Hyperbaric oxygen therapy in acute fracture management
Report by John Butler, A&E/ITU Consultant
Checked by Bernard Foex, A&E/ITU Consultant
Manchester Royal Infirmary, Manchester, UK
Abstract
A short cut review was carried out to establish whether hyperbaric oxygen therapy (HBOT) is advantageous in fracture healing. A total of 26 citations were found of which one answered the three part question. The clinical bottom line is that there is insufficient evidence to support the use of hyperbaric oxygen therapy for fracture healing.
Three part question
[In patients with acute fractures of the metatarsals] does the use of [hyperbaric oxygen] enhance [fracture healing and reduce the time to return to normal activity]?
Clinical scenario
A footballer presents to the emergency department having sustained a foot injury in a blatant and unnecessary foul on the edge of the opponents' penalty box. X ray confirms a fracture of the 4th metatarsal which you decide can be treated conservatively. The patient mentions to you that he has heard of certain footballers with similar injuries having “oxygen therapy” to speed up their recovery. You wonder if there is any evidence to support this form of treatment.
Search strategy
Cochrane Database Issue 2, 2006. Medline 2003 to May 2006: [bone fracture.mp. or exp Fractures, Bone/ or exp “Bone and Bones”/ or bone break.mp. or fracture.mp. or exp Fracture Healing/] AND [oxygen.mp. or exp Oxygen/ or exp Oxygen Inhalation Therapy/ or exp Hyperbaric Oxygenation/ or hyperbaric oxygen.mp. or barotherapy.mp. or exp Atmosphere Exposure Chambers/ or HBOT.mp.] limit to (humans and enlglish language and yr = “2003–2006”)
Search outcome
There was one Cochrane review first published in January 2005 (searched to 2003) (table 4). Therefore, Medline was searched from 2003. A total of 206 papers were found in the Medline search, but none were relevant to the question.
Table 4.
| Author, date, country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study weaknesses |
|---|---|---|---|---|---|
| Bennett et al, 2005, Australia | RCTs comparing HBOT with no, or sham HBOT in any patient with a bone fracture | Systematic review | 1. Bone union, 2. time to bone union | No RCTs were found to support or refute the use of hyperbaric oxygen in fracture healing | None |
HBOT, hyperbane oxygen therapy; RCT, randomised control trial
Comment(s)
HBOT consists of intermittently administering 100% oxygen at pressures greater than 1 atm in a pressurised vessel. HBOT aims to increase the supply of oxygen to the fracture site and subsequently improve healing. There is one Cochrane Systematic Review addressing this clinical question. This review found only one small RCT which had no clinically important outcome measures. The conclusion of the review was there is no evidence from RCTs to support the use of this treatment, which may, rarely, result in serious long‐term adverse effects, that is barotrauma to the ears, lungs, and sinuses.
Clinical bottom line
There is insufficient evidence to support the use of hyperbaric oxygen therapy for fracture healing.