Biomechanics of Traumatic Head and Neck Injuries on Women: A State-of-the-Art Review and Future Directions

SIMPLE SUMMARY: With this review, the authors aim at providing the reader a concise biological and biomechanical description of the main contributions in the field of traumatic brain injuries and neurodegenerative outcomes for women, especially related to chronic traumatic encephalopathy. A review on numerical models created to address these issues is also performed, discussing the use (or the lack of use) of sex-specific validation experiments to validate those models. A discussion is also performed to alert to some considerations to be taken in account when numerically modelling those same injury scenarios. ABSTRACT: The biomechanics of traumatic injuries of the human body as a consequence of road crashes, falling, contact sports, and military environments have been studied for decades. In particular, traumatic brain injury (TBI), the so-called “silent epidemic”, is the traumatic insult responsible for the greatest percentage of death and disability, justifying the relevance of this research topic. Despite its great importance, only recently have research groups started to seriously consider the sex differences regarding the morphology and physiology of women, which differs from men and may result in a specific outcome for a given traumatic event. This work aims to provide a summary of the contributions given in this field so far, from clinical reports to numerical models, covering not only the direct injuries from inertial loading scenarios but also the role sex plays in the conditions that precede an accident, and post-traumatic events, with an emphasis on neuroendocrine dysfunctions and chronic traumatic encephalopathy. A review on finite element head models and finite element neck models for the study of specific traumatic events is also performed, discussing whether sex was a factor in validating them. Based on the information collected, improvement perspectives and future directions are discussed.