During Hyperbaric Oxygen Therapy, oxygen content of the blood increases substantiallyi. Breathing 100% oxygen at the pressure of 2 ATA leads to alveolar oxygen partial pressure (in the lungs) of approximately 1,400 mmHg!!! In a unique experiment at 1960, Boerema demonstrated that experimental animals were still alive even after complete exsanguination, when breathing 100% oxygen at 3 ATAii. Using hyperbaric oxygen, sufficient amount of oxygen reaches body tissues that have been rendered hypoxic due to inherent perfusion particularities, local conditions (inflammation, hematoma, infection, microcirculatory damage etc) and/or systematic pathology (Diabetes Mellitus, medications, radiation therapy etc)
Conclusively, use of Hyperbaric Oxygen Therapy in Orthopaedics involve:
Compartment syndrome, crush injury, acute traumatic ischemia and chronic (refractory) Osteomyelitis are complex conditions where Hyperbaric Oxygen Therapy is universally used
Delayed union & pseudarthrosis (fracture complications), avascular necrosis and infections (septic arthritis, periprosthetic infections post arthroplasty etc) are cases where Hyperbaric Oxygen is a valuable adjunct.
Any orthopaedic condition in an irradiated area should receive Hyperbaric Oxygen for correction of microvasculatory damage and hypoxia. If surgery is necessary on irradiated tissues (eg arthroplasty, osteosynthesis) Hyperbaric Oxygen Therapy should be initiated before surgical management.
In orthopaedic conditions coexisting with pathology that results in hypoxia (diabetes mellitus, peripheral arterial disease, vasculitis etc), Hyperbaric Oxygen Therapy could prevent complications to occur. But when they appear, its use is crucial for successful outcome – recovery.
i Kindwall E. The physics of diving and hyperbaric pressures. In Kindwall EP, Whelan HT, editors. Hyperbaric Medicine Practice. 2nd ed revised. Flagstaff: Best Publishing Company;2004. p21-35.
ii Boerema I, Meyne NG, Brummelkamp WK, Bouma S, Mensch MH, Kamermans F, Hanf MS, van Aalderen W. Life without blood. J Cardiovasc Surg 1960;1:133-146.