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Non-healing Bone:

Hyperbaric Oxygen Therapy (HBOT) can help to heal bone disorders by stimulating the osteoclasts and osteoblasts. This helps and leads to the re-absorption of dead bone and the creation of new bone. In addition, HBOT stimulates the production of new blood vessels, so that the growing bone receives a steady supply of nutrients, including oxygen. This blood vessel network does two other things: it helps support the function of the osteoclasts, and brings infection fighting white blood cells to the area.

Infected, non-healing fractures of the leg are difficult management problems. They often result in extended hospitalizations, permanent disability and amputations. Over a six year period 21 patients with infected, non-healing fractures were referred for HBOT in addition to their injury management. After some months of treatment, Seventy five percent healed in six months or less. In addition, the infection arrested in 95% of these patients.

The one modality introduced in our management that was not used in the patient’s treatment prior to their referral was Hyperbaric Oxygen Therapy. We feel that HBOT is an important adjunct in improving the host environment. It is our opinion that the primary problem in the infected non-healing fracture is that of ischemia at the fracture site. This is due to revitalized bone and poorly vascularized scar tissue. HBOT is believed to compliment the debridement process by improving oxygenation at the fracture site. This promotes revascularization and improves other host factors such as white blood cell oxidative killing, fibroblastic proliferation and osteoclastic activity. The osteoclast is known to be very oxygen dependent cell. HBOT appears to stimulate osteoclast function. The osteoclasts then become effective in clearing residual infected, non-viable bone whereas they were unable to do so in the hypoxic environment. These preliminary experiences suggest that it is an adjunct that compliments the proper use of antibiotics, wound care, and appropriately timed surgery.

References:

  1. Weiland, A.J., Moore, J.R., and Daniel, R.K. The efficacy of free tissue transfer in the treatment of osteomyelitis. J. Bone Joint Surg. 66-A: 181-193, Feb 1984.
  2. Osteomyelitis therapy failure found related to a few factors. Orthopaedic news, Jan-Feb 1984, pp. 1, 7.
  3. Niinikoski, J., and Hunt, T.K., Oxygen tension in healing bone. Surg. Gynecol. Obstet. 134:746-750, 1972.
  4. Hunt, T.K., Zederfeldt, B., and Goldstick, T.K. Oxygen and Healing, Am. J. Surg. 118:521-525, 1969
  5. Mader, J.T. Brown, G.L., Guckian, J.C., Wells, C.H., and Reinarz, J.A., A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J. Infect. Dis. 142:915-922, 1980
  6. Strauss, M.B., Malluche, H.H., Faugere, M.C., Greenberg, D.A., Hart, G.B., and Green, S., Effect of hyperbaric oxygen on bone resorption in rabbits. Presented at Seventh Annual Conference on the Clinical Application of Hyperbaric Oxygen, June 9-11, 1982, Disneyland, Anaheim, CA.