Abstract
Purpose
Methods to administer intramedullary medication and fluid infusion in both adults and children date to the early twentieth century. Studies have shown that intraosseous access in the proximal tibia is ideal for resuscitation efforts as fewer critical structures are at risk, and neither is the blood flow to the lower limbs compromised. Insertion of a needle in children younger than 5 years does have the risk to damage to the epiphyseal growth plate. Therefore, the aim of this study was to determine the ideal intraosseous insertion site distal to the epiphyseal growth plate in neonates.
Methods
The samples consisted of both the left and right sides of 15 formalin-fixed neonatal cadavers. The dimensions were measured on the superior surfaces of each section, anteromedial border, cortical thickness, and medullary space.
Results
The most desirable location to gain vascular access is at 10 mm inferior to the tibial tuberosity.
Conclusion
The smallest cortical thickness (1.32 mm), the largest medullary space (4.50 mm), and the largest anteromedial surface (7.72 mm) were observed at 10 mm inferior to the tibial tuberosity. It is imperative that health care professionals are familiar with the osteological sites that could be safely used for an intraosseous infusion procedure.
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Data availability
The quantitative and qualitative data used to support the findings of this study are included within the article, and additional data may be requested from the corresponding author.
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Acknowledgements
The authors sincerely thank those who donated their bodies to science so that anatomical research could be performed. Results from such research can potentially increase mankind's overall knowledge that can then improve patient care. Therefore, these donors and their families deserve our highest gratitude. Additionally, the authors would like to thank Prof. JM Boon and Ms. D Naidoo for making the initial cuts of the tibias.
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The authors declare that this research and publication is not funded by any financial supporting body.
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All the authors had substantial contributions to the conception of the work, analysis, or interpretation of data for the work. This included drafting the work or revising it critically for important intellectual content. The final version of this document was approved by all the authors before submission. Additionally, all the authors agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. DJvT contributed to protocol development, data collection, data analysis, and manuscript writing. MLvN was involved in protocol development and manuscript editing. AvS contributed to project development, data collection, data analysis, and manuscript editing.
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This research was part of a research project at the University of Pretoria, which was submitted to and approved (Ethics clearance: 447/2018) by the Ethics Committee at the University of Pretoria. We certify that this study was performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.
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van Tonder, D.J., van Niekerk, M.L. & van Schoor, A. Proximal tibial dimensions in a formalin-fixed neonatal cadaver sample: an intraosseous infusion approach. Surg Radiol Anat 44, 239–243 (2022). https://doi.org/10.1007/s00276-021-02843-1
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DOI: https://doi.org/10.1007/s00276-021-02843-1