ANTHROPOMETRY AND TRAUMATOLOGY OF THE ......Michigan, USA, Feb. 1975, Paper 75 04 23 8. Tanner,...
Transcript of ANTHROPOMETRY AND TRAUMATOLOGY OF THE ......Michigan, USA, Feb. 1975, Paper 75 04 23 8. Tanner,...
ANTHROPOMETRY AND TRAUMATOLOGY OF THE PELVIS OF CHILDREN
by G . Stürtz
Daiml e r - Benz AG, Stuttgart , Germany
ABSTRACT
In the c a s e of child road users the p elvi s shows the lowe st r i sk of inj ury compar e d to o ther b o dy regions . Be ing also l o c a t e d near to the b o dy ' s centre of gravity , the pelvis i s particularly sui t ab l e for the diver sion of mass forc e s .
For this reason , an analy s i s will be given o f the traumat o l o gy , the b i ome chani c s and e sp e c i a l ly the anthropometry of the child ' s pelvi s , taking the following i t ems into considerat ion :
o typ i c al contact region of exterior road users under lat eral l o a d
o contact region o f r e s trained p a s senger car o c cupant s under frontal load
o g e ometri cally r e levant constru c t i on in the case of anthropome tric dununi e s .
Using frontal ( anterior - p o s t erior ) and lat eral X-ray phot o graphs of the p elvi s with children - given by p o s t mort em examinations - , the typ i c a l geometry o f the pelvis depending on phy s i o lo g i cal age is d e duc e d . In addi tion to thi s , the s e r e su l t s are compared with data of anthrop ome t r i c dummi e s .
Furthermore , an analy s i s o f the traumat o logy o f the child ' s p e lvis· is carr i e d out wi th r egard t o. typ e , s everi ty and r i sk of injur i e s b a s e d o n in-depth s ingle - c a s e analys e s of r e a l road a c ci dent s . The aim of thi s i s to improve the understanding of the sp e c ial injury me chani sms of this b o dy region r e s p e c t ively t o round off the l evel of knowl e dg e by d e s cribing the general biomechani c s o f the p e lvi s .
INTRODUCTI ON
The traumat o l o gy of road a c c i dents shows that the child ' s pelvis region is marked by a low r i sk of injury ( 1 ) . Part i cularly in the c a s e of child p e d e s tr ians ( 1 ) i t b e comes apparent that among the body r e gi ons in que s t ion s truck by a blunt l a t eral load at the same imp a c t sp e e d , the Relat ive Trauma t i c �egr e e ( combination of injury fre quency and inj ury s everity ) of the p e lvis r egion i s lowe s t .
Therefore this region i s o f s·p e cial importan c e :
o a s a lat eral conta c t area t o be aimed for in the c a s e o f p e d e s trians and , t o some ext ent , a l s o two -wh e e l - r i ders
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o a s a front al contact zone for a lap belt for older chi l dren
o with r e gard t o the de s ign o f anthropomet r i c dummi e s .
TRAUMATOLOGY
In order t o demonstrate the sp e c ial injury mechani sms o f the pelvis region, the trauma t i c degree a s well a s the s ever i ty and type of injur i e s ob s erve d are explained in the following .
On the b a s i s of in-depth s ingle - ca s e analy s e s of r e a l road a c c ident s in which children were involve d , i t turns out conc erning the degree of endangerment ( Tr auma t i c Degr e e ) compared to o ther b o dy regions , the pelvis region can be c l a s s i f i e d a s follows :
o in the c a s e o f p e d e s tr i ans ( 1 ) approx . r ank 8
o in the case of re strained and unr e strained c ar o c cupant s ( 1 ) appro x . rank 9 r e sp e c t ively 5
o in the c a s e of two -wh e e l -riders ( 2 ) approx . rank 5
The severity degree of the injur i e s caused t o children i s on average appro x . AIS 2 ( J ) for p e d e s t r i ans , AIS 1 for r e s trained p a s s enger c ar o c cupant s , appro x . AIS 2 for unr e s trained o c cup ant s ( 1 ) and AIS 1 to 2 for two-whe e l -r i ders ( 2 ) .
Among 49 c a s e s wi th injur i e s of the pelvis r e g i o n , the maj or i ty , i . e . 2 9 children , had soft t i s sue injur i e s , and the !arger part of the s e ( n = 2 3 ) suffered brui s e s and , in some c a s e s , haematoma s . P elvic bone injur i e s have b e en o b s erve d in 1 9 c a s e s a s follows :
o in e i ght c a s e s a pub i s frac ture and of the s e one c a s e with bur st of the symphy s i s ( AIS 2 to J )
o in four c a s e s a p e lvis girdle fracture , o f t h e s e two c a s e s with j o int p an p ar t i cipat ion ( AIS J )
o in four c a s e s a palm frac ture ( AI S 2 ) o and in thr e e c a s e s an i s chial fractur e , two c a s e s o f the s e
from type o f a doub l e fra c ture ( AI S J )
BIOMECHANI C S
A d e s cription of some facts o f t h e general b i ome chani c s of the pelvis is added to round off the l evel of knowl e dg e of thi s b o dy region . The child pelvis i s r elat ively soft and smal l and up to the age o f 10 no i l i a c spinae have yet devel op e d ( 4 ) . The rounded p elvi s palms , t o ge ther wi th the thick sub cutaneous t i s sue , produ c e a negat ive submarining effect o f the child ' s pelvis and urogenital region under a lap b e l t ( 5 ) . Thi s i s only partly comp ensat e d for by the lordo s i s of the lumbar vertebrae .
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DERIVATION OF CHILD PELVIS GEOMETRY
Using frontal ( anterior - p o s t erior ) and lat eral X-ray photographs of the infant pelvis ( sour c e s : Hannover Medical Univers ity , Institute for Forensi c Medic ine o f Heidelberg University ) from p o s t mortem examina t i ons , the typ i cal geometry of the p elvi s can be derived depending on physiologi cal age .
Ten children b e tween 2 , 1 0 and 1 1 , 8 years of age are documented ( se e F i gure 1 ) . In order t o a s s e s s the p o s it ion of the children examined in the general spe c trum , apart from s e x , the following data have been r e corded :
Body mas s Height S i t t ing height Circumference o f ehe st Circumference o f upper arm Circumference of wri s t Circumference o f c alf
The knowle dge o f the s e anthropometric data and the use of rel evant l i t erature ( 6 ) ( 7 ) make s it p o s s ib l e to derive a physiologi cal age ( 8 ) whi ch describes the state of phy s i cal development ( growth and shap e ) and who s e mean value - as c al culat e d from th� two sour c e s -i s g i ven in F i gure 1 . As a r e sul t , the age group t o b e exam·ined r e a che s from approx . 2 , 10 to 1 q , 5 years of age .
To c a l culat e the enlargement of the p e lvis image or part thereof on the X-ray pho t ograph s , the following s e t t ing data for the X-ray equipment have been r e g i s t er e d in addit ion :
Distanc e b e tween focus and obj e c t Distance b e tween focus and plate Di s t ance b e twe en focus and film
F i gure 2 provi d e s a frontal and l at eral view of the do cument ed p elvis regions . The following geometrically s i gnificant dimens ions ( se e a l s o F i gure J ) - do cumented in Figure 1 - c an be derived from thi s view :
YB lateral width of the p elvic brim
lateral d i st ance b etween the anterior sup erior i l i a c cre s t s
lateral c l e arance between the tuber o f the i s chium
ant erior/p o s t erior di stance b etween ant erior sup er i or i l i a c c r e s t and sacrum
ver t ic a l di s tance b etween tubers o f the i schium and proximal p elvi s p alms
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ver t i cal distance b etween tubers o f the i schium and ant erior sup erior iliac crest
RESULTS
From Figure 2 can b e taken , that the rounded p elvis p alms respe c t ively the not or incomp l e t e develop e d iliac sp inae produce a negat ive submarining effect under a lap b e l t the younger the children are .
A de s crip t i on of the derived anthropometric data of the p elvis region versus physiologi cal age is given in Figure J . Since the individual c a s e s are no t s cattered linearly over the physiologi cal age , it has not b e en po s sible to supply dat a dir e c t for every a g e group . For this reason, linear regress ion analy s e s have b e en carried out ( correla t �on co effic i ent s 0 , 8 3 - 0 , 96 ) which make it p o s s ible t o read off charac t e r i s t i c anthropometr i c p elvi s data of 3 - , 6 - and 10-year-old dhi ldren a s shown in Figure 4 . Figure 3 and 4 also contains the r e sp e ctive data of anthropome tric dummi e s , namely of the Alderson VIP Je and 6 c who s e p elvi s r egion is also shown in Fi gure 2 lat erally and in a/� view. In addi t i on Figure 3 shows the charat eristic data of the Hybrid I I dummy .
The geometrical dimensions of the p elvis o f chil d dummi e s differ s l ightly or consi derably from tho s e of the do cument e d chil dren. For instanc e , the ver t ical he ight o f the p e lvis ( zTp ) a s well a s the a/p distance between ant erior sup erior i l i a c crest and sacrum ( xcs > i s considerably greater in the dummi e s , whereas the l at eral distance be tween the ant erior sup erior iliac cre s t s (yc ) i s in some c a s e s much too small .
In the c a s e of the child dummi e s di s cus s e d here , the lower . pe lvi s region ( tubers of the i s chium , lower r egion of the p elvis palms ) i s not shap e d anthropometri c al ly . As c ompared t o r eality p o s i t i oning o f a lap belt and compre s s ion in the seat area i s exp e c t e d t o b e different a s well a s there i s no frontal support in the lower region of the p e lvi s palm s .
DISCUSSION
The analys i s o f traumatology o f the p e lvis r egion of infants shows that the p elvi s region app ears to be more suitabl e for the diver s ion of IDCl S S for c e s than o ther body regions in the cas e that there is no great surfac e loading .
Using a lap belt it has to b e concidered that the not or incomp l e t e develop e d iliac spinae produce a negat ive submarining effect under a lap belt .
In some items the construction of the p elvis region with dummie s do e s not corre spond t o that o f children. In d i s t inction t o the adult dummy ( Hybri d II ) , the p elvis of the child dummy is only imp erfectly de s igne d . Consequently , drawbacks in s imulat ion quality must be exp e c t e d due to the partly l imited repr e sentat ivity o f the actual d e s ign o f the p elvis region.
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REFERENCES
1 . Stürtz , G . : "Das Kind im Verkehrsunfal l : Biomechanik , Anforde rungen an die Äußere und Innere Si cherh e i t von Kraftwagen " . For t s chr i t t -Berichte der VDI -Z e i t s chriften , Reihe 1 7 , Nr . 8 , Düs s e l dorf 1 98 1
2 . Stürtz , G . , Suren , E . G . , Got z e n , L . , Behrens , S . , Richt er , K . : " Kop f - , Hal s - und Wirbel säulenverletzungen und Tode sur s a chen b e i Äußeren Verkehr s t e ilnehmern'� Pro c . 2nd Int . Conf . o n Biomechan i c s o f S erious Trauma , IRCOB I , Birmingham , Eng l and , Sep t . 1 9 7 5
3 . Jo int Commi t t e e o f AMA; SAE & AAAM : �The Abbrevi a t e d Inj ury S c a l e ( A I S ) 1 9 76 , Revi s i on , AAAM , Morton Grove , I l l i no i s , USA , 1 9 76
1 4 . Has s l e v , N . O . , Due , O . , Hir dt o , J . , Torgersen, R . N . : " Ch i l dren in Car s " . Department s Offs e t c entral , Sto ckholm 1 9 76 , Nordi sk Trafiksikkerheds Rad , Rep . 1 1A
5 . Stür t z , G . : "Biome chanical Data o f Chi l dr en " . Pro c . 2 4 th Stapp Car Crash Conf . , Troy , Michigan , USA , Oct . 1 980
6 . Documenta Geigy : "Wi s s ens chaftl i che Tab e l l en " . IR Geigy A . G . Pharma , Bas el , Schwe iz , 7 . Edition
7 . Snyder , R . G . : "Anthropometry o f U . S . Infants and Chi l dren " . SAE Automotive Engineering Congre s s and Exp o s i t i o n , Detro i t , Michigan , USA , Feb . 1 9 75 , Pap er 75 0 4 2 3
8 . Tanner , J . M . : "Wachstum und Reifung des Menschen " , Georg Thieme Verlag , Stuttgart , 1 962
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Regr e s sion analy s e s of character i s t i c g e ome trical pelvi s data versus phy s io l o gi cal age - ·---- - ·-- . -
Chilqren Jyears VIP Je 6years VIP 6c 10 years
Ya 152 - 147 173 - 188 199
Yc 1 3 9 - 100 157 - 1 50 182
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xcs 107 "" 1 3 7 126 - 160 150
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Charac t e r i s t i c geome trical pe lvi s data o f the 3 - , 6 -and 10-year-old chi ldren a s we l l a s the r e s p e c t ive data of anthropome tric dumm i e s