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  • Conference paper
    Villette CC, Thibon A, Modenese L, Phillips ATMet al., 2013,

    Combined musculoskeletal and finite element modelling of the femur

    , International Society of Biomechanics

    In the 1870’s, Wolff formulated a ‘trajectory theory’ about trabecular bone architecture which can be succinctly written as follows: bone adapts its structure to loading conditions in a way that follows principal stress trajectories. In this study, it was assumed that the human femur is optimally adapted to the loading conditions experienced during daily activities such as walking or climbing stairs. Hence, an initially randomized structural mesoscale model of a femur was iteratively adapted to the loading conditions experienced during a range of daily activities. The resulting structure shows a good visual comparison with clinical observation and the model proved computationally efficient.
  • Conference paper
    Modenese L, Gopalakrishnan A, Lloyd DG, Phillips ATMet al., 2013,

    Falsification of a lower limb model predicting hip contact force vectors

    , International Society of Biomechanics
  • Journal article
    Singleton JAG, Gibb IE, Hunt NCA, Bull AMJ, Clasper JCet al., 2013,

    Identifying future 'unexpected' survivors: a retrospective cohort study of fatal injury patterns in victims of improvised explosive devices

    , BMJ Open, Vol: 3, ISSN: 2044-6055

    Objectives To identify potentially fatal injury patterns in explosive blast fatalities in order to focus research and mitigation strategies, to further improve survival rates from blast trauma.Design Retrospective cohort study.Participants UK military personnel killed by improvised explosive device (IED) blasts in Afghanistan, November 2007–August 2010.Setting UK military deployment, through NATO, in support of the International Security Assistance Force (ISAF) mission in Afghanistan.Data sources UK military postmortem CT records, UK Joint Theatre Trauma Registry and associated incident data.Main outcome measures Potentially fatal injuries attributable to IEDs.Results We identified 121 cases, 42 mounted (in-vehicle) and 79 dismounted (on foot), at a point of wounding. There were 354 potentially fatal injuries in total. Leading causes of death were traumatic brain injury (50%, 62/124 fatal injuries), followed by intracavity haemorrhage (20.2%, 25/124) in the mounted group, and extremity haemorrhage (42.6%, 98/230 fatal injuries), junctional haemorrhage (22.2%, 51/230 fatal injuries) and traumatic brain injury (18.7%, 43/230 fatal injuries) in the dismounted group.Conclusions Head trauma severity in both mounted and dismounted IED fatalities indicated prevention and mitigation as the most effective strategies to decrease resultant mortality. Two-thirds of dismounted fatalities had haemorrhage implicated as a cause of death that may have been anatomically amenable to prehospital intervention. One-fifth of the mounted fatalities had haemorrhagic trauma which currently could only be addressed surgically. Maintaining the drive to improve all haemostatic techniques for blast casualties, from point of wounding to definitive surgical proximal vascular control, alongside the development and application of novel haemostatic interventions could yield a significant survival benefit. Prospective studies in this field are indicated.
  • Journal article
    Singleton JAG, Gibb IE, Bull AMJ, Mahoney PF, Clasper JCet al., 2013,

    Primary blast lung injury prevalence and fatal injuries from explosions: Insights from postmortem computed tomographic analysis of 121 improvised explosive device fatalities

    , JOURNAL OF TRAUMA AND ACUTE CARE SURGERY, Vol: 75, Pages: S269-S274, ISSN: 2163-0755
  • Conference paper
    Harris K, Campos-Pires R, Kiru L, Franks NP, Dickinson Ret al., 2013,

    The NMDA receptor glycine site mediates xenon neuroprotection against traumatic brain injury in vitro

    , British Neuroscience Association Meeting
  • Conference paper
    Villette CC, Phillips ATM, Modenese L, 2013,

    Combined Musculoskeletal and Finite Element Modelling of the Femur

    , XXIV Congress of the International Society of Biomechanics
  • Journal article
    Proud WG, 2013,

    Future Research Areas

    , PROPELLANTS EXPLOSIVES PYROTECHNICS, Vol: 38, Pages: 167-167, ISSN: 0721-3115
  • Journal article
    Ramasamy A, Hill AM, Masouros S, Gibb I, Phillip R, Bull AMJ, Clasper JCet al., 2013,

    Outcomes of IED foot and ankle blast injuries.

    , J Bone Joint Surg Am, Vol: 95

    BACKGROUND: Improvements in protection and medical treatments have resulted in increasing numbers of modern-warfare casualties surviving with complex lower-extremity injuries. To our knowledge, there has been no prior analysis of foot and ankle blast injuries as a result of improvised explosive devices (IEDs). The aims of this study were to report the pattern of injury and determine which factors are associated with a poor clinical outcome. METHODS: U.K. service personnel who had sustained lower leg injuries following an under-vehicle explosion from January 2006 to December 2008 were identified with the use of a prospective trauma registry. Patient demographics, injury severity, the nature of the lower leg injury, and the type of clinical management were recorded. Clinical end points were determined by (1) the need for amputation and (2) ongoing clinical symptoms. RESULTS: Sixty-three U.K. service personnel (eighty-nine injured limbs) with lower leg injuries from an explosion were identified. Fifty-one percent of the casualties sustained multisegmental injuries to the foot and ankle. Twenty-six legs (29%) required amputation, with six of them amputated because of chronic pain eighteen months following injury. Regression analysis revealed that hindfoot injuries, open fractures, and vascular injuries were independent predictors of amputation. At the time of final follow-up, sixty-six (74%) of the injured limbs had persisting symptoms related to the injury, and only nine (14%) of the service members were fit to return to their preinjury duties. CONCLUSIONS: This study demonstrates that foot and ankle injuries from IEDs are associated with a high amputation rate and frequently with a poor clinical outcome. Although not life-threatening, they remain a source of long-term morbidity in an active population.
  • Journal article
    Proud WG, 2013,

    The physical basis of explosion and blast injury processes

    , JOURNAL OF THE ROYAL ARMY MEDICAL CORPS, Vol: 159, Pages: 4-9, ISSN: 0035-8665
  • Journal article
    Newell N, Masouros SD, Bull AMJ, 2013,

    A comparison of MiL-Lx and hybrid-III responses in seated and standing postures with blast mats in simulated under-vehicle explosions

    , 2013 IRCOBI Conference Proceedings - International Research Council on the Biomechanics of Injury, Pages: 135-144

    Blast mats that can be retrofitted to the floor of military vehicles are considered to reduce the risk of injury from under-vehicle explosions. Anthropometric test devices (ATDs) are validated for use only in the seated position. The aim of this study was to use a traumatic injury simulator fitted with 3 different blast mats in order to assess the ability of 2 ATD designs to evaluate the protective capacity of the mats in 2 occupant postures under 2 severities. Tests were performed for each combination of mat design, ATD, severity and posture using an antivehicle under-belly injury simulator. The differences between mitigation systems were larger under the H-III compared to the MiL-Lx. There was little difference in how the 2 ATDs and how posture ranked the mitigation systems. Results from this study suggest that conclusions obtained by testing in the seated position can be extrapolated to the standing. However, the different percentage reductions observed in the 2 ATDs suggests different levels of protection. It is therefore unclear which ATD should be used to assess such mitigation systems. A correlation between cadavers and ATDs on the protection offered by blast mats is required in order to elucidate this issue.
  • Journal article
    Ramasamy MA, Hill AM, Phillip R, Gibb I, Bull AMJ, Clasper JCet al., 2013,

    FASS is a Better Predictor of Poor Outcome in Lower Limb Blast Injury Than AIS: Implications for Blast Research

    , JOURNAL OF ORTHOPAEDIC TRAUMA, Vol: 27, Pages: 49-55, ISSN: 0890-5339
  • Journal article
    Modenese L, Gopalakrishnan A, Phillips ATM, 2013,

    Application of a falsification strategy to a musculoskeletal model of the lower limb and accuracy of the predicted hip contact force vector

    , Journal of Biomechanics, Vol: 46, Pages: 1193-1200

    In the literature, lower limb musculoskeletal models validated against in vivo measured hip contact forces (HCFs) exhibit a tendency to overestimate the HCFs magnitude and predict inaccurate components of the HCF vector in the transverse plane. In order to investigate this issue, a musculoskeletal model was forced to produce HCFs identical to those measured and the resulting joint equilibrium equations were studied through both a general approach and a static optimization framework. In the former case, the existence of solutions to the equilibrium equations was investigated and the effect of varying the intersegmental moments and the muscle tetanic stress assessed: for a value of 100 N/cm2 and moments calculated from an inverse dynamics analysis on average only 62% of analyzed frames were solvable for level walking and 70% for stair climbing. In the static optimization study, the model could reproduce the experimental HCFs but the recruited muscles were unable to simultaneously equilibrate the hip intersegmental moments without the contribution of reserve moment actuators. Without constraints imposed on the HCFs, the predicted HCF vectors presented maximum angle deviations up to 22° for level walking and 33° for stair climbing during the gait stance phase. The influence of the medio-lateral HCF component on the solvability of the equilibrium equations and the muscle recruitment alteration when the model was forced to produce the experimental HCFs suggest that a more accurate geometrical representation of the gluteal muscles is mandatory to improve predictions of the HCF vector yielded by the static optimization technique.
  • Journal article
    Newell N, Masouros SD, Ramasamy A, Bonner TJ, Hill AM, Clasper JC, Bull AMJet al., 2012,

    Use of cadavers and anthropometric test devices (ATDs) for assessing lower limb injury outcome from under-vehicle explosions

    , 2012 IRCOBI Conference Proceedings - International Research Council on the Biomechanics of Injury, Pages: 296-303

    Lower extremities are particularly susceptible to injury in an under-vehicle explosion. Operational fitness of military vehicles is assessed through anthropometric test devices (ATDs) in full-scale blast tests. The aim of this study was to compare the response between the Hybrid-III ATD, the MiL-Lx ATD and cadavers in our traumatic injury simulator, which is able to replicate the response of the vehicle floor in an under-vehicle explosion. All specimens were fitted with a combat boot and tested on our traumatic injury simulator in a seated position. The load recorded in the ATDs was above the tolerance levels recommended by NATO in all tests; no injuries were observed in any of the 3 cadaveric specimens. The Hybrid-III produced higher peak forces than the MiL-Lx. The time to peak strain in the calcaneus of the cadavers was similar to the time to peak force in the ATDs. Maximum compression of the sole of the combat boot was similar for cadavers and MiL-Lx, but significantly greater for the Hybrid-III. These results suggest that the MiL-Lx has a more biofidelic response to under-vehicle explosive events compared to the Hybrid-III. Therefore, it is recommended that mitigation strategies are assessed using the MiL-Lx surrogate and not the Hybrid-III.
  • Journal article
    Masouros SD, Newell N, Bonner TJ, Ramasamy A, Hill AM, West ATH, Clasper JC, Bull AMJet al., 2012,

    A standing vehicle occupant is likely to sustain a more severe injury than one who has flexed knees in an under-vehicle explosion: A cadaveric study

    , 2012 IRCOBI Conference Proceedings - International Research Council on the Biomechanics of Injury, Pages: 289-295

    The lower limb of military vehicle occupants has been the most injured body part due to undervehicle explosions in recent conflicts. Understanding the injury mechanism and causality of injury severity could aid in developing better protection. Therefore, we tested 4 different occupant postures (seated, brace, standing, standing with knee locked in hyper-extension) in a simulated under-vehicle explosion (solid blast) using our traumatic injury simulator in the laboratory; we hypothesised that occupant posture would affect injury severity. No skeletal injury was observed in the specimens in seated and braced postures. Severe, impairing injuries were observed in the foot of standing and hyper-extended specimens. These results demonstrate that a vehicle occupant whose posture at the time of the attack incorporates knee flexion is more likely to be protected against severe skeletal injury to the lower leg.
  • Journal article
    Arora H, Hooper PA, Del Linz P, Yang H, Chen S, Dear JPet al., 2012,

    Modelling the behaviour of composite sandwich structures when subject to air blast loading

    , International Journal of Multiphysics, Vol: 6, Pages: 199-218, ISSN: 1750-9548
  • Journal article
    Rankin SM, 2012,

    Chemokines and adult bone marrow stem cells

    , IMMUNOLOGY LETTERS, Vol: 145, Pages: 47-54, ISSN: 0165-2478
  • Journal article
    Rankin S, 2012,

    Mesenchymal stem cells

    , THORAX, Vol: 67, Pages: 565-566, ISSN: 0040-6376
  • Journal article
    Eardley WGP, Bonner TJ, Gibb IE, Clasper JCet al., 2012,

    Spinal Fractures in Current Military Deployments

    , JOURNAL OF THE ROYAL ARMY MEDICAL CORPS, Vol: 158, Pages: 101-105, ISSN: 0035-8665
  • Conference paper
    Bo C, Balzer J, Hahnel M, Rankin SM, Brown KA, Proud WGet al., 2012,

    CELLULAR CHARACTERIZATION OF COMPRESSION-INDUCEDDAMAGE IN LIVE BIOLOGICAL SAMPLES

    , 7th Biennial Conference of the American-Physical-Society-Topical-Group on Shock Compression of Condensed Matter, Publisher: AMER INST PHYSICS, ISSN: 0094-243X
  • Journal article
    Phillips ATM, 2012,

    Structural Optimisation: Biomechanics of the Femur

    , Engineering and Computational Mechanics, Vol: 165, Pages: 147-154, ISSN: 1755-0777

    A preliminary iterative 3D meso-scale structural model of the femur was developed, in which bar and shell elements were used to represent trabecular and cortical bone respectively. The crosssectionalareas of the bar elements and the thickness values of the shell elements were adjustedover successive iterations of the model based on a target strain stimulus, resulting in an optimised construct. The predicted trabecular architecture, and cortical thickness distribution showed good agreement with clinical observations, based on the application of a single leg stance load caseduring gait. The benefit of using a meso-scale structural approach in comparison to micro ormacro-scale continuum approaches to predictive bone modelling was achievement of thesymbiotic goals of computational efficiency and structural description of the femur.

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