Treatment of chronic refractory osteomyelitis with adjunctive hyperbaric oxygen

Twenty-eight consecutive patients with chronic refractory osteomyelitis uncomplicated by persistent segmental bone defect, fracture nonunion, septic arthritis, total joint arthroplasty, or major systemic disease (immune deficiency, malignancy, diabetes mellitus, malnutrition, or renal or hepatic failure) were treated from January, 1980 through December, 1985 to evaluate the potential benefits of hyperbaric oxygen therapy. Patients were classified by a staging system that took into account the bone involved; subchondral, periarticular bone involvement; extent of bone involvement; quality of soft tissue envelope and vascular supply; and general health status of the patient. Using this staging system, patients were assigned to either hyperbaric oxygen therapy or control status after their initial debridement. A regimen of hyperbaric oxygen therapy consisting of 100% oxygen, two atmospheres pressure, two hour duration, one dive per day, six dives per week was used in 14 of the 28 patients. Hyperbaric oxygen had no effect on length of hospitalization, rapidity of wound repair, initial clinical outcome, or recurrence of infection noted to date in this patient population.