Inadvertent intraosseous injection during fluoroscopy-guided joint injection of two adult patients

Two cases of inadvertent intraosseous injection during fluoroscopy-guided joint injection are presented. The first case occurred during a pre-MRI hip arthrogram while the second case happened during a glenohumeral joint steroid injection. Both cases were performed on osteopenic female patients over 60 years old who reported significant pain during injection of contrast and fluoroscopic imaging showed pooling of contrast in bone during attempted injection. Both procedures were corrected by retracting the needle to achieve intraarticular injection. Being aware of intraosseous injection as a possible reason for difficulty during the procedure both guides the operator to proper correction (retraction of the needle) and also avoids a non-diagnostic or less effective procedure. •Intraosseous injection is an infrequent but possible pitfall that occur when performing fluoroscopy guided injections of large joints.•Contrast injected during intraosseous needle placement can pool between dominant trabeculae and extend several centimeters away from the needle location.•Osteoporosis is a likely predisposing factor for inadvertent intraosseous injection.