleation in gelatin samples as a function of gel concentration utilizing well-controlled mechanical impacts and (2) mechanistic understanding of complex coupling between cavitation and liquid-/solid-like material properties of gel. The new capabilities of testing soft gels, which can be tuned to mimic material properties of target organs, at high loading rate conditions and accurately predicting their cavitation behavior are an important step towards developing reliable cavitation criteria in the scope of their biomedical applications.

Use of agar/glycerol and agar/glycerol/water as a translucent brain simulant for ballistic testing

The suitability of agar/glycerol/water and agar/glycerol mixtures as brain simulants was investigated. Test specimens (n=15) (50x27×37mm) were fabricated for these different mixtures and conditioned to 12°C, 22°C, and 26°C prior to testing. For comparison, fresh deer brain specimens (n=20) were sourced and prepared to the same dimensions as the agar/glycerol(/water) mixtures and conditioned to 12°C and 37°C. High impact tests were carried out with a 0.22-caliber air rifle pellet and a high-speed camera was used to record the projectile as it passed through the specimens, allowing for energy loss and vertical displacement velocity calculation. Although the agar/glycerol/water mixture presented with similar vertical expansion and contraction of the specimens to the warm and cold deer brains, a two-fold decrease of the vertical expansion and contraction was noticed with the agar/glycerol specimens. Also considerably less extrusion of this mixture out of the exit and entry sides after specimen penetration was observed. Of the simulants tested, agar/glycerol/water was the most suitable brain simulant for ballistic testing and impact studies.

Evaluating simulant materials for understanding cranial backspatter from a ballistic projectile

In cranial wounds resulting from a gunshot, the study of backspatter patterns can provide information about the actual incidents by linking material to surrounding objects. This study investigates the physics of backspatter from a high-speed projectile impact and evaluates a range of simulant materials using impact tests. Next, we evaluate a mesh-free method called smoothed particle hydrodynamics (SPH) to model the splashing mechanism during backspatter. The study has shown that a projectile impact causes fragmentation at the impact site, while transferring momentum to fragmented particles. The particles travel along the path of least resistance, leading to partial material movement in the reverse direction of the projectile motion causing backspatter. Medium-density fiberboard is a better simulant for a human skull than polycarbonate, and lorica leather is a better simulant for a human skin than natural rubber. SPH is an effective numerical method for modeling the high-speed impact fracture and fragmentations.

Development of a finite element model of decompressive craniectomy

Decompressive craniectomy (DC), an operation whereby part of the skull is removed, is used in the management of patients with brain swelling. While the aim of DC is to reduce intracranial pressure, there is the risk that brain deformation and mechanical strain associated with the operation could damage the brain tissue. The nature and extent of the resulting strain regime is poorly understood at present. Finite element (FE) models of DC can provide insight into this applied strain and hence assist in deciding on the best surgical procedures. However there is uncertainty about how well these models match experimental data, which are difficult to obtain clinically. Hence there is a need to validate any modelling approach outside the clinical setting. This paper develops an axisymmetric FE model of an idealised DC to assess the key features of such an FE model which are needed for an accurate simulation of DC. The FE models are compared with an experimental model using gelatin hydrogel, which has similar poro-viscoelastic material property characteristics to brain tissue. Strain on a central plane of the FE model and the front face of the experimental model, deformation and load relaxation curves are compared between experiment and FE. Results show good agreement between the FE and experimental models, providing confidence in applying the proposed FE modelling approach to DC. Such a model should use material properties appropriate for brain tissue and include a more realistic whole head geometry.

NUMERICAL ANALYSIS OF A PROJECTILE PENETRATION INTO THE HUMAN HEAD VIA MESHLESS METHOD

In recent years, physicists, engineers and medical scientists have tried to demonstrate the biomechanics of gunshot wounds with numerical methods and experimental observations. Currently, the finite element method (FEM) is the most widely used numerical method among the studies related to ballistic wound injuries. However, when the FEM is used for the penetration analysis, the path of the projectile in the skull is subjected to extremely large deformations which will introduce errors due to distortion of elements. To overcome this error, the meshfree technique was established to simulate the gunshot wound as a preliminary study in which the skull was modeled by smoothed particle hydrodynamics (SPH) and the projectile was modeled by nondeformable rigid elements. In order to simulate a realistic penetration phenomenon, orthotropic material properties were defined for different regions (forehead, zygomatic and mandible) with material principal axis along the surface of the bones.

Human response to the ballistics impacts were determined in terms of force occurring along the pathway of the bullet in the skull, residual velocity of the projectile and penetration depth. The obtained results were compared with the data reported in literature. As a result, mechanical behavior of the head under ballistic impacts simulated by the SPH, compared well with the results determined by the data given in literature, which indicates the applicability of the SPH method as a powerful technique in simulating different gunshot wound mechanisms.

Experimental investigation of the mechanical properties of brain simulants used for cranial gunshot simulation

The mechanical properties of the human brain at high strain rate were investigated to analyse the mechanisms that cause backspatter when a cranial gunshot wound occurs. Different concentrations of gelatine and a new material (M1) developed in this work were tested and compared to bovine brain samples. Kinetic energy absorption and expansion rate of the samples caused by the impact of a bullet from .22 air rifle (AR) (average velocity (uav) of 290m/s) and .22 long rifle (LR) (average velocity (uav) of 330m/s) were analysed using a high speed camera (24,000fps). The AR projectile had, in the region of interest, an average kinetic energy (Ek) of 42±1.3J. On average, the bovine brain absorbed 50±5% of Ek, and the simulants 46-58±5%. The Ek of the .22 LR was 141±3.7J. The bovine brain absorbed 27% of the .22LR Ek and the simulants 15-29%. The expansion of the sample, after penetration, was measured. The bovine brain experienced significant plastic deformation whereas the gelatine solution exhibited a principally elastic response. The permanent damage patterns in the M1 material were much closer to those in brain tissue, than were the damage patterns in the gelatine. The results provide a first step to developing a realistic experimental simulant for the human brain which can produce the same blood backspatter patterns as a human brain during a cranial gunshot. These results can also be used to improve the 3D models of human heads used in car crash and blast trauma injury research.

Volumetric intraoperative brain deformation compensation: model development and phantom validation

During neurosurgery, nonrigid brain deformation may affect the reliability of tissue localization based on preoperative images. To provide accurate surgical guidance in these cases, preoperative images must be updated to reflect the intraoperative brain. This can be accomplished by warping these preoperative images using a biomechanical model. Due to the possible complexity of this deformation, intraoperative information is often required to guide the model solution. In this paper, a linear elastic model of the brain is developed to infer volumetric brain deformation associated with measured intraoperative cortical surface displacement. The developed model relies on known material properties of brain tissue, and does not require further knowledge about intraoperative conditions. To provide an initial estimation of volumetric model accuracy, as well as determine the model's sensitivity to the specified material parameters and surface displacements, a realistic brain phantom was developed. Phantom results indicate that the linear elastic model significantly reduced localization error due to brain shift, from > 16 mm to under 5 mm, on average. In addition, though in vivo quantitative validation is necessary, preliminary application of this approach to images acquired during neocortical epilepsy cases confirms the feasibility of applying the developed model to in vivo data.

Designing the ideal model for assessment of wound contamination after gunshot injuries: a comparative experimental study

Background

Modern high-velocity projectiles produce temporary cavities and can thus cause extensive tissue destruction along the bullet path. It is still unclear whether gelatin blocks, which are used as a well-accepted tissue simulant, allow the effects of projectiles to be adequately investigated and how these effects are influenced by caliber size.

Method

Barium titanate particles were distributed throughout a test chamber for an assessment of wound contamination. We fired .22-caliber Magnum bullets first into gelatin blocks and then into porcine hind limbs placed behind the chamber. Two other types of bullets (.222-caliber bullets and 6.5 × 57 mm cartridges) were then shot into porcine hind limbs. Permanent and temporary wound cavities as well as the spatial distribution of barium titanate particles in relation to the bullet path were evaluated radiologically.

Results

A comparison of the gelatin blocks and hind limbs showed significant differences (p < 0.05) in the mean results for all parameters. There were significant differences between the bullets of different calibers in the depth to which barium titanate particles penetrated the porcine hind limbs. Almost no particles, however, were found at a penetration depth of 10 cm or more. By contrast, gas cavities were detected along the entire bullet path.

Conclusion

Gelatin is only of limited value for evaluating the path of high-velocity projectiles and the contamination of wounds by exogenous particles. There is a direct relationship between the presence of gas cavities in the tissue along the bullet path and caliber size. These cavities, however, are only mildly contaminated by exogenous particles.

Wounding capacity of muzzle-gas pressure

BACKGROUND

Suicidal gunshot wounds that are caused by ammunition fired from a 9-mm Luger pistol, with direct contact between the gun muzzle and the victim's head, present a serious injury pattern even with full metal jacket bullets. Wound ballistic experiments were performed to clarify whether muzzle gases from the firearm have an additional wounding potential.

METHODS

Fifteen head models were prepared as follows: an acryl sphere measuring 14 cm in diameter was completely covered with a layer of silicon that was 3 mm thick. These spheres were filled with 10% gelatine. At 4°C, these models were fired at with a 9-mm Luger pistol, loaded with Quick Defense 1 expanding bullets. Five shots were fired with direct muzzle contact, one shot was fired from a distance of 10 cm, four shots were fired from a distance of 2 m, and five shots were fired from a distance of 4 m.

RESULTS

Each projectile penetrated the model; all but one projectile deformed regularly. Each acryl sphere shattered into comminuted pieces but was held together by the silicon cover. The gelatine filling was then cut into slices 1 cm thick, and each slice was optically scanned. An evaluation was performed following both Fackler's Wound Profile method and the polygon procedure method. The pattern of gelatine disruption did not differ in shots from intermediate ranges, but the amount of gelatine destruction was always more extended in the case of muzzle contact shots. Depending on the section of the bullet path, crack lengths were 31% to 133% longer in contact shots. The first centimetre and the second half of the bullet path showed the greatest increase.

CONCLUSION

The experimental findings prove the wounding capacity of muzzle gases.

A new model for the characterization of infection risk in gunshot injuries: technology, principal consideration and clinical implementation

INTRODUCTION

The extent of wound contamination in gunshot injuries is still a topic of controversial debate. The purpose of the present study is to develop a model that illustrates the contamination of wounds with exogenous particles along the bullet path.

MATERIAL AND METHODS

To simulate bacteria, radio-opaque barium titanate (3-6 μm in diameter) was atomized in a dust chamber. Full metal jacket or soft point bullets caliber .222 (n = 12, v0 = 1096 m/s) were fired through the chamber into a gelatin block directly behind it. After that, the gelatin block underwent multi-slice CT in order to analyze the permanent and temporary wound cavity.

RESULTS

The permanent cavity caused by both types of projectiles showed deposits of barium titanate distributed over the entire bullet path. Full metal jacket bullets left only few traces of barium titanate in the temporary cavity. In contrast, the soft point bullets disintegrated completely, and barium titanate covered the entire wound cavity.

DISCUSSION

Deep penetration of potential exogenous bacteria can be simulated easily and reproducibly with barium titanate particles shot into a gelatin block. Additionally, this procedure permits conclusions to be drawn about the distribution of possible contaminants and thus can yield essential findings in terms of necessary therapeutic procedures.

Effects of tissue preservation temperature on high strain-rate material properties of brain

Postmortem preservation conditions may be one of factors contributing to wide material property variations in brain tissues in literature. The objective of present study was to determine the effects of preservation temperatures on high strain-rate material properties of brain tissues using the split Hopkinson pressure bar (SHPB). Porcine brains were harvested immediately after sacrifice, sliced into 2 mm thickness, preserved in ice cold (group A, 10 samples) and 37°C (group B, 9 samples) saline solution and warmed to 37°C just prior to the test. A SHPB with tube aluminum transmission bar and semi-conductor strain gauges were used to enhance transmitted wave signals. Data were gathered using a digital acquisition system and processed to obtain stress-strain curves. All tests were conducted within 4 h postmortem. The mean strain-rate was 2487±72 s(-1). A repeated measures model with specimen-level random effects was used to analyze log transformed stress-strain responses through the entire loading range. The mean stress-strain curves with ±95% confidence bands demonstrated typical power relationships with the power value of 2.4519 (standard error, 0.0436) for group A and 2.2657 (standard error, 0.0443) for group B, indicating that responses for the two groups are significantly different. Stresses and tangent moduli rose with increasing strain levels in both groups. These findings indicate that storage temperatures affected brain tissue material properties and preserving tissues at 37°C produced a stiffer response at high strain-rates. Therefore, it is necessary to incorporate material properties obtained from appropriately preserved tissues to accurately predict the responses of brain using stress analyses models, such as finite element simulations.