THE BIOMECHANICS OF

THORACIC TRAUMA IN FRONTAL

IMPACT
JM Cavanaugh
BME, ECE, ME 7160

Introduction
The U.S. Centers for Disease Control (CDC) reported that
injuries to the torso are the second major cause of death by
specific body region next to the head and neck.
During a motor vehicle impact, the thorax can contact various
components of the automobile interior, including restraint
systems. Contacts include unrestrained driver or passenger with
steering wheel or instrument panel, and contact with active or
passive restraints, including three point lap/shoulder belts,
two-point shoulder belts, knee bolsters, and air bags.
Injury to the thorax commonly occurs in frontal and side impacts
and in oblique directions intermediate to these two.

Epidemiology
Nirula and Pintar analyzed the National Automotive Sampling
System (NASS) databases from 1993 to 2001 and the Crash
Injury Research and Engineering Network (CIREN) databases
from 1996 to 2004.
The incidence of severe chest injury (AIS 3 and greater) in
NASS and CIREN were 5.5% and 33%, respectively.
The steering wheel, door panel, armrest and seat were identified
as contact points associated with an increased risk of severe
chest injury. The door panel and arm rest were consistently a
frequent cause of severe injury.
Nirula R, Pintar FA (2008) Identification of vehicle components associated with severe thoracic injury in motor vehicle crashes: a
CIREN and NASS analysis. Accident; analysis and prevention 40 (1):137-141. doi:10.1016/j.aap.2007.04.013

Epidemiology
In a study of motor vehicle crashes in the UK, Morris et al. examined
vehicle crash injury data to determine to determine the relative injury
risk of occupants of different age groups.
For all occupants, the body region most prone to injury in frontal
impact crashes was the chest.
Older and middle-aged occupants were at greater risk of sustaining
MAIS3+ chest injuries.
In frontal impacts, the majority of chest injuries were caused by the
restraint system, whereas other interior vehicle components
accounted for only 4% of the injuries.
A significant portion of middle-aged and older passengers were
female. A seat-belt pre-tensioner was found to have a general effect of
reducing the risk of MAIS 3+ chest injury to all age groups.
Morris A, Welsh R (2003) Requirements for the crash protection of older vehicle passengers. Annu Proc Assoc Adv Automot Med
47:165-180

Outline of talk

Epidemiology
Introduction to FMVSS 208
Chest anatomy
Chest injury mechanisms
Chest injury tolerance
Chest injury criteria adapted by NHTSA
and IIHS
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The following 5 slides

from Jeff Pikes lecture

New FMVSS 208 Injury Criteria

y
C
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a

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208 Phase In

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ANATOMY OF THE THORAX

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AIS INJURY SCALING

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AIS: RIB FRACTURES

AIS 1: 1 RIB FRACTURE
AIS 2: 2-3 RIB FRACTURES
AIS 3: > 3 ON ONE SIDE, =< 3 ON OTHER
SIDE
AIS 4: > 3 RIB FRACTURES ON BOTH SIDES;
ALSO FLAIL CHEST
AIS 5: BILATERAL FLAIL CHEST
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AIS: OTHER CHEST INJURY

AIS 1: skin abrasion, contusion or minor
laceration
AIS 2: major skin laceration, partial
thickness tear of bronchus
AIS 3: minor heart contusion, unilateral
lung contusion
AIS 4: severe heart contusion, intimal
tear of aorta
AIS 5: major aortic laceration, heart
perforation, ventricular heart rupture

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Aortic Trauma
In studies from the 1980s it was estimated that
7500-8000 cases of blunt aortic injury occurred
each year (Jackson, 1984; Mattox, 1989).

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Prospective study at 50 trauma centers

(Fabian et al, 1997)
274 cases over 2.5 years
81% caused by MVAs
Of these, 72% head on, 24% side impact
Overall mortality was 31%
This does not include the 80-85% who are dead
at the scene.

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Various Aortic Injury Mechanisms

Proposed
Traction or shear forces between mobile points
of the vessel and points of fixation.
Direct compression over the vertebral column.
Sudden increases in intraluminal pressure.

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Prof. King-Hay Yang

Human Thorax vs. FE Thorax

Pulmonary Trunk

Heart

Aorta

SVC

Lung

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Diaphragm

Parametric Study
Impact angle (Velocity in m/s)

0 (6.5)
30 (6.5)
60 (6.5)

Impactor
Mass: 23 kg
Diameter: 150 mm
Edge Radius: 12 mm

90 (6.5 and 6.9)

L
P

120 (6.5)
A

180 (6.5)

150 (6.5)

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FE Aorta

Isthmus

Root
Mid Descending
Valve
Level of Hiatus
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Hardy WN, Shah CS, Kopacz JM, Yang KH, Van Ee CA, Morgan R, Digges K
(2006) Study of potential mechanisms of traumatic rupture of the aorta using
insitu experiments. Stapp Car Crash J 50:247-266

Hardy et al. investigated TRA mechanisms in PMHS in four quasi-static and one
dynamic tests . The quasi-static tests included anterior, superior, and lateral
displacement of the heart and aortic arch in the mediastinum, resulting in partial tears to
complete transection. All injuries occurred within the peri-isthmic region.
The average failure load and stretch were 148 N and 30 % for the quasi-static tests.
The results indicated that intraluminal pressure and whole-body acceleration are not
required for TRA to occur and that the role of the ligamentum-arteriosum is likely
limited.
The studies indicated that tethering of the descending thoracic aorta by the parietal
pleura was a principal aspect of this injury.

28

Hardy WN, Shah CS, Mason MJ, Kopacz JM, Yang KH, King AI, Van Ee CA,
Bishop JL, Banglmaier RF, Bey MJ, Morgan RM, Digges KH (2008) Mechanisms
of traumatic rupture of the aorta and associated peri-isthmic motion and
deformation. Stapp Car Crash J 52:233-265
Hardy et al. investigated the mechanisms of traumatic rupture of the aorta (TRA) in
eight unembalmed PMHS which were inverted and tested in various dynamic blunt
loading modes . Impacts were conducted using a 32-kg impactor with a 152-mm face.
High-speed biplane x-rays of radiopaque markers on the aorta were used to visualize
aortic motion.
Clinically relevant TRA was observed in seven of the tests. Peak average longitudinal
Lagrangian strain was 0.644 and the average peak strain for all tests was 0.208 +/0.216. Peak intraluminal pressure was 165 kPa.
Longitudinal stretch of the aorta was found to be a principal component of injury
causation. Stretch of the aorta was generated by thoracic deformation, which was
required for injury to occur. Atherosclerosis further promoted injury.

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INJURY CRITERIA
IN FRONTAL IMPACT

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Acceleration Criterion
60 g limit in FMVSS 208 for adults.

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Colonel John Stapp, MD

Rocket sled acceleration studies in 1950s.

Human tolerance when belt restraints worn.
40-45 gs for 100 ms or less was tolerated.
30 gs reached at 1000 g/s were not tolerated.

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Eiband analyzed Stapp data

Acceleration tolerance decreased as
duration of exposure increased

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Mertz and Gadd (1971)

Studied 16 free falls in a 40 year old
stunt man.
27-57 foot fall onto a thick mattress
Chest decel measured in 10 tests
Authors concluded that 50 g chest
acceleration for pulses < 100 ms was
within tolerance for healthy adult males.
60 g with pulse < 100 ms was
recommended as a tolerance limit until
further data became available.

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Indy car study (Melvin et al,

1998)
Showed that with tight wide double shoulder
belts, uniform body support and lack of intrusion
there was no serious torso injury in 202 Indy
race car crashes. The mean peak chassis decel
was 53 g with 7 cases above 100 g.
The Melvin study throws into question the use
of peak acceleration as a sole injury criterion.

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Critique
Spinal acceleration is an indicator of overall
severity of impact but does not necessarily
reflect local impact conditions.
Compression, rate of compression, and force
can account for these.

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Force Criterion

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Unrestrained cadaver sled tests

Patrick (1965)
Gadd and Patrick (1968)
Patrick et al (1969)

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Data used in the development

of the energy absorbing
steering column
3.3 kN hub load to the sternum
8.8 kN distributed load to the
shoulder and chest
Resulted in only minor trauma
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Force Criterion - Belt Loading

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Bendjellal et al (1997) field study,

belt loads
Evaluated the 6 kN programmed restraint
system (PRS)
Only two cases of AIS 3
Recommended further reduction to 4 kN belt
loading

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Foret-Bruno (1998), belt loads

50% probability of AIS 3+ injury at 6.9 kN belt
load
4 kN limit with a specially designed airbag could
protect 95% of those in frontal impact from AIS
+ chest injuries.

51

Bag-belt loading (NHTSA

studies)

Yoganandon et al (1993)
Morgan et al (1994)
Kallieris (1995)
Kuppa et al (1998)

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Compression Criterion
3 inch (76 mm) limit in old FMVSS 208
based on work of Kroell, Nahum and
Viano.
2.5 inch (63 mm) limit in new FMVSS
208 to limit probability of chest AIS to 4
or less.
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Loading to mid-sternum
(1970s)

Kroell et al (1971,74)
Nahum et al (1970, 1971, 1975)
Stalnaker (1973)
Lobdell (1973)
Neathery (1974)

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Kroell corridors, 23.4 kg

impactor, mid sternum impact
4.02-5.23 m/s impacts
6.71-7.38 m/s impacts

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Compression Criterion Kroell et al

AIS = -3.78 + 19.56 C
30% Cmax (AIS 2): 69 mm
40 % Cmax (AIS 4): 92 mm

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Compression Criterion
40% Cmax - 92 mm in 50th percentile
40% Cmax - flail chest - Nahum et al (1975)
40% Cmax - severe internal injury Viano (1978)

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Compression Criterion
32% Cmax - maintain rib cage integrity - 74 mm
- Viano (1978)
Old FMVSS 208 - 76 mm limit

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Development of new FMVSS 208

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Combined Thoracic Index

(CTI)
Reported by Kuppa et al (1998)
71 human surrogate (cadaver) tests
Multi-center study

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Combined Thoracic Index

(CTI)

3 point belt
2 point belt/ knee bolster
3 point belt/ air bag
air bag/ knee bolster
air bag/ lap belt
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Data used
Chest bands at the 4th and 8th ribs
T1 triaxial accelerations

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Chest loading - bag-like and

belt-like
Bag like: more uniform deformation of
the chest.
Belt like: more concentrated
deformation at the belt line.

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Univariate and mutlivariate

analyses

3 ms clip T1 resultant accel

Dmax
Vmax
Vcmax
Combinations of these responses

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Insurance Institute for

Highway Safety
www.iihs.org
The Insurance Institute for Highway Safety (IIHS) is an independent,
nonprofit scientific and educational organization dedicated to reducing the
losses deaths, injuries and property damage from crashes on the
nation's roads.
The Highway Loss Data Institute (HLDI) shares and supports this mission
through scientific studies of insurance data representing the human and
economic losses resulting from the ownership and operation of different
types of vehicles and by publishing insurance loss results by vehicle make
and model.
Both organizations are wholly supported by these auto insurers and
insurance associations.
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Viscous Criterion

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Viscous Criterion (VCmax)

Lau and Viano (1981a, 1981b)
Viano and Lau (1983, 1985)
Lau and Viano (1986)

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Viscous Criterion (VCmax)

Kroell et al (1981, 1986)
Rouhana (1986, 1987)

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Viscous Criterion (VCmax)

Soft tissue injury is compression dependent and
rate dependent
VCmax is a measure of the energy dissipated by
the viscous elements of the chest (Viano and
Lau, 1985)
Derivation (attached)

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Viano and Lau (1985)

Analyzed 39 cadaver test performed by Kroell
and others
VCmax of 1.3 m/s, 50% prob of AIS 3+
VCmax of 1.0 m/s, 25% prob of AIS 3+

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Lau and Viano (SAE # 861882)

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Summary

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Peak chest or spine

acceleration reflects the
overall severity of torso impact
to the occupant
Peak acceleration upper limit of 60 g to
spine in frontal impact in old and new
FMVSS 208

90

Chest compression reflects local

skeletal injury and underlying soft
tissue injury due to crush.
Cmax of 32-33% between chest wall and
spine was old FMVSS 208 criteria to avoid
flail chest and severe chest injuries in sternal
impacts. (3 inch limit for 50th percentile male)
Cmax of 27% to limit probability of AIS 4 to
5% or less in new FMVSS 208. (2.5 inch limit
for 50th percentile male).
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The Viscous Response

reflects rate dependent soft
tissue injury and to some
extent, skeletal injury.
VCmax of 1.0 m/s to limit internal organ
injury to the chest and rate-dependent
rib cage injury.
Adapted by the IIHS but not in NHTSA
rulemaking
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Compression/ acceleration
combinations were proposed
by the NHTSA but have not
been adopted

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THANK YOU

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