Anatomical analysis of proximal tibia: selecting ideal sites for pediatric intraosseous infusion

Intraosseous access is a safe and efficient method to administer medications to patients that require advanced life support when intravenous access is not easily available. This study aims to narrow down the ideal insertion site for intraosseous access within the proximal tibia in a pediatric population. The study utilized computed tomography scans that were retrospectively collected from scans of five infant patients between four-weeks and two-years old, seven young children between two-years and six-years old, and ten children between six-years and twelve-years of age. Analysis of the computed tomography scans started at 10mm and extended to 50mm distally to the tibial tuberosity at 10mm increments. The smallest cortical thickness to medullary space ratio and most desirable cortical thickness to anteromedial border ratio across all three groups – infants, young children, and child – was identified as 10mm inferior to the tibial tuberosity. Meanwhile, the largest medullary space to anteromedial border ratio was at 10mm inferior to the tibial tuberosity for the infants and young child groups, and at 30mm for the child group. This study showed that, overall, the ideal needle insertion site to gain vascular access for an intraosseous infusion procedure in the proximal tibial in infants, young child, and children is 10mm distal to the tibial tuberosity.