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。一岁及以下的儿童尤其面临风险；在这个年龄组中，大约每48个儿童中就有1个是虐待或忽视的受害者。儿童身体虐待的案例通常被误认为是意外创伤。如果虐待没有被发现，孩子就有进一步升级伤害的风险。受虐待的儿童回到不安全的家庭环境后，遭受额外伤害的风险高达80%，死亡风险高达30%。这些反复发生的事件可以通过及早发现滥用行为加以预防。骨折是儿童受虐待的早期迹象，但也是意外创伤的常见结果，比如在家中摔倒。临床医生经常面临的任务是确定儿童的伤害是意外原因的结果，还是应该怀疑虐待。由于家庭摔伤是看护人为隐瞒虐待创伤而提供的常见虚假病史，因此，关于短距离摔伤可能导致骨折的信息以及具体类型

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.