Intraosseous Therapy, Robotics and Outcome Measures in Trauma & Orthopaedics
DNB Orthopaedics • October 2023 • Paper IV • Question 3 • 10 Marks [3+3+4]
A. Intraosseous Therapy in Orthopaedics [3 Marks]
Definition
Intraosseous (IO) therapy refers to administration of fluids, blood products or drugs directly into the medullary cavity of bone, allowing rapid access to the systemic venous circulation when conventional intravenous access is difficult, delayed or impossible.
The medullary cavity functions as a non-collapsible venous access route, making IO access particularly valuable during emergency resuscitation.
Principle
The highly vascular marrow cavity drains through medullary venous sinusoids into the systemic circulation. Therefore medications and fluids administered through an IO cannula reach the central circulation rapidly.
IO NEEDLE ↓ CORTEX ↓ MEDULLARY CAVITY ↓ VENOUS SINUSOIDS ↓ CENTRAL CIRCULATION
Indications
- Cardiac arrest
- Major trauma with difficult IV access
- Severe haemorrhagic shock
- Burns
- Paediatric emergencies
- Entrapped trauma patient
- Pre-hospital resuscitation
- Any emergency where rapid vascular access cannot be established promptly
In trauma practice, IO access is generally considered a temporary emergency vascular access rather than a substitute for definitive peripheral or central venous access.
Common Sites
| Site | Clinical Use |
|---|---|
| Proximal tibia | Common and easily accessible site |
| Proximal humerus | Useful in… |