Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis

Twenty-eight consecutive patients with chronic refractory osteomyelitis uncomplicated by persistent fracture nonunion, septic arthritis, total joint arthroplasty, or major systemic disease (immune deficiency, malignancy, malnutrition, renal or hepatic failure) were treated from January 1980 through December 1985 to evaluate the potential benefits of hyperbaric oxygen (HBO) therapy. Patients were classified by a staging system taking 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. Hyperbaric oxygen therapy on a 100% oxygen, 2 atmospheres pressure, 2-hour duration, one dive per day, six dives per week regimen was utilized 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.