Terry R Trammell MD. Henry Bock MD

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1 Spine Fractures in Open Cockpit Open Wheel Race Car Drivers Reducing the Risk through Seat Modification Terry R Trammell MD OrthoIndy Trammell Motorsports and Consulting Indy Racing League Henry Bock MD Indy Racing League

2 Introduction 11,000 cases of Spinal Cord Injury / year in US 47.5% from MVA Spinal Cord Injury: Facts and Figures at a Glance. 2004, National Spinal Cord A Injury Statistical Center. CIRENS Data Spinal Fractures 18.6% of Injuries in MVA Spine and Spinal Cord Injury in MVC: Smith and Siegel New Jersey Medical School CIREN Center

3 Introduction Incidence of Spinal Fractures in Indy Car From % of drivers injured 9.8% of all injuries (12/123) Spinal Injuries in Indy Car a 12 year experience Presented at the ICMS Mtg Toronto CA 11/23/06 IRL % of drivers injured

4 Introduction PURPOSE OF INVESTIGATION Spinal Fractures Occurrence Location / level Type Severity Correlate with direction of major impact Determine Kinematics Accident analysis Barrier Impact test Sled tests Computer modeling Determine Load Path Preventative measures

5 Material and Methods Spinal fractures occurring in Open cockpit Open wheel single occupant racecars Seasons IRL,IPS,CART, F-1,Toyota Atlantic, and Champ Car

6 Materials and Methods Data Extracted Impact direction Fracture location Fracture type and severity Data Generated Impact Barrier test HYGE sled tests X-ray Analysis of Spinal Contour Measurement of Seated Position in race car Computer modeling

7 Material and Methods Driver Data Principal Author Initial or Final Treating Physician 35 of 36 surviving drivers Extracted from Medical Records Diagnostic Imaging (X-rays, CT and MRI) Autopsy Results in two

8 Materials and Methods SPINAL REGIONS Occipital Cervical (O-C1-2) Cervical (C3 T1) Thoracic (T2 T9) Thoracolumbar (T10 L2) LumboSacral (L3 Sacrum) Courtesy DaVinci

9 Materials and Methods Impact Vector Analysis in 35 of 38 ADR 2 data Accident reports Video tape

10 Materials and Methods ADR 2 Crash Recorder Attached to the chassis of race car 6 axis accelerometer Senses and records 1000 times/sec Prior to, during and after a triggering event Records X,Y,Z accelerations Yaw rate Steering angle

11 Materials and Methods Fracture Classification: Comprehensive Classification System Gertzbein in Controversies in Spine Surgery Vol 1, 1999

12 Materials and Methods Fracture classification Gertzbein s Comprehensive Classification system

13 Materials and Methods Definition of Fracture Severity: 1. Compression Fracture without Deformity (vertebral contusion) 2. Compression Fracture <10% compression (single endplate) <15 angulation 3. Compression Fractures >10%<30% compression >15 <30 angulation

14 Materials and Methods Definition of Fracture Severity: 4. Compression or single endplate burst fx >30% compression 30 angulation 5. #4 + posterior column injury Burst Fracture (both endplates) 6. Fracture Dislocation / Cord Injury

15 Materials and Methods Driver Seated Position in the Car Series of Measurements (direct and indirect) Seated in the car in race trim Belts tightened HANS Helmet

16 Materials and Methods X-ray Analysis of Spinal contour in race car Indy Pro Series tub X-rays obtained w/wo HANS Upright Nose down Nose up Inverted Normal standing and seated posture

17 Materials and Methods Barrier Impact Test Fully loaded Indy Car Rearward into a rigid barrier Hybrid III with HANS and Helmet High speed video Multiple channels Multiple accelerometers

18 Materials and Methods HYGE Sled Tests Delphi Vandalia OH 80 g pulse THOR ATD T8 and T12 load cells HANS Indy Car Posture Reclined 45

19 Material and Methods Computer Model MADYMO Full FE Human body Model SAE MSEC # MADYMO Facet Human Body Model Correlated with sled test Validated

20 Materials and Methods THOR Physical dummy In frontal impact, up to 30mph THOR dummy math model Real human body At frontal and rear impacts, under low severity impacts Human Body math model

21 Results Fracture Data Number Location Impact direction Classification Severity Barrier Impact Test Spinal Alignment X-ray analysis Seated Position Measurements from driver in car HYGE sled tests Computer model

22 Results Spinal Fractures 36 - drivers sustained spinal injury 38 - incidents resulted in spinal injury Two drivers with two separate incidents 54 - spinal levels injured 9 sustained injury at more than one level

23 Results Fracture Location Region of Injury OCC Cervical Thoracic ThoracoLumbar LumboSacral Region

24 Results Fracture Location Cervical Fractures by Level Number O-C2 C3 C4 C5 C6 C7 Level

25 Results Fracture Location Thoracic Fractures Number T2 T3 T4 T5 T6 T7 T8 T9 Level

26 Results Fracture Location Thoracolumbar Fractures Number T10 T11 T12 L1 L2 Level

27 Results Fracture Location Lumbosacral Fractures L3 L4 L5 Sacrum Level

28 Results Impact Direction Impact Direction vs. Injury Frontal Rearward Axial Poly Direction

29 Results Impact Direction Impact Direction v. Fracture Region OC Fracture Region Cervical Thoracic ThoracoL L/S Poly Axial Rearward Frontal Frontal Rearward Axial Poly OC Fracture Region Cervical Thoracic ThoracoL L/S Frontal Rearward Axial Poly

30 Results Impact Direction Impact Direction vs. Cervical Level Number Total Number Rearward Impacts O-C2 C3 C4 C5 C6 C7 Level

31 Results Impact Direction Thoracic Fractures: Impact Direction Thoracolumbar Fractures: Impact Direction Number All Fractures Rearward Axial Force Only Number 3 All Fractures Rearward Impact T2 T3 T4 T5 T6 T7 T8 T9 Level 0 T10 T11 T12 L1 L2 Level

32 Results Data Segregation Study of thoracic and thoraco- lumbar fractures Fractures resulting from rearward impacts 22 cases (drivers injured) 13 incidents of thoracic and thoracolumbar fractures» 19 levels fractured

33 Results Fracture Classification: Comprehensive Classification System Gertzbein in Controversies in Spine Surgery Vol 1, 1999

34 Results Fracture Type by Direction of Impact Frontal Rearward Type B2 Flexion Axial Compression Type A1 Axial Compression

35 Results Classification of Fractures from Rearward Impacts All Type A Vertebral Body Compression Group 1 Impaction Fracture -11 Subgroup 1 End Plate Infraction 4 Subgroup 3 Wedge impaction - 7 Group 3 Burst Fracture Subgroup 1 Partial burst - 2

36 The Injury FRACTURE SEVERITY CLASSIFICATION Type 1: Vertebral compression without deformity Only present on MRI seen best in T2 sagittal

37 The Injury Type 2: <10% Comp; <15

38 Type 3: >10%<30% compression;>15 <30 The Injury 26% & 27 * 38% & 14 Type 4: 30% 30 ± posterior injury

39 The Injury Type 6: Fracture dislocation T12 Burst Fracture >50% compression Type 5: Burst Fracture

40 Results Injury Severity Severity vs. Direction T11 - L1 T-3-9 T11 - L1 Overall Severity forward rearward axial T-3-9 Overall Severity forward rearward axial T T11 - L

41 The Focus REARWARD IMPACTS 67% of the injuries 63% levels injured 2.9 ave.severity index (frontal = 4.8) Large database

42 Accident Analysis Analysis of Crash Videos and ADR data + x g s = 60 -z g s = 25 Δ V = 68 mph

43 Accident Analysis A Group 1 Type 4

44 Accident Analysis ADR 2 Data 13 incidents of rearward impact with Th and T/L spinal fractures Average ΔV G s x z

45 Barrier Impact Test 50 mph cv (80kph) ; +x g s = z g s = 44.6 Pelvic displacement = 4.7 inches

46 Driver Position in Race Car MEASUREMENTS Driver height Below roll hoop Forward of roll hoop Faceplate to steering wheel Chest to steering wheel Height above surround at visor pivot HANS to helmet

47 V H Visor P Chest Height 69.1 Rollbar V 14.8 Rollbar H 7.8 Pivot 2.0 Visor 13.2 Chest 13.6 HANS 1.1 HANS to Helmet

48 Spinal Contour Spine X-rays in tub with and without HANS in 4 orientations

49 Spinal Contour X-ray acquisition and analysis

50 Spinal Contour Normal Th Kyphosis T10 L2 0 Lumbar Lordosis Seated in race car Th Kyphosis 59 T10 L2 +17 (kyphosis) Lumbar Lordosis -5-40

51 Spinal Contour SEAT CONTOUR and ALIGNMENT

52 Seat Contours

53 HYGE Sled Testing ATD CALIBRATION & VALIDATION THOR Hybrid III

54 HYGE Sled Testing New Sled Buck designed and built to accommodate THOR Variable seat back angle Thigh torso angle Complete visibility of ATD HyG Sled buck for THOR and variable seat back angle and thigh torso angle

55 SledChk Rev IRL Rear Impact, Pulse 107, THOR Std Pulse: PlsI107 ATD Position: Buck/All Positions Test# IS56F031 Test Type: Frontal Sled Time [Sec] Released By: WT Process Date: (+)Le Re Accel. Max.: 2.2[G's] Time of Max.Acc: [Sec] Le Re Accel. Min.: -73.3[G's] Time of Min.Acc: [Sec] (*)Std Pulse Accel. Max.: 0.0[G's] Time of Max.Acc: [Sec] Std Pulse Accel. Min.: -82.1[G's] Time of Min.Acc: [Sec] CAC: CFC60 THOR N6060FtRLft 8010 RVHIC15S 41 HIC36S Ili Cht A CtLd 3S lti SAEJ1727 3S ThorFtLowerSpine Rev ThorFtLowerSpine Rev Rear Impact Sled Test With 6pt Belts ATD Type: THOR ATD Position: Front Row Left Test# IS66F010 Test Type: Frontal Sled Rear Impact Sled Test With 6pt Belts ATD Type: THOR ATD Position: Front Row Left Test# IS66F010 Test Type: Frontal Sled Time [Sec] Time [Sec] Filter Class: Released By: M.Shipp Process Date: (X)-Force X Max.: 1.326E+02[N] Time of Max. X: [Sec] (X)-Force X Min.: E+03[N] Time of Min. X.: [Sec] (+)-Force Y Max.: 4.087E+02[N] Time of Max. Y: [Sec] (+)-Force Y Min.: E+03[N] Time of Min. Y.: [Sec] (*)-Force Z Max.: 8.218E+02[N] Time of Max. Z: [Sec] (*)-Force Z Min.: E+04[N] Time of Min. Z.: [Sec] CAC: Filter Class: CFC1000 Released By: M.Shipp Process Date: (X)-Force X Max.: 3.503E+02[N] Time of Max. X: [Sec] (X)-Force X Min.: E+03[N] Time of Min. X.: [Sec] (+)-Force Y Max.: 7.912E+01[N] Time of Max. Y: [Sec] (+)-Force Y Min.: E+02[N] Time of Min. Y.: [Sec] (*)-Force Z Max.: 2.367E+03[N] Time of Max. Z: [Sec] (*)-Force Z Min.: E+04[N] Time of Min. Z.: [Sec] CAC: CFC1000 Page of Test# IS66F010 Page of Test# IS66F010 HYGE Sled Testing T-8_X_Y_Z [N] 8360N Thor T8 Load Cell T-12_X_Y_Z [N] 80g s +x Page of Test# IS56F031 Indy Car Rear Impact Pulse 8430N Thor T12 Load Cell Sled_X [G's]

56 Computer Modeling COMPUTER MODELING Validation and refinement Integration of known parameters Acquisition of software Sled Model integration Model Behavior with variable modification Review past work SAE papers on FE model Schmidt Thesis Model refinement Model development

57 Computer Modeling Full MADYMO FE HBM Unable to allow IndyCar Seating position (SAE ) MADYMO Facet Model Adapted to position of the reclined driver posture Reliable at high g s MADYMO Facet Human Body Model

58 Computer Modeling Facet Model demonstrated large z loads at all vertebral levels with applied pulse in the +x direction

59 HBM Positioning HBM Positioning by Rotating the Whole body Pre-positioned HBM From TASS

60 Result Analysis Overall Occupant Kinematics HBM Positioning by Rotating the Whole body Pre-positioned HBM From TASS Movie

61 Result Analysis Overall Occupant Kinematics HBM Positioning by Rotating the Whole body Pre-positioned HBM From TASS Movie

62 Result Analysis Overall Occupant Kinematics T=0ms T=3ms T=6ms T=35ms Note: All vertebrae are made of rigid elements, no deformation, no stress and strain outputs

63 Result Analysis Acceleration Comparison The acceleration curves from the THOR dummy sled test only as a reference point for the HBM responses. THOR dummy math model outputs expected to match dummy sled test outputs The HBM outputs not expected to match those of the THOR dummy sled test or dummy math model General trend of HBM accelerations reasonable Rock-and-roll spinal motion resulting in unrealistic pelvis acc

64 Result Analysis Numerical Stability Pre-positioned model becoming unstable after 35ms Excessive element deformation Penetrations among the internal organs, the skeleton and the skin Elbow joint dislocation

65 THUMS Computer Modeling Total Human Model for Safety Toyota Motor Corporation Toyota Central Research and Development Laboratory

66 Validation Toyota FIA Modeling Project Cooperative with THUMS

67 Discussion PATHOPHYSIOLOGY Load required to produce fracture Effect of rate of application Effect of position Degree of flexion Superior endplate failed most commonly Wedging

68 Discussion Loads to failure for Endplate and Vertebral Body were rate dependant Higher velocity loading resulted in increased likelihood of fracture Loads from 2500N N Thoracic Vertebral Fractures 4200N 7600N Dependent on the age of the specimen

69 Discussion Type and Severity of Fx Force Magnitude Point of application Rate of application Associated moment Direction +x (rearward) -y (axial compression) Effect of loading rate on endplate and vertebral body strength in human lumbar vertebrae Ochia, R., Tencer, A. & Ching, R. Journal of Biomechanics 36 (2003)

70 Discussion Major Injury Vector Major Injury Vector Compression loading of the end plate z axis (axial) Fracture types from rearward impacts are variants of axial loading with some flexion moment

71 Discussion EJECTION SEAT INJURY STUDIES Biomechanics of fracture Load path z axis Magnitude of load >20 g s Rise time (rate) Crash pulse Canon shell Rocket motor Spatial orientation of the vertebral column out of position spinal flexion Dampening effect of the seat material Eccentric Load vs Facet Rotation * **

72 Discussion Common Factors ejection vs. race car Fracture type Fracture severity Anatomical location Mid Thoracic Upper Lumbar Posture at impact Out of position Indy Car posture

73 Discussion EJECTION SEAT INJURIES Spatial Orientation Normal contours Thoracic kyphosis Lumbar lordosis Straight spine Thigh Trunk angle 135 Pelvis anchored INJURY LEVELS Mid thoracic spine Compression Fractures less likely when spine extended Thoracolumbar contour preserved

74 Discussion Risk of Fracture Reduced Maintaining physiologic posture Contact with seat back Altered position of ejection lever Anchoring pelvis Thigh torso angle 135 Reducing rate of force application <20g s Limiting rise time with rocket Seat cushion material

75 Discussion Results of Previous Modeling Optimum Position for Rearward Impact

76 Discussion Driver Kinematics Forward rotation of torso Out of position seating Ramping phenomenon Video analysis Rear impact barrier test HYGE sled tests Viano effect

77 Discussion Compressive Loads Ramping with inertial loading Torso rise Frontal rise on impact Straightening of thoracic kyphosis Viano data VIANO EFFECT: Impact applied to the thoracic kyphosis resulted in straightening of the spine and a compressive load on the spine remote from the point of force application

78 Discussion THOR in HYGE Sled z (axial) loads produced in rearward impact (+x) T8 and T12 load cells Ramping Model Validation

79 Discussion Seated Position Upright seated posture in aircraft ejection and preservation of physiologic contours reduced fracture risk

80 The Mechanism Seating Position Confirmed by xray analysis and seat contour

81 Discussion Environmental Limitations Cockpit /Monocoque dimensions fixed Maximum driver height below roll hoop Driver size Anthropometry Height 67.9 inches Weight 164.5# Seated height 35.2 in

82 Discussion Variation in Fx Level Load Path ADR shows -z loads Rear crash test high z loads (compressive) Injuries consistent with z loading Rear Crash test demonstrated chassis buckling and rise

83 Discussion Variation in Fx Level Load Path ADR shows -z loads Rear crash test high z loads (compressive) Injuries consistent with z loading Rear Crash test demonstrated chassis buckling and rise

84 Discussion Variation in Fx Level Load Path ADR shows -z loads Rear crash test high z loads (compressive) Injuries consistent with z loading Rear Crash test demonstrated chassis buckling and rise

85 Conclusions Spinal fractures occurrence increasing 8.5% to 21% 71.4% in rearward impacts (+x) All fractures MIV is in z axis (axial compression)

86 Conclusions Rearward (+x) impact generates a compressive (z) in the driver s spine ADR-2 chassis accelerometer (z) ADR-2 ear accelerometer (z) Barrier Impact test with Hybrid III ATD HYGE sled test with THOR ATD MADYMO Facet HBM Load is sufficient to produce fracture 6000N or 20g s vertical

87 Conclusions X-ray Analysis of Driver in Car Loss of normal spinal contours Loss of lumbar and cervical lordosis Accentuated Thoracic Kyphosis Thoracolumbar kyphosis Pre loads vertebral endplate Hydrostatic property of intervertebral disc

88 Conclusions Development of Spinal Compressive (z) loads is multifactoral Spinal alignment Ramping of the torso Viano effect Frontal rise of vehicle during impact

89 Conclusions Interaction of torso with the seat Material characteristics Energy management Variable density Control ramping Pelvic anchorage Promote/maintain lumbar lordosis

90 Conclusions Goal of Study to reduce Compressive loading of 6500 N Vertical g s < 20 g s

91 HYGE Sled Testing New Sled Buck designed and built to accommodate THOR Variable seat back angle Thigh torso angle Complete visibility of ATD HyG Sled buck for THOR and variable seat back angle and thigh torso angle

92 Seat Modification EPP 1.76# IS64f030 66F012 Drilled IS66F013 67F012 EAR foam added IS68F025 With pelvic void IS68F028

93 Seat Modification EEP 1.76# with carve out IS72F022 With EPS 1.5# IS72F024 Posterior Void filled IS72F25-26 Carbon Kevlar unsupported ISbF024

94 Seat Modification Hyge Sled Testing Rearward impact Test No. T1 G's Z T8 Z (N) 8 MnY (Nm T12 Z (N) T12 MnY (Nm) IS64F IS65F IS66F IS66F011 x IS66F IS66F IS67F IS68F IS68F IS69F IS69F IS6BF

95 Progress Report Past Testing and Analysis EPS and EPP testing Seat back too stiff (hard) Unable to manage energy Ramping Thoracic straightening Loads in excess of limits Drilled out seat to soften Results improved Belt Geometry alterations 7 point most effective

96 Progress Report Testing in February 2007 Proof of Concept Carbon Kevlar Shell Foam backed Reduced loads T8 z s = 7500 T12 z s = 4700 Excessive excursion Available space ~ 2 in

97 Progress Report Testing in June 2007 New Bracket design All restraint harness anchor points out of position relative to ATD Invalid tests!

98 Progress Report Testing in August sled runs EPS seats from Mk 1 Corrugated EPP seats from Createc Modular backing Fenestrated Corrugated

99 Progress Report Results: Data wouldn t trend T8 & T12 loads remarkable similar regardless of condition Unpredictable effects of seat modification

100 Progress Report Analysis of Results ATD unsupported by seatback Lack of contact due to error in original seat molding - pour Original mold used to form all subsequent seats All tests to date unrepresentative of actual event

101 The Problem New Spine Fx s in IRL 2 IPS 2 Champ Car

102 Progress Report New seat mold made for THOR Bald Spot / Createc and Mk-1 have use of mold Both have fabricated new seats with accurate fit to THOR Carbon Kevlar shell EPS and EPP backing and seats

103 Progress Report Sled Testing at CAPE (preliminary results) 6 rearward runs BSS - 1.7# EPP Mk # EPS BSS - 1.0# EPS Mk # EPS with Carbon Shell Mk EPS beads All performed below fracture threshold, issues with motion and undesirable loading

104 Progress Report

105 Progress Report T8 X (N) T8 Z (N) T8 MnY (Nm) T12 X (N) T12 Z (N)

106 Progress Report Summary Injury mechanism validated Clinical review, sled test analysis, THUMS Seating platform design Seat parameters defined Softer seat with better energy management to capture pelvis and prevent ramping Design to lessens loads below threshold as yet unidentified

107 Guidelines Obtain Seat from either Bald Spot Sports or Mark 1 Composites DO NOT MAKE IT YOURSELF from 2 part foam Don t press yourself into the mold when making seat try to maintain normal contour

108 Desired Seat Contour

109 Guidelines 2 inch minimum thickness of the back 1 inch minimum thickness of the bottom High friction surface Don t cover the seat with glossy duct tape

110 Guidelines Restraints Use a 7 th center belt Use the Schroth HANS 2 over 3 shoulder belts (HANS goes between the belts) Protect your knees Pad the forward side of the dash bulkhead

111 Goal of Project

112 Goal of Project

113 Goal of Project A Happy Ending

114 The End

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