On equal footing: Trends in ankle/foot injuries for men vs. women

Trend, disparities, and projection analysis of public data on foot fractures in Sweden: a retrospective analysis of 179 129 fractures

INTRODUCTION

Orthopedic injuries to the foot constitute a significant portion of lower extremity injuries, necessitating an understanding of trends for effective preventive strategies and resource allocation. Demographic shifts, improved traffic safety, and lifelong physical activity may alter incidence rates, trauma mechanisms, and fracture distribution. This study explores the prevalence of foot fractures in Sweden using publicly available data.

METHODS

Utilizing data from the Swedish National Board of Health and Welfare (SNBHW) spanning 2008-2022, retrospective study focuses on foot fractures in Sweden. Analysis includes calculating annual incidence rates per 100,000 person-years, assessing temporal trends, and exploring seasonal variations. Poisson regression analysis was used for projections into 2035.

RESULTS

Between 2008-2022, the average annual foot fracture incidence was 11,942, with notable fluctuations influenced by the COVID-19 pandemic. Age and sex disparities impact rates, and seasonal variance highlights increased incidence in summer. By 2035, foot fractures will decreasae amongst several demographic groups.

CONCLUSION

This study provides insights into temporal trends, sex differences, and seasonal variations foot fracture patterns in Sweden. The identified trends suggest the utilization of targeted preventive strategies, efficient resource allocation, and informed healthcare planning. Despite limitations, this research offers valuable insights into foot fractures within the Swedish population, utilizing publicly aggregated data.

Lower Extremity Impact and Injury Responses of Male and Female PMHS to High-Rate Vertical Loading

Whole-body PMHS (Post Mortem Human Surrogate) testing was conducted on the Accelerative Loading Fixture (ALF), which is designed to generate floor and seat loading conditions at the level, rate, location, direction, and extent seen in UBB (Underbody Blast). The overarching goal of this research effort was to examine potential differences in the lower extremity response of females and males under UBB conditions. The ALF consists of an occupant platform that is driven upward by the detonation of an explosive charge. The floor plate undergoes plastic deformation. The occupant platform supports two rigid seats for surrogates. Twenty un-embalmed PMHS were tested, including 50th-percentile males, 75th-percentile females, and 5th-percentile females. Two test series were conducted. Series A had a target floor speed of 8 m/s (2-ms time-to-peak) with a target seat speed of 5 m/s (4-ms time-to-peak). Series B had a target floor speed of 20 m/s (2-ms time-to-peak) with a target seat speed of 4 m/s (7-ms time-to-peak). Major damage occurred to the femur, tibia, fibula, talus, and calcaneus. Lower extremity damage type, incidence, and extent varied between the two sexes. Fifty-percent probability of calcaneus fracture for less than 3-ms time-to-peak is associated with a 781-g peak tibia vertical acceleration for 50th-percentile males, 650-g for 75th-percentile females, and 396-g for 5th-percentile females. Fifty-percent probability of calcaneus fracture, regardless of time-to-peak, is associated with a 368-g peak femur vertical acceleration for 50th-percentile males, 332-g for 75th-percentile females, and 218-g for 5th-percentile females. These results show differences in kinematics and damage outcome between female and male PMHS in UBB conditions. These findings will inform future decisions regarding the requirements for test capabilities that incorporate the female Warfighter. Ultimately, advancements can be made in injury assessment tools such as improved physical surrogates, injury assessment and prediction criteria, modeling and simulation capabilities, test methods, and the optimization of military ground vehicles, personal protective equipment, and injury countermeasures.

Assessing the Cushion Effect: A Systematic Review and Meta-Analysis of the Role of Obesity in Motor Vehicle Injuries and Fatalities

PURPOSE

A systematic review and meta-analysis were done to evaluate the effect of obesity in injury and mortality due to motor vehicle accidents.

MATERIALS & METHODS

The systematic review consisted of 20 studies meeting the inclusion criteria. The meta-analysis was conducted on these studies to analyze obesity as a risk factor for specific injuries, as well as overall injury and mortality compared to non-obese patients.

RESULTS

The data revealed that obesity was associated with increased lower extremity injuries (odds ratio [OR] = 1.44, 95% confidence interval [CI] = 1.19-1.69, P ≤ 0.05), neck injuries (OR = 3.38, 95% CI = 1.58-5.19, P ≤ 0.05), and overall mortality (OR = 1.51, 95% CI = 1.40-1.61, P ≤ 0.05). When stratified for obesity class with class I as BMI >30.1-34.9, class II BMI 35-39.9, and class III BMI >40, only class II (OR = 1.20, 95% CI = 1.15-1.24, P ≤ 0.05) and class III (OR = 1.49, 95% CI = 1.30-1.68, P ≤ 0.05) were associated with increased mortality risk. No significant differences were seen with head, upper extremity, thoracic, abdominal, or pelvic injuries.

CONCLUSION

Obesity is a risk factor in motor vehicle accidents for fatality and injury, specifically lower extremity and neck injuries.

Numerical investigation of driver lower extremity injuries in finite element frontal crash reconstruction

OBJECTIVE

Lower extremity injuries are the most frequent Abbreviated Injury Scale (AIS) 2 injury for drivers in frontal crashes. The objective was to reconstruct 11 real-world motor vehicle crashes (2 with AIS 2+ distal lower extremity injury and 9 without lower extremity injury) and to analyze the vehicle parameters and driver attributes that affect injury risk.

METHODS

Eleven frontal crashes were reconstructed with a finite element simplified vehicle model (SVM) using a semi-automated optimization method. The SVM was tuned to each corresponding vehicle and the Total HUman Model for Safety (THUMS) Ver 4.01 was scaled and positioned in a baseline configuration to mimic the documented precrash driver posture. The event data recorder crash pulse was applied as the boundary condition for each case. Additionally, for the 2 cases with lower extremity injury, 120 simulations to quantify the uncertainty and response variation were performed varying the following parameters using a Latin hypercube design of experiment (DOE): seat track position, seatback angle, steering column angle, steering column position, and D-ring height. Injury metrics implemented within THUMS were calculated from the femur, tibia, and ankle and cross-compared among the 11 baseline cases using tibia index and multiple injury risk functions. Kinetic and kinematic data from the 120-simulation DOE were analyzed and fit to regression models to examine any causal relationship between occupant positioning and lower extremity injury risk.

RESULTS

Of the 11 real-world crashes, both cases with lower extremity injuries resulted in elevated tibia axial forces and resultant bending moments, compared to the 9 cases without lower extremity injury. The average tibia index of the 2 cases with distal lower extremity injury (left: 1.79; right: 1.19) was higher than that in the 9 cases without lower extremity injury (left: 1.16, P =.024; right: 0.82, P =.024). An increased risk of AIS 2+ tibia shaft (33.6%), distal tibia and hindfoot (20.0%), as well as ankle malleolar (14.5%) fracture was also observed for the injured compared to the noninjured cases. Rearward seat track position, reclined seat back angle, and reduced seat height were correlated with elevated tibia axial force and increased tibia index, imposing additional lower extremity injury risk.

CONCLUSIONS

This study provides a computational framework for assessing lower extremity injuries and elucidates the effect of precrash driver posture on lower extremity injury risk while accounting for vehicle parameters and driver attributes. Results from the study aid in the evaluation of real-world injury data, the understanding of factors contributing to injury risk, and the prevention of lower extremity injuries.