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Abstract
A&E statistics in the UK demonstrate that as high as 60% of bone fractures occur as a result of trips and falls. Subsequently, many studies have been undertaken to simulate the occurrence of hip fractures. Little simulation has been considered outside of the older population. In 2010, 6,870 UK children were on the child protection register under the category of physical abuse (Non-Accidental Injury). The diagnosis of NAI is complex, and mis-diagnosis can have severe consequences. Development of simulation techniques has allowed high resolution three-dimensional models of bone to be created from patient-specific medical imaging. To ensure accuracy in simulation, extensive physical validation must be undertaken. The ‘gold standard’ for human simulation is to use human bone samples. However, the inaccessibility of human samples often leads to small sample sizes, typically considering only a few injury types.
In this thesis, patient-specific simulation was used to investigate the torsional (spiral fractures can be an indicator NAI) and compressive fracture of long bones. Extensive physical validation was undertaken. Fundamentally, the applicability of animal substitution in testing and simulation was considered. This allows testing of samples that are more available than the human counterpart, offering the opportunity to test more samples, and to obtain developing bones. Testing and simulation performed favourably; accurate results demonstrated the viability of the techniques used in simulation. The applicability of the simulation was confirmed through accurate prediction of the failure load of porcine samples. Using validated, high accuracy simulation on a patient-specific basis is the future of healthcare. Combining the accuracy observed within this thesis, with developing bone samples from animals may be the next step in developing the simulation procedure for clinical application in NAI. This is a goal that has far reaching social implications and could help in the protection of the most vulnerable of patients.
