Pierre-Jean Arnoux

Montreal Polytechnic, Montréal, Quebec, Canada

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Publications (24)32.8 Total impact

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    ABSTRACT: Study Design. Measurements of cervical and thoraco-lumbar human spinal cord (SC) geometry based on in vivo MRI and investigation of morphological "invariants".Objective. The current work aims at providing morphological features of the complete in vivo human normal spinal cord and at investigating possible "invariant" parameters that may serve as normative data for individualized study of SC injuries.Summary of Background Data. Few in vivo MR-based studies have described human SC morphology at the cervical level, and similar description of the entire SC only relies on post-mortem studies, which may be prone to atrophy biases. Moreover, large inter-individual variations currently limit the use of morphological metrics as reference for clinical applications or as modeling inputs.Methods. Absolute metrics of SC (transverse and antero-posterior diameters, anterior and posterior horns width, cross-sectional SC area and white matter percentage) were measured using semi-automatic segmentation of high resolution in vivo T2*-weighted transverse images acquired at 3T, at each SC level, on healthy young (N = 15) and older (N = 8) volunteers. Robustness of measurements, effects of subject, age, or sex, as well as comparison to previously published post mortem data were investigated using statistical analyses (Separate analysis of variance, Tukey-HSD, Bland-Altman). Normalized-to-C3 parameters were evaluated as invariants using a leave-one-out analysis. Spinal canal parameters were measured and occupation ratio (OR) border values were determined.Results. Metrics of SC morphology showed large intra- and inter-individual variations, up to 30% and 13% respectively in average. Sex had no influence except on posterior horns width (p<0.01). Age-related differences were observed for anteroposterior diameter and white matter percentage (p<0.05) and all postmortem metrics were significantly lower than in vivo values (p<0.001). In vivo normalized SC area and diameters appeared to be invariants (R>0.74, RMSE<10%) Finally, minimal and maximal OR were 0.2 and 0.6, respectively.Conclusion. This study presented morphological characteristics of the complete in vivo human spinal cord. Significant differences linked to age and postmortem state have been identified. Morphological "invariants" that could be used to accurately calculate the normally expected morphology, were also identified. These observations should benefit to biomechanical and spinal cord pathology studies.
    Spine 11/2013; · 2.16 Impact Factor
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    ABSTRACT: Thoracolumbar spine fracture classifications are mainly based on a post-traumatic observation of fracture patterns, which is not sufficient to provide a full understanding of spinal fracture mechanisms. This study aimed to biomechanically analyze known fracture patterns and to study how they relate to fracture mechanisms. The instigation of each fracture type was computationally simulated to assess the fracture process. A refined finite element model of three vertebrae and intervertebral connective tissues was subjected to 51 different dynamic loading conditions divided into four categories: compression, shear, distraction and torsion. Fracture initiation and propagation were analyzed, and time and energy at fracture initiation were computed. To each fracture pattern described in the clinical literature were associated one or several of the simulated fracture patterns and corresponding loading conditions. When compared to each other, torsion resulted in low-energy fractures, compression and shear resulted in medium energy fractures, and distraction resulted in high-energy fractures. Increased velocity resulted in higher-energy fracture for similar loadings. The use of a finite element model provided quantitative characterization of fracture patterns occurrence complementary to clinical and experimental studies, allowing to fully understand spinal fracture biomechanics.
    Medical & Biological Engineering 10/2013; · 1.76 Impact Factor
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    ABSTRACT: To date, developing geometrically personalized and detailed solid finite element models of the spine remains a challenge, notably due to multiple articulations and complex geometries. To answer this problem, a methodology based on a free form deformation technique (kriging) was developed to deform a detailed reference finite element mesh of the spine (including discs and ligaments) to the patient-specific geometry of 10 and 82-year old asymptomatic spines. Different kriging configurations were tested: with or without smoothing, and control points on or surrounding the entire mesh. Based on the results, it is recommended to use surrounding control points and smoothing. The mean node to surface distance between the deformed and target geometries was 0.3 mm ± 1.1. Most elements met the mesh quality criteria (95%) after deformation, without interference at the articular facets. The methods novelty lies in the deformation of the entire spine at once, as opposed to deforming each vertebra separately, with surrounding control points and smoothing. This enables the transformation of reference vertebrae and soft tissues to obtain complete and personalized FEMs of the spine with minimal post-processing to optimize the mesh.
    IEEE transactions on bio-medical engineering 02/2013; · 2.15 Impact Factor
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    ABSTRACT: Intestinal injuries are responsible for significant morbidity and mortality arising from trauma to the abdomen. The biomechanical characterisation of the small intestine allows for the understanding of the pathophysiological mechanisms responsible for these injuries. Studies reported in the literature focus principally on quasi-static tests, which do not take into account the stresses experienced during high kinetic trauma. In addition, the use of embalmed human tissue can alter the recorded response. The stress-strain curves from 43 tensile tests performed at 1 m/s were analysed. Samples were prepared from four fresh human intestines and from four embalmed cadaveric intestines. The data indicated a two-phase response, with each response consisting of a quasi-linear increase in the stress followed by an inflection in the curve before a peak preceding the loss of stress. The fresh tissue was more deformable than the embalmed tissue, and its first peak stress was lower (P = 0.034). A complementary histological analysis was performed. The results of the analysis enable an investigation of the response of the intestinal wall layers to stress as a two-layer structure and highlight the high sensitivity of the structure's mechanical behaviour to the speed of loading and the method of preservation.
    Medical & Biological Engineering 10/2012; · 1.76 Impact Factor
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    ABSTRACT: The temporal bone shields sensorineural, nervous, and vascular structures explaining the potential severity and complications of trauma related to road and sport accidents. So far, no clear data are available on the exact mechanisms involved for fracture processes. Modelization of structures helps to answer these concerns. Our objective was to design a finite element model of the petrous bone structure to modelize temporal bone fracture propagation in a scenario of lateral impact. A finite element model of the petrous bone structure was designed based on computed tomography data. A 7-m/s lateral impact was simulated to reproduce a typical lateral trauma. Results of model analysis was based on force recorded, stress level on bone structure up to induce a solution of continuity of the bony structure. Model simulation showed that bone fractures follow the main axes of the petrous bone and occurred in a 2-step process: first, a crush, and second, a massive fissuration of the petrous bone. The lines of fracture obtained by simulation of a lateral impact converge toward the middle ear region. This longitudinal fracture is located at the mastoid-petrous pyramid junction. Using this model, it was possible to map petrous bone fractures including fracture chronology and areas of fusion of the middle ear region. This technique may represent a first step to investigate the pathophysiology of the petrous bone fractures, aiming to define prognostic criteria for patients' care.
    Otology & neurotology: official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology 06/2012; 33(4):651-4. · 1.44 Impact Factor
  • Eric Wagnac, Pierre-Jean Arnoux, Anaïs Garo, Carl-Eric Aubin
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    ABSTRACT: Despite an increase in the number of experimental and numerical studies dedicated to spinal trauma, the influence of the rate of loading or displacement on lumbar spine injuries remains unclear. In the present work, we developed a bio-realistic finite element model (FEM) of the lumbar spine using a comprehensive geometrical representation of spinal components and material laws that include strain rate dependency, bone fracture, and ligament failure. The FEM was validated against published experimental data and used to compare the initiation sites of spinal injuries under low (LD) and high (HD) dynamic compression, flexion, extension, anterior shear, and posterior shear. Simulations resulted in force-displacement and moment-angular rotation curves well within experimental corridors, with the exception of LD flexion where angular stiffness was higher than experimental values. Such a discrepancy is attributed to the initial toe-region of the ligaments not being included in the material law used in the study. Spinal injuries were observed at different initiation sites under LD and HD loading conditions, except under shear loads. These findings suggest that the strain rate dependent behavior of spinal components plays a significant role in load-sharing and failure mechanisms of the spine under different loading conditions.
    Medical & Biological Engineering 05/2012; 50(9):903-15. · 1.76 Impact Factor
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    ABSTRACT: To prevent abdominal organs' traumas in crash situations, the definition of efficient safety devices should be based on a detailed knowledge of human tolerance, i.e., injury mechanisms and related injury criteria. This knowledge should be based on experimental observation of these mechanisms through damage and failure analysis. In this study, 10 human cadaveric livers are uniaxially compressed using three different loading velocities (0.0013, 0.2, and 1 m/s). Injuries induced are analyzed at two observation levels through a macroscopic study of internal and external cracks and a histologic study of damage initiation. Liver global behavior is similar for the three loading velocities, but loading rate seems to influence the stiffness and the severity of failure process. Macroscopic injury analysis showed four patterns of laceration because of organ spreading during its compression exhibiting liver structure incidence. Histologic analysis shows two different damage occurrences: microcracking and cavitation. The crack propagation is observed to occur preferentially within the lobules. Influence of the vascular system is also highlighted. Both macroscopic and histologic injuries obtained are relevant with those clinically observed under trauma situations. Based on experimental investigation of human liver under compression, this work provides a multiscale evaluation of injury process coupling mechanical and histologic analysis. Injury mechanisms postulated involve vascular structures and capsule. All this information is essential for the design of dedicated behavior laws and finite element models.
    The journal of trauma and acute care surgery. 03/2012; 72(3):727-32.
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    ABSTRACT: Under fast dynamic loading conditions (e.g. high-energy impact), the load rate dependency of the intervertebral disc (IVD) material properties may play a crucial role in the biomechanics of spinal trauma. However, most finite element models (FEM) of dynamic spinal trauma uses material properties derived from quasi-static experiments, thus neglecting this load rate dependency. The aim of this study was to identify hyperelastic material properties that ensure a more biofidelic simulation of the IVD under a fast dynamic compressive load. A hyperelastic material law based on a first-order Mooney-Rivlin formulation was implemented in a detailed FEM of a L2-L3 functional spinal unit (FSU) to represent the mechanical behavior of the IVD. Bony structures were modeled using an elasto-plastic Johnson-Cook material law that simulates bone fracture while ligaments were governed by a viscoelastic material law. To mimic experimental studies performed in fast dynamic compression, a compressive loading velocity of 1 m/s was applied to the superior half of L2, while the inferior half of L3 was fixed. An exploratory technique was used to simulate dynamic compression of the FSU using 34 sets of hyperelastic material constants randomly selected using an optimal Latin hypercube algorithm and a set of material constants derived from quasi-static experiments. Selection or rejection of the sets of material constants was based on compressive stiffness and failure parameters criteria measured experimentally. The two simulations performed with calibrated hyperelastic constants resulted in nonlinear load-displacement curves with compressive stiffness (7335 and 7079 N/mm), load (12,488 and 12,473 N), displacement (1.95 and 2.09 mm) and energy at failure (13.5 and 14.7 J) in agreement with experimental results (6551 ± 2017 N/mm, 12,411 ± 829 N, 2.1 ± 0.2 mm and 13.0 ± 1.5 J respectively). The fracture pattern and location also agreed with experimental results. The simulation performed with constants derived from quasi-static experiments showed a failure energy (13.2 J) and a fracture pattern and location in agreement with experimental results, but a compressive stiffness (1580 N/mm), a failure load (5976 N) and a displacement to failure (4.8 mm) outside the experimental corridors. The proposed method offers an innovative way to calibrate the hyperelastic material properties of the IVD and to offer a more realistic simulation of the FSU in fast dynamic compression.
    Journal of Biomechanical Engineering 10/2011; 133(10):101007. · 1.52 Impact Factor
  • Cécile Conte, Catherine Masson, Pierre-Jean Arnoux
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    ABSTRACT: To prevent traumas to abdominal organs, the selection of efficient safety devices should be based on a detailed knowledge of injury mechanisms and related injury criteria. In this sense, finite element (FE) simulation coupled with experiment could be a valuable tool to provide a better understanding of the behaviour of internal organs under crash conditions. This work proposes a methodology based on inverse analysis which combines exploration process optimisation and robustness study to obtain mechanical behaviour of the complex structure of the liver through FE simulation. The liver characterisation was based on Mooney-Rivlin hyperelastic behaviour law considering whole liver structure under uniform quasi-static compression. With the global method used, the model fits experimental data. The variability induced by modelling parameters is quantified within a reasonable time.
    Computer Methods in Biomechanics and Biomedical Engineering 05/2011; 15(9):993-9. · 1.39 Impact Factor
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    ABSTRACT: In the field of numerical crash simulations in road safety research, there is a need to accurately define the initial conditions of a frontal impact for the car occupant. In particular, human models used to simulate such impacts barely take into account muscular contracting effects. This study aims to quantify drivers' behaviour in terms of posture and muscular activity just before a frontal impact. Experiments on volunteers were performed in order to define these conditions, both on a driving simulator and on a real moving car. Brake pedal loads, lower limbs kinematics and muscle activation were recorded. Coupling instantaneous data from both experimental protocols (simulator versus Real car), a standard emergency braking configuration could be defined as (1) joint flexion angles of 96 degrees, 56 degrees and 13 degrees for the right hip, knee and ankle respectively; (2) a maximum brake pedal load of 780N; (3) a muscular activation of 55% for the anterior thigh, 26% for the posterior thigh, 18% for the anterior leg and 43% for the posterior leg. The first application of this research is the implementation of muscle tone in human models designed to evaluate new safety systems.
    Accident; analysis and prevention 05/2010; 42(3):797-801. · 1.65 Impact Factor
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    ABSTRACT: In spinal instrumentation surgery, the optimal placement of pedicle screws that takes into account the cortical/cancellous bone quality, geometry and property distribution, and screw design is still undetermined despite several in vitro experiments. The objective of this study was to evaluate the feasibility of using a detailed finite element model (FEM) of an instrumented vertebra to simulate screw axial pull-out and to analyze the bone-screw mechanical interaction. The FEM was built using CT-scan images of the L3 vertebra (0.6mm thick contiguous slices) of a 50th percentile human male volunteer, in order to virtually implant a fully customizable pedicle screw in a straight-forward position. The 753,000 elements model takes into account local cortical bone thickness and integrates advanced material behavior (elasto-plastic) laws that simulate bone failure. Screw axial pull-out was simulated and compared to in vitro experimental data, and the stress distribution at the screw thread-bone interface was analyzed. The simulated screw pull-out force (non-linear response with a failure at 640N) was within the range of experimental data (500-660N). Von Mises stresses in the bony structures were concentrated around the root of each internal thread, with the maximum stress located near the first proximal thread, in the cortical bone of the posterior wall of the pars. This study shows the feasibility and relevance of using a detailed FEM to simulate screw pull-out and to analyze the bone-screw mechanical interaction.
    Studies in health technology and informatics 01/2010; 158:167-71.
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    ABSTRACT: The trunk of a car occupant can be injured by a frontal or lateral impact. Lesions can be either intrusion injuries or due to the effects of deceleration alone. The aim of this study conducted with human cadavers was to explore the effects of deceleration on the liver during frontal or lateral deceleration. Trunks previously instrumented with accelerometers in three sites, the left and right lobes of the liver and the retrohepatic inferior vena cava, were subjected to substantial deceleration in three orientations: frontal, left, and right lateral. The anatomic consequences and deceleration data were measured. A deceleration ratio was defined as a peak deceleration measured in the liver divided by peak deceleration imposed on the trunk. Peak deceleration imposed on the trunks was up to 60 g, which caused peak deceleration up to 26 g in the liver. No anatomic injury was observed. For each orientation, deceleration ratios were not significantly different among the three sites (p = 0.64) or between left and right lateral decelerations (p = 0.12). Deceleration ratios were significantly different (p = 0.001) between frontal (3 sites combined) and lateral (3 sites of left and right lateral orientations combined) decelerations: 39.4% (+/-6) versus 48.4% (+/-11). In conclusion, at tested decelerations, under the hepatic injury threshold, cadaveric liver seemed to be subjected to higher deceleration when the trunk was decelerated in lateral than in frontal direction, without terminal impact.
    The Journal of trauma 08/2009; 67(1):40-4. · 2.35 Impact Factor
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    Éric Wagnac, Pierre-Jean Arnoux, Carl-Éric Aubin
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    ABSTRACT: In the last decade, many finite element (FE) models of the spine were used as surrogate experiments to provide relevant knowledge on the biomechanics of spinal trauma [1-2]. One of the major concerns in the development of such model is the modeling and validation of the spinal components’ mechanical behavior in dynamic loading conditions. For instance, very few FE models have considered the strain rate dependency shown by the intervertebral disk (IVD) when submitted to high strain rates [3], thus limiting their ability to represent traumatic conditions. Such limitations arise from the lack of appropriate material properties available in the literature. Thus, the purpose of the current study was to determine suitable material properties of the IVD for its FE modeling under dynamic compressive loads. Lumbar spine; Material properties; Finite element analysis; Reliability study, High strain rate.
    Computer Methods in Biomechanics and Biomedical Engineering 08/2009; · 1.39 Impact Factor
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    ABSTRACT: Sudden deceleration and frontal/rear impact configurations involve rapid movements that can cause spinal injuries. This study aimed to investigate the rotation rate effect on the L2-L3 motion segment load-sharing and to identify which spinal structure is at risk of failure and at what rotation velocity the failure may initiate? Five degrees of sagittal rotations at different rates were applied in a detailed finite-element model to analyze the responses of the soft tissues and the bony structures until possible fractures. The structural response was markedly different under the highest velocity that caused high peaks of stresses in the segment compared to the intermediate and low velocities. Under flexion, the stress was concentrated at the upper pedicle region of L2 and fractures were firstly initiated in this region and then in the lower endplate of L2. Under extension, maximum stress was located in the lower pedicle region of L2 and fractures started in the left facet joint, then they expanded in the lower endplate and in the pedicle region of L2. No rupture has resulted at the lower or intermediate velocities. The intradiscal pressure was higher under flexion and decreased when the endplate was fractured, while the contact forces were greater under extension and decreased when the facet surface was cracked. The highest ligaments stresses were obtained under flexion and did not reach the rupture values. The endplate, pedicle and facet surface represented the potential sites of bone fracture. Results showed that spinal injuries can result at sagittal rotation velocity exceeding 0.5 degrees /ms.
    Journal of biomechanics 06/2009; 42(9):1252-62. · 2.66 Impact Factor
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    ABSTRACT: Trauma affect between 3 and 7% of all pregnancies in industrialized countries, and the leading cause of these traumas is car crashes. The difficulty to appreciate physiologic and anatomic changes occurring during pregnancy explain that majority of studies were not based on anatomical data. We present a protocol to create a realistic anatomical model of pregnant woman using a post mortem human subject (PMHS). We inserted a physical model of the gravid uterus into the pelvis of a PMHS. 3D acceleration sensors were placed on the subject to measure the acceleration on different body segments. We simulated three frontal impact situations at 20 km/h between two average European cars. Two main kinematics events were identified as possible causes of injuries: lap belt loading and backrest impact. Cadaver experiments provide one interesting complementary approach to study injury mechanisms related to road accidents involving pregnant women. This anatomical accuracy makes it possible to progress in the field of safety devices.
    Surgical and Radiologic Anatomy 06/2008; 30(3):185-9. · 1.13 Impact Factor
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    ABSTRACT: The improvement of vulnerable users' protection has become an essential objective for our society. Injury assessments observed in clinical traumatology have led researchers and manufacturers to understand the mechanisms involved and to design safe vehicles (to reduce the severity of pedestrian injuries). In all, 137 crash tests between 1979 and 2004 with postmortal human subjects (PMHS) were performed at the Laboratory of Applied Biomechanics to access pedestrian protection. A retrospective analysis of these experimental tests, pedestrian/car impacts (full scale or subsystems), performed at the laboratory is thus proposed. This document focuses on injury mechanisms investigation on the evolution of the experimental approach, as well as on the vehicles' technological improvements performed by car manufacturers. The analysis of experimental results (injury assessment, kinematics, vehicle deformations, etc.) shows the complexity and variety of injury mechanisms. The injury assessment shows the need to improve lower-limb joints protection, as well as head and spine segments, because of the difficulties of surgical repair of these injuries. Experimental tests contribute to evaluate the automobile safety evolution in the field of pedestrian protection. The main induced car improvements concern considerable efforts on vehicle material behavior and their capacity to dissipate energy during shocks (replacement of the convex rigid bumpers by deformable structures, modification of the windscreen structure). They also concern the suppression of all aggressive structures for the pedestrian (spare wheel initially placed on the front part of the vehicle, protection of the heels of windscreen wiper, etc.).
    The Journal of trauma 03/2007; 62(2):512-9; discussion 519. · 2.35 Impact Factor
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    ABSTRACT: In order to improve the pedestrian safety during an impact with a vehicle, subsystem tests have been defined to evaluate the aggressiveness of the front- end of cars. These subsystems tests have to be reproducible and are representative of the three decomposed impacts of the pedestrian with the car: lower leg on the bumper, upper leg on the hood, head on the hood or the windscreen. The velocity, angle and mass of the adult headform impactor and its impact area are invariable parameters. Upper legform impactor parameters are determined by vehicle characteristics. Lower legform impactor parameters are invariable (velocity and positioning). Nevertheless, these decoupled tests do not take into account the influence of the whole body on impacts. Therefore, it appears important to compare these subsystem tests with global conditions observed in real accidents. The objective of this paper is to perform this work on two French vehicles. Concerning the global conditions, four full-scale experimental tests with PMHS and the associating multibody numerical simulations were performed in classical (lateral impact for the pedestrian, centred for the vehicle) and real configurations.
    01/2007;
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    ABSTRACT: Mechanisms of hepatic injury remain poorly understood. Surgical literature reports some speculative theories that have never been proved. The aim of this study was to examine the behavior of the liver during brutal frontal deceleration. Six trunks, removed from human cadavers, underwent free falls at 4, 6, and 8 meters per second (mps). Accelerometers were positioned in the two lobes of the liver, in front of the vertebra L2, and in the retro hepatic inferior vena cava. Relative motions of the lobes of the liver and of the two other anatomic marks were observed. In parallel, numerical simulations of this experiment have been performed using a finite element model. In the direction of impact, the vertebra L2 had no considerable displacement with the inferior vena cava. There was a noteworthy displacement between the two hepatic lobes. The left hepatic lobe had a large relative displacement with the vertebra L2 and the inferior vena cava. The right hepatic lobe was more stable with the vertebra L2 and the inferior vena cava. Numerical simulation of the same protocol underlined a rotation effect of the liver to the left around the axis of the inferior vena cava. These results support the surgical data. They highlight a crucial zone and explain how dramatic lacerations between the two lobes of the liver can occur.
    The Journal of trauma 11/2006; 61(4):855-61. · 2.35 Impact Factor
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    ABSTRACT: Blunt traumatic aortic rupture (BTAR) is a common catastrophic injury leading to death. Considerable uncertainty remains regarding the pathogenic cause. This study examines the comportment of the heart and the aorta during a frontal deceleration. Accelerometers were placed in the right ventricle of the heart, the aorta, the sternum, and the spine of six trunks removed from human cadavers. Different vertical decelerations were applied to cadavers and the relative motion of these organs was studied (19 tests). The deceleration recorded in the isthmus of the aorta was always higher that the one recorded in the heart (p < 0.05). The difference of deceleration was 17% and increased with the speed's fall (extremes 5-25%). There was no significant difference of deceleration between the bony structures of the thorax. These results experimentally demonstrate for the first time that the fundamental mechanism of BTAR is sudden stretching of the isthmus of the aorta. Four mechanisms are suspected to explain the location of the rupture: two hemodynamic mechanism (sudden increase of intravascular pressure and the water-hammer effect), and two physical mechanisms (sudden stretching of the isthmus and the osseous pinch). A greater understanding of the mechanism of this injury could improve vehicle safety leading to a reduction in its incidence and severity. Future work in this area should include the creation of an inclusive, dynamic model of computer-based modeling systems. This study provides for the first time physical demonstration and quantification of the stretching of the isthmus, leading to a computerized model of BTAR.
    The Journal of trauma 10/2006; 61(3):586-91. · 2.35 Impact Factor
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    ABSTRACT: This study lies within the scope of passive road safety, and more particularly injury mechanisms of the abdominal area. The finite element modeling, which makes it possible to simulate a road accident and to observe the possible bone fractures or internal tissue injuries, allows large projections in the comprehension of injury mechanisms. However, the digital models already available and used in accidentology do not offer as one very simplified description of the diaphragm, as well for its geometry as for its bracing aspect and the modifications that this could induce in the behavior of abdominal organs and vessels at impact. In order to develop an accurate model of diaphragm for road safety research, a 3D reconstruction was performed, based on a sitting post-mortem Human subject sections. The resulting geometry was then turned into a segmented mechanical component (using the finite element method) and included in a full human model already available. The result is a valuable tool to improve the knowledge of injury mechanisms involved in car crashes at the abdominal level.
    Surgical and Radiologic Anatomy 06/2006; 28(3):235-40. · 1.13 Impact Factor

Publication Stats

67 Citations
32.80 Total Impact Points

Institutions

  • 2010–2012
    • Montreal Polytechnic
      • • Institut de génie biomédical
      • • Département de génie mécanique
      Montréal, Quebec, Canada
  • 2009
    • Centre Hospitalier Universitaire de Dijon
      Dijon, Bourgogne, France
  • 2008
    • Aix-Marseille Université
      • Laboratoire de biomécanique appliquée (UMR_T 24 LBA)
      Marseille, Provence-Alpes-Cote d'Azur, France
  • 2006
    • Centre Hospitalier Universitaire de Nice
      Nice, Provence-Alpes-Côte d'Azur, France