Infections may complicate fracture healing and result in deficient or unsuccessful callus formation, called delayed union or nonunion. Hyperbaric oxygen has been used to treat these complications of fractures. In one study, infection developing after surgery/orthopaedic operation, resolved completely resulting subsequently in fracture healing. This was achieved after 20 – 30 sessions of hyperbaric oxygen therapyi.

Hyperbaric Oxygen Therapy has been also successful in reconstructive surgery when combined with distraction osteogenesis (eg Ilizarov method) and biomaterials used (eg ΒΜΡ – bone morphogenetic protein) in complicated cases that require such a composite approach.

Anatomical location of fracture may be important for healing. Lower part of tibia has relatively poor blood supply by definition and microcirculatory damage due to the injury causing a fracture in that area may compromise oxygen delivery and healing capacity. Furthermore, pathological conditions causing vascular disease predispose to such complications. Special consideration should be given to Diabetes Mellitus which is known to cause microcirculatory injury that jeopardises perfusion, immune response, healing and thus, presents as a combination of risk factors. Medications taken for other conditions may cause trouble as well. Corticosteroids, for example, which are used for management of immunological disorders (eg rheumatic diseases) leads to osteoporosis and insufficient healing. These patients are exposed to extra risk for complications. Last, but not least, irradiated tissues are hypoxic and susceptible to infections with reduced healing capacity

Occasionally, the exact cause of delayed fracture healing cannot be identified. In all aforementioned conditions, however, there is increased risk for insufficient healing to occur. It is in those cases that the use of Hyperbaric Oxygen Therapy is a valuable adjunct right from the start, combined with standard practice of fracture management, to prevent occurrence of delayed union or nonunion. Addition of HBOT to the management of established delayed unionhas excellent results and leads to recovery in the majority of cases.

i Atesalp AS, Komurcu M, Basbozkurt M, Kurklu M. The treatment of infected tibial nonunion with aggressive debridement and internal bone transport. Mil Med 2002;167:978-981.