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In the real world, the severity of traumatic injuries is measured using the Abbreviated Injury Scale (AIS) and is often estimated, in finite element human computer models, with the maximum principal strains (MPS) tensor. MPS can predict when a serious injury is reached, but cannot provide any AIS measures lower and higher from this. To overcome these limitations, a new organ trauma model (OTM2), capable of calculating the threat to life of any organ injured, is proposed. The OTM2 model uses a power method, namely peak virtual power, and defines brain white and grey matters trauma responses. It includes human age effect (volume and stiffness), localised impact contact stiffness and provides injury severity adjustments for haemorrhaging. The focus, in this case, is on real-world pedestrian brain injuries. OTM2 model was tested against three real-life pedestrian accidents and has proven to reasonably predict the post mortem (PM) outcome. Its AIS predictions are closer to the real-world injury severity than the standard maximum principal strain (MPS) methods currently used. This proof of concept suggests that OTM2 has the potential to improve forensic predictions as well as contribute to the improvement in vehicle safety design through the ability to measure injury severity. This study concludes that future advances in trauma computing would require the development of a brain model that could predict haemorrhaging.

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RATIONALE, AIMS AND OBJECTIVES: Three-dimensional (3D) medical images are shown to patients during clinical consultations about certain health conditions. However, little is known about patients' experience of viewing them. The aim of this qualitative study was to explore the impact of sharing 3D medical images with patients during a clinical consultation about hip surgery, from the perspective of patients, health care professionals, and lay representatives. METHOD: Interviews were conducted with 14 patients who were shown their own 3D medical images during their clinical consultation and four health care professionals conducting consultations within one orthopaedic outpatient clinic. In addition to interviews, 31 lay representatives participated in six focus groups. The focus groups aimed to gain a broader understanding of the advantages and concerns of showing patients their medical images and to compare 3D and two-dimensional (2D) medical images. Interviews and focus groups were audio-recorded, transcribed verbatim, and analysed using thematic analysis. RESULTS: Three themes were developed from the data: (a) the truthful image, (b) the empowering image, and (c) the unhelpful image. Focus group participants' preference for 3D or 2D images varied between conditions and groups, suggesting that the experience of viewing images may differ between individuals and conditions. CONCLUSIONS: When shown to patients during an orthopaedic clinical consultation, 3D medical images may be an empowering resource. However, in this study, patients and focus group participants perceived medical images as factual and believed they could provide evidence of a diagnoses. This perception could result in overreliance in imaging tests or disregard for other forms of information.

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OBJECTIVE: This study compared the experience of viewing 3D medical images, 2D medical images and no image presented alongside a diagnosis. METHODS: We conducted two laboratory experiments, each with 126 healthy participants. Participants heard three diagnoses; one accompanied by 3D medical images, one accompanied by 2D medical images and one with no image. Participants completed a questionnaire after each diagnosis rating their experience. In Experiment 2, half of the participants were informed that image interpretation can be susceptible to errors. RESULTS: Participants preferred to view 3D images alongside a diagnosis (p<0.001) and reported greater understanding (p<0.001), perceived accuracy (p<0.001) and increased trust (p<0.001) when the diagnosis was accompanied by an image compared to no image. There was no significant difference in trust between participants who were informed of errors within image interpretation and those who were not. CONCLUSION: When presented alongside a diagnosis, medical images may aid patient understanding, recall and trust in medical information. PRACTICAL CONSIDERATIONS: Medical images may be a powerful resource for patients that could be utilised by clinicians during consultations.

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In total hip arthroplasty, determining the impingement free range of motion requirement is a complex task. This is because in the native hip, motion is restricted by both impingement as well as soft tissue restraint. The aim of this study is to determine a range of motion benchmark which can identify motions which are at risk from impingement and those which are constrained due to soft tissue. Two experimental methodologies were used to determine motions which were limited by impingement and those motions which were limited by both impingement and soft tissue restraint. By comparing these two experimental results, motions which were limited by impingement were able to be separated from those motions which were limited by soft tissue restraint. The results show motions in extension as well as flexion combined with adduction are limited by soft tissue restraint. Motions in flexion, flexion combined with abduction and adduction are at risk from osseous impingement. Consequently, these motions represent where the maximum likely damage will occur in femoroacetabular impingement or at most risk of prosthetic impingement in total hip arthroplasty.

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INTRODUCTION: Trauma remains a major cause of mortality and morbidity, particularly among young adults. A major trauma (whole-body) CT protocol based upon mechanism of injury was investigated in a busy emergency department. METHODS: Trauma patients presenting in two 3-month periods before and after the introduction of a major trauma CT protocol were identified. The mechanism of injury, Injury Severity Score, radiological imaging performed and injuries detected were recorded. RESULTS: More eligible patients received major trauma CT scanning post-protocol than pre-protocol (87/114 (76%) vs 44/94 (47%)). There were no adverse effects attributable to major trauma CT. Seventeen injuries were detected post-protocol that would not have been detected had imaging been conducted based on clinical suspicion rather than mechanism of injury. In three cases an immediate intervention was required. CONCLUSION: Our major trauma CT protocol, based on mechanism of injury, resulted in substantial changes in clinical management in a small number of patients without any increase in adverse events. However, it is not a substitute for clinical acumen in the initial assessment of trauma patients.

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