Biomechanical Assessment of Femur Fracture in Pediatric Falls

描述（由申请人提供）：虐待儿童是四岁以下儿童创伤相关死亡的主要原因。1岁及1岁以下的儿童尤其面临风险;在这一年龄组中，每48名儿童中约有1名是虐待或忽视的受害者。虐待儿童的案件通常被误认为是意外创伤。如果虐待得不到承认，孩子就有可能受到进一步的、不断升级的伤害。一个受虐儿童回到一个不安全的家庭环境有高达80%的风险，额外的伤害和高达30%的死亡风险。这些重复发生的情况可以通过及早发现虐待行为加以预防。骨折是虐待儿童的早期迹象，但也是意外创伤的常见结果，如家庭福尔斯。临床医生经常面临的任务是确定儿童的伤害是否是意外原因的结果，或者是否应该怀疑虐待。由于家庭福尔斯是一种常见的虚假历史，由照顾者隐瞒虐待创伤，有关骨折的潜在信息，在短距离福尔斯，特别是什么类型 不同的跌倒场景可能导致骨折，可以帮助临床医生区分虐待儿童和意外伤害，从而提高虐待儿童诊断的准确性。 本研究的目的是提供关于短距离福尔斯跌落中股骨骨折可能性的客观生物力学信息。为实现这一目标，确定了三个具体目标：（1）描述与幼儿短距离福尔斯跌倒相关的股骨载荷（类型和大小），（2）描述短距离福尔斯跌倒时股骨骨折的可能性，（3）更好地理解儿童特定骨骼特征对骨折可能性的影响。 这项研究将涉及三个主要的方法组成部分。首先，CRABI 12个月大的拟人测试装置（ATD）将被修改，以提高下肢的生物逼真度和测量股骨载荷的仪器。然后，将使用改进的替代品进行跌倒模拟，以确定股骨载荷特性。最后一部分涉及开发一个12个月大的人类儿童股骨的有限元模型。将在有限元模型中再现ATD实验的股骨载荷。这将为实验测量的组合载荷情况下的断裂潜力提供深入了解。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，以确定其对断裂可能性的影响。这将阐明儿童特定特征（如骨密度）对股骨骨折可能性的影响。这项研究的结果将提供一个更好的理解股骨骨折的潜力，在短距离的儿科福尔斯，并奠定了基础，为未来的工作，将改善临床评估的伤害和历史的兼容性。此外，虽然本研究的重点是股骨骨折的可能性，但所使用的方法可作为未来研究其他骨骼骨折可能性的模型。

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.