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    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
    Proud WG, 2013,

    Future Research Areas

    , PROPELLANTS EXPLOSIVES PYROTECHNICS, Vol: 38, Pages: 167-167, ISSN: 0721-3115
    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.

    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
    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
    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
    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.

    Arora H, Hooper P, Del Linz P, Yang H, Chen S, Dear Jet al., 2012,

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

    , The International Journal of Multiphysics, Vol: 6, Pages: 199-218, ISSN: 1750-9548
    Arora H, Hooper PA, Dear JP, 2012,

    Blast loading of sandwich structures and tubes

    , Dynamic Failure of Composite and Sandwich Structures, Editors: Abrate, Castanié, Rajapakse, ISBN: 9789400753297
    Bo C, Balzer J, Hahnel M, Rankin SM, Brown KA, Proud WGet al., 2012,


    , 7th Biennial Conference of the American-Physical-Society-Topical-Group on Shock Compression of Condensed Matter, Publisher: AMER INST PHYSICS, ISSN: 0094-243X
    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.

    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.

    Phillips ATM, 2012,

    Structural optimisation: Biomechanics of the femur

    , Proceedings of the Institution of Civil Engineers: Engineering and Computational Mechanics, Vol: 165, Pages: 147-154, ISSN: 1755-0777

    A preliminary iterative three-dimensional 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 cross-sectional areas of the bar elements and the thickness values of the shell elements were adjusted over 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 case during gait. The benefit of using a meso-scale structural approach in comparison to micro- or macroscale continuum approaches to predictive bone modelling was achievement of the symbiotic goals of computational efficiency and structural description of the femur.

    Rankin S, 2012,

    Mesenchymal stem cells

    , THORAX, Vol: 67, Pages: 565-566, ISSN: 0040-6376
    Rankin SM, 2012,

    Chemokines and adult bone marrow stem cells

    , IMMUNOLOGY LETTERS, Vol: 145, Pages: 47-54, ISSN: 0165-2478
    Bo C, Balzer J, Brown KA, Walley SM, Proud WGet al., 2011,

    Development of a chamber to investigate high-intensity compression waves upon live cell cultures

    Bonner TJ, Eardley WGP, Newell N, Masouros S, Matthews JJ, Gibb I, Clasper JCet al., 2011,

    Accurate placement of a pelvic binder improves reduction of unstable fractures of the pelvic ring

    , JOURNAL OF BONE AND JOINT SURGERY-BRITISH VOLUME, Vol: 93B, Pages: 1524-1528, ISSN: 0301-620X
    Ramasamy A, Hill AM, Masouros SD, Gordon F, Clasper JC, Bull AMJet al., 2011,

    Evaluating the effect of vehicle modification in reducing injuries from landmine blasts. An analysis of 2212 incidents and its application for humanitarian purposes

    , ACCIDENT ANALYSIS AND PREVENTION, Vol: 43, Pages: 1878-1886, ISSN: 0001-4575
    Villette CC, Phillips ATM,

    Combined predictive structural finite element and musculoskeletal modeling of bone structure for study of fracture under solid blast condition

    , IStructE Young Researchers' Conference
    Villette CC, Phillips ATM,

    Towards a patient-specific combined musculoskeletal and finite element model of bone structure

    , 2nd UK Patient Specific Modelling Meeting - IPEM conferences

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