Necrosis after cortisone injections

Injections of corticoid preparations can have severe side effects. In this issue of Deutsches Ärzteblatt International, Christian Holland and coauthors contribute to physicians' awareness of problems of this type with a report on the relevant findings of medicolegal expert committees in Germany.

One patient, for example, received multiple intramuscular injections of dexamethasone and diclofenac for the treatment of back pain. Six weeks after the last injection, 500 g of necrotic tissue had to be surgically removed from the site of the injections; a subsequent wound infection led to multiple further hospitalizations. The authors describe both aseptic and septic complications, including abscesses and purulent joint infections. When they affect the spine, such complications can cause weakness of varying degrees of severity, ranging all the way to para- or tetraplegia. Fatal sepsis can also occur.

From 2005 to 2009, the German medicolegal expert committees and arbitration panels dealt with 278 cases of complications after corticoid injections. Medical errors were found to have been committed in 40% of cases. Typical errors were faulty asepsis, treatment without indication, and injections that were too closely spaced in time or in excessive doses. Furthermore, whenever it is determined that a patient has not given legally valid informed consent for an injection, the physician is liable for any and all adverse consequences of the injection for the patient's health. By giving physician readers the appropriate knowledge base, the article is intended to help them avoid such difficult medicolegal situations.