Adjunctive Hyperbaric Oxygen Therapy During Femoral Limb Lengthening in a Child: A Case Report

Hyperbaric oxygen therapy (HBOT) has several established clinical applications, including treatment of severe anemia, crush injuries, and necrotizing soft tissue infections. Increasing interest also exists in its potential to enhance bone regeneration, as demonstrated in animal models. Improved regenerate formation and maturation could shorten treatment time during distraction osteogenesis (DO). We describe the feasibility and application of HBOT as an adjunct during femoral limb lengthening with a magnetic lengthening nail in a pediatric patient. A pediatric patient underwent two sequential femoral lengthening procedures with a magnetic lengthening nail at ages 6 and 10 years. HBOT was used as a patient-initiated, self-referred adjunctive therapy during both treatments to promote regenerate bone formation. Outcomes assessed included pixel value ratio (PVR), bone healing index (BHI), time to full weight-bearing (FWB), lengthening rate and duration, radiographic and clinical findings, hardware function, and complications. The patient completed 46 HBOT sessions during the first lengthening and 36 during the second. Regenerate PVR remained consistently above 0.85 relative to surrounding bone throughout distraction and consolidation. The length gained was 4.0 cm and 4.8 cm, respectively. BHI was 27.25 days/cm for the first procedure and 18.54 days/cm for the second. Full weight-bearing was achieved by 12 weeks postoperatively. This case demonstrates the novel use of HBOT as an adjunct in human lower extremity DO. In this patient, HBOT was feasible and associated with robust regenerate formation and early recovery. Further study is warranted to determine whether HBOT can improve outcomes in limb lengthening patients.