Tibial Osteomyelitis Following Prehospital Intraosseous Access

Abstract

Intraosseous (IO) access is a lifesaving alternative to peripheral or central venous access in emergency care. However, emergency physicians and prehospital care providers must be aware of the potential for infectious complications associated with this intervention. We describe the case of a HIV-negative, otherwise immunocompetent adult patient who underwent prehospital insertion of a tibial IO device. Following successful resuscitation, the patient developed tibial osteomyelitis requiring multiple operative debridements, soft tissue coverage, and several courses of prolonged antimicrobial therapy. Skin antisepsis prior to device insertion followed by early device removal are important strategies for reducing the risk of infection associated with IO access.

Propionibacterium acnes Osteomyelitis after Intraosseous Cannulation in a Child

“…Recently, there has been increasing interest in P. acnes- related infections due to its causative role in prosthetic joint infections in upper and lower extremities and the difficulties in eradicating the organism despite skin decontamination as these bacilli reside deep within the pilosebaceous glands [5–8]. Intraosseous device insertion-related infections are rare events with scattered reports describing Staphylococcus aureus osteomyelitis occurring after rapid intraosseous vascular access [2, 10]. However, to the best of our knowledge, tibial Propionibacterium acnes osteomyelitis in a child after intraosseous cannulation for fluid resuscitation, as demonstrated in our patient, has not been previously reported.…”

Acute Tibial osteomyelitis caused by intraosseous access during initial resuscitation: a case report and literature review

“…However, extravasation, air embolism or skin abscesses have been reported. Osteomyelitis occurs in less than 1% [4, 5] with a very small number of cases reported, to the best of our knowledge [6–10]. We report an unusual case of massive acute tibial osteomyelitis in an adult, three months after an IO infusion used in an initial resuscitation at home.…”

Intraosseous Tibial Resuscitation After a Total Knee Arthroplasty Leading to Osteonecrosis and Loosening of the Tibial Component

“…The most common complication of IO access is extravasation leading to compartment syndrome, followed by osteomyelitis, cellulitis, and skin abscesses [ 2 , 5 ]. While a few cases of osteomyelitis after IO access have progressed to osteonecrosis (ON) [ [9] , [10] , [11] ], there are no incidents of isolated ON after IO access reported in the literature.…”