HBO in Orthopedic Disorders

  • F. Malerba
  • G. Oriani
  • A. Farnetti
  • G. Bouachour
  • P. Cronier


Every trauma determines a state of local hypoxia that follows tissular ischaemia, because of anatomical vascular lesions or functional obstacles, which interfere with cellular metabolic processes. In soft tissues the post-traumatic interruption of the perfusion and oxygenation provokes mortification and necrosis. In the bones, the damage in the blood supply, which we can observe after a fracture, provokes an ischaemic-hypoxic state that interferes with the repairing processes that originate in the post-fracture haematoma and are completed only in normal oxygen conditions, causing a delay in the formation of the bone callus and, consequently, in the consolidation of the fractures.


Compartment Syndrome Open Fracture Hyperbaric Oxygen Crush Injury Reflex Sympathetic Dystrophy 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Thibodeau A (1986) Fisiologia Umana- Casa Ed. AmbrosianaGoogle Scholar
  2. 2.
    Boume GH - The biochemistry and biology of the bone. Second Ed. vol 3. Development and growth. New York and London-Academic PressGoogle Scholar
  3. 3.
    Davis JC (1978) Refractory osteomyelitis of the extremities and axial skeleton. In: Davis JC, Hunt TK Hyperbaric oxygen therapy. Bethesda, MD: Undersea Medical Society, pp 217–227Google Scholar
  4. 4.
    Oriani G, Gaietta T (1986) Oxygen hyperbaric therapy for orthopaedic disorders. Proceedings of Seventh Congress of SIMSI (Italian Society for Underwater Medicine). Ed. Mari Lanza Palermo, pp 121–132Google Scholar
  5. 5.
    Oriani G, Faglia E (1989) Ossigenoterapia Iperbarica. Applicazioni cliniche. Ed. SIO MilanoGoogle Scholar
  6. 6.
    Mally R, Kolodny S (1977) Osteogenesis enhancement. Hyperbaric oxygen therapy by Davis JC, Hunt TK Undersea Medical Society, Bethesda MD, pp 181–285Google Scholar
  7. 7.
    Penttinen R, Niinikoski J, Kulonen E (1972) Hyperbaric oxygenation and fracture healing. A biochemical study with rats. Acta Chir Scand, pp 138–139Google Scholar
  8. 8.
    Niinikoski J (1977) Oxygen and wound healing. Clin Plast Surg 4, pp 361–374Google Scholar
  9. 9.
    Han AW (1971) Repair and transplantation of bone vol, pp 337–339 Academic Press, New YorkGoogle Scholar
  10. 10.
    Basset CAL, Herzman I (1961) Influence of oxygen concentration and mechanical factors on differentiation of connective tissue in vitro nature 190: 460–461Google Scholar
  11. 11.
    Hunt TK, Pai MP (1972) The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 135: 561–567PubMedGoogle Scholar
  12. 12.
    Hunt TK, Niinikoski J, Zederfeldt BH (1977) Oxygen in wound healing enhancement: cellular effects of oxygen in hyperbaric oxygen therapy. Davis JC, Hunt TK eds, Undersea medical Society, Bethesda MD, pp 111–122Google Scholar
  13. 13.
    Ketchums A, Thomas AN, Hall AD (1970) Angiographic studies of the effects of hyperbaric oxygen on burn wound revascularization. Proc Fourth International Congress of Hyperbaric Medicine - J. Wada, T. Iwa eds Tokyo: Igaku Shoin, p 388Google Scholar
  14. 14.
    Melerba F, Oriani G (1981) L oxygenoterapie hyperbare et les traumatisme du pied. Estratto da Chirurgia del piede, vol 5 n° 3–4 Luglio-DicembreGoogle Scholar
  15. 15.
    Haimovici H (1973) Myopathic nephrotic metabolic syndrome associated with massive acute arterial occlusion. J Cardiovasc SurgGoogle Scholar
  16. 16.
    Strauss MB, Hart GB (1983) Hyperbaric oxygen and the skeletal-muscle compartment syndrome. Contemp Orthop 18: 167–174CrossRefGoogle Scholar
  17. 17.
    Sheffield J (1985) Tissue oxygen measurements with respect to soft tissue wound healing with normobaric and hyperbaric oxygen. HBO Rev 6: 18–46Google Scholar
  18. 18.
    Strauss MB, Hart GB (1984) Crush injury and the role of hyperbaric oxygen. Topics in Emergency Med 6: 6–24Google Scholar
  19. 19.
    Miller HH, Welch CS (1949) Quantitatives studies of the time factor in arterial injuries. Ann Surg 130: 428–438CrossRefGoogle Scholar
  20. 20.
    Hargenas AR (1981) Compartment syndrome and Volkman’s contracture. Philadelphia: WB Saunders, pp 41–70Google Scholar
  21. 21.
    Russel RC, Roth AC, Kucan JW, Zook EG (1989) Reperfusion injury and oxygen free radicals. A review. J Reconstr Microsurg 5: 79–84CrossRefGoogle Scholar
  22. 22.
    Angel MF, Ramasastry SS, Swartz WM (1987) Free radicals: basic concepts concerning their chemistry, pathophysiology and relevance to plastic surgery. Plast Reconstr Surg 79: 990PubMedCrossRefGoogle Scholar
  23. 23.
    Mason PN, Anthenelli PRM, Im GM The role of oxygen free radicals in ischemic tissue injury in island skin flaps.Google Scholar
  24. 24.
    Zamboni WA, Roth AC, Russel RC, Graham B, Sichy H, Kucan JO (1993) Morphological analysis of the microcirculation during reperfusion of ischemic skeletal muscle and the effect of HBO. Plast Reconstr Surg 91: 1110–1123PubMedCrossRefGoogle Scholar
  25. 25.
    Feng LJ, Berger BE, Lysz TV, Shaw WW (1988) Vasoactive prostaglandins in the impending no-flow primary disturbance in microvascular tone. Plast Reconstr Surg 91: 755Google Scholar
  26. 26.
    Mathieu D, Wattel F, Bouacour G, Billard V, Defoin JF (1990) Post-traumatic limb ischemia: predicting of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen. J Trauma 30: 307–314PubMedCrossRefGoogle Scholar
  27. 27.
    Zamboni WA, Roth AC, Bergman BA, Russel RC, Stephenson LL (1992) Experimental evaluation of oxygen in the treatment of ischemic skeletal muscle. Undersea Biomed Res 19: 78Google Scholar
  28. 28.
    Oriani G (1992) L’ossigenoterapia iperbarica nel trauma. Ed. Caravatti-Varese, pp 53–62Google Scholar
  29. 29.
    Champion WM, McSherry CK, Goulian D (1967) Effect of hyperbaric oxygen on survival of pedicled skin flaps. J Surg Res 7: 583–586PubMedCrossRefGoogle Scholar
  30. 30.
    McFarlane RM, Wermuth RE (1966) The use of hyperbaric oxygen to prevent necrosis in experimental pedicle flaps and composite skin grafts. Plast Reconstr Surg 37: 422–430PubMedCrossRefGoogle Scholar
  31. 31.
    Shulman AG, Viron HL (1967) Influence of hyperbaric oxygen and multiple skin allografts on the healing of skin wounds. Surgery 62: 1051–1058PubMedGoogle Scholar
  32. 32.
    Oriani G, Barnini C (1984) Ossigenoterapia iperbarica e patologia ortopedica. Ed. IOG MilanoGoogle Scholar
  33. 33.
    Davis JC, Hunt TK (1977) Refractory osteomyelitis of the extremities. Hyperb Oxygen Ther 217–225Google Scholar
  34. 34.
    Bakker DJ (1987) Necrotizing soft tissue infections. J Hyperb Med 2 (3): 161–169Google Scholar
  35. 35.
    Strauss MB (1980) Chronic refractory osteomyelitis: review and role of hyperbaric oxygen. HBO Rev 1: 231–255Google Scholar
  36. 36.
    Mader JT, Adams KR, Sutton TE (1987) Infections diseases. Pathophysiology and mechanism of hyperbaric oxygen. J Hyperb Med 2 (3): 133–151Google Scholar
  37. 37.
    Slack WK, Thomas DA, Perrins DJD (1965) Hyperbaric oxygenation in chronic osteomyelitis. Lancet 1: 1093–1094PubMedCrossRefGoogle Scholar
  38. 38.
    Mader JT, Brown GL, Guckian JC, Wells CH, Renarz JA (198o) A mechanism for the amelioration by oxygen hyperbaric on experimental staphylococcal osteomyelitis in rabbit. J Infect DisGoogle Scholar
  39. 39.
    Morrey BF, Dunn JM, Heimbach RD et al. (1979) Hyperbaric oxygen and chronic osteomyelitis. Clin Orthop Rel Res 144: in-127Google Scholar
  40. 40.
    Doury P (1989) Algodistrophies. Encycl Med Chir Ortopedie et traumatologie 10: 1486A 10Google Scholar
  41. 41.
    Amor B, Tallet F, Raichvarg D (1982) Algodistrofies et anomalies metaboliques Rev Rhumat 49: 827–833Google Scholar
  42. 42.
    Basle MF, Rebel A, Renier JC (1983) Bone tissue in reflex sympathetic dystrophy syndrome Sudek’s atrophy: structural and ultra-structural studies. Metab Bone Dis Relat Res 4: 305–311PubMedCrossRefGoogle Scholar
  43. 43.
    Ogilvie-Harris DJ, Roscoe M (1987) Reflex sympathetic dystrophy of the knee. J Bone Joint Surg 69-B, 804–806Google Scholar
  44. 44.
    Schwartzman RJ, McLellan TL (1987) Reflex sympathetic dystrophy: a review. Arch Neurol 44: 555–561PubMedCrossRefGoogle Scholar
  45. 45.
    Melzack R, Wall PD (1965) Pain mechanism: a new theory. Science 150: 971–979PubMedCrossRefGoogle Scholar
  46. 46.
    Doury P, Dirheimer Y, Pattin S (1981) Algodistrophy. Diagnosis and therapy of a frequent disease of the locomotor apparatus, vol. Springer Verlag Ed. Berlin Heidelberg NewYork, p 165Google Scholar
  47. 47.
    Druker WR, Hubay CA, Holden WD, Bukovnic JA (1959) Pathogenesis of post-traumatics sympathetic dystrophy. Am Surg, pp 454–465Google Scholar
  48. 48.
    Oriani G, Tecchio G, Meazza D, Turati A (1990) The Sudek’s knee syndrome: treatment with hyperbaric oxygen. Proc of Xth International Congress on HBO Amsterdam, pp 163–166Google Scholar
  49. 1.
    Drapanas T, Hewitt RL, Weichert RT et al. (1970) Civilian vascular injuries. A critical appraisal of three decades of management. Ann Surg 172: 351–360PubMedCrossRefGoogle Scholar
  50. 2.
    Keeley SB, Sydner WH, Weigelt JA (1983) Arterial injuries below the knee: fifty-one patients with eighty-two injuries. J Trauma 23: 285–292PubMedCrossRefGoogle Scholar
  51. 3.
    Lange RH, Bach AW, Hansen ST et al. (1985) Open tibial fractures with associated vascular injuries: prognosis for limb salvage. J Trauma 25: 203–208PubMedCrossRefGoogle Scholar
  52. 4.
    Strauss MB (1981) Role of hyperbaric oxygen therapy in acute ischemias and crush injuries–an orthopedic perspective. HBO Rev 2: 87–106Google Scholar
  53. 5.
    Shupak A, Gozal D, Ariel A, Melamed Y, Katz A (1987) Hyperbaric oxygenation in acute peripheral post-traumatic ischemia. J Hyper Med 2: 7–14Google Scholar
  54. 6.
    Gustillo R, Williams DN (1984) The use of antibiotics in the managements of open fractures. Orthopaedics 7: 1617–1619Google Scholar
  55. 7.
    Byrd HS, Spicer TE, Cierny G (1985) Management of open tibial fractures. Plast Reconstr Surg 76: 719–728PubMedCrossRefGoogle Scholar
  56. 8.
    Gustillo RB, Mendoza RM, Williams DN (1984) Problems in the management of type III (severe) open fractures: a new classification of type III open fractures. J Trauma 24: 742–746CrossRefGoogle Scholar
  57. 9.
    Swartz WM, Mears DC (1985) The role of free tissue transfer in lower extremity reconstruction. Plast Reconstr Surg 76: 364–373PubMedCrossRefGoogle Scholar
  58. 10.
    Danckwardt-Lillieström G, Lorenzi GL, Olerud S (1970) Intramedullary nailing after reaming, an investigation on the healing process in osteomized rabbit tibias. Acta Orthop Scand (Suppl) 134: 1–78Google Scholar
  59. 1.
    Byrd HS, Cierny GH, Tebbets JB (1981) The management of open tibial fractures with associated soft-tissue loss: external pin fixation with early flap coverage. Plast Reconstr Surg 68: 73–79PubMedCrossRefGoogle Scholar
  60. 12.
    Gustillo RB, Anderson JT (1976) Prevention of infection in the treatment of one thousand and twenty-five open fractures of long bones. J Bone Joint Surg 58A: 453–458Google Scholar
  61. 13.
    Pierce EC II (1969) Pathophysiology, apparatus and methods, including the special techniques of hypothermia and hyperbaric oxygen. In: Pierce EC II (ed) Extracorporeal circulation for open heart surgery. Charles C. Thomas Springfield, Ill, pp 83–84Google Scholar
  62. 14.
    Krogh A (1919) The number and distribution of capillaries in muscle with calculations of the oxygen pressure head necessary for supplying the tissue. J Physiol 52: 409–415PubMedGoogle Scholar
  63. 15.
    Gottrup F, Firmin R, Hunt TK, Mathes SJ (1984) The dynamic properties of tissue oxygen in healing flaps. Surgery 95: 527PubMedGoogle Scholar
  64. 16.
    Guyton AC, Ross JM, Cornier D et al. (1964) Evidence for tissue oxygen demand as the major factor causing autoregulation. Circ Res 15 (Suppl): 60–69PubMedGoogle Scholar
  65. 17.
    Meijne NG (1965) Flow distribution changes during extracorporeal circulation at two atmospheres absolute. In: Ledingham IMCA (ed) Hyperbaric oxygenation. Livingstone, Edinburgh and London, pp 136–148Google Scholar
  66. 18.
    Wang MCH, Reich T, Lesho WH et al. (1966) Hyperbaric oxygenation: oxygen exchange in an acutely ischemic vascular bed. Surgery 59: 94-loiGoogle Scholar
  67. 19.
    Stalker CG, McEwan AJ, Ledhingham IMCA (1973) The effect of increased 02 in acute limb ischemia. Br J Surg 60: 144–148PubMedCrossRefGoogle Scholar
  68. 20.
    Bird AD, Telfer ABM (1965) Effect of hyperbaric oxygen on limb circulation. Lancet 1: 355–356PubMedCrossRefGoogle Scholar
  69. 21.
    Sullivan SM, Johnson PC (1981) Effect of oxygen on blood flow autoregulation in cat sartorius muscle. Am J Physiol 41: H807 - H815Google Scholar
  70. 22.
    Nylander G, Lewis D, Nordstrom H, Larson J (1985) Reduction of postischemic edema with hyperbaric oxygen. Plast Reconstr Surg 76: 595–603Google Scholar
  71. 23.
    Skyhar MJ, Hargens AR, Strauss MB, Gershuni DH, Hart GB, Akeson WH (1986) Hyperbaric oxygen reduces edema and necrosis of skeletal muscle in compartment syndromes associated with hemorrhagie hypotension. J Bone Joint Surg 68A: 1218–1224PubMedGoogle Scholar
  72. 24.
    Strauss MB, Hargens AR, Gershuni D, Greenberg DA, Crenshaw AG, Hart GB, Akeson WH (1983) Reduction of skeletal muscle necrosis using intermittent hyperbaric oxygen in a model of compartment syndrome. J Bone Joint 65A: 656–662Google Scholar
  73. 25.
    Nylander G, Nordstrom H, Lewis D, Larson J (1987) Metabolic effects of hyperbaric oxygen in postischemic muscle. Plast Reconstr Surg 79: 91–96PubMedCrossRefGoogle Scholar
  74. 26.
    Hunt TK, Linsey M, Grislis G, Sonne M, Jawetz E (1975) The effect of different ambient oxygen tensions of wound infection. Ann Surg 181: 35–39PubMedCrossRefGoogle Scholar
  75. 27.
    Mader JT, Brown GI, Guckian JC, Wells CH, Reinarz JA (1980) A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis 142: 915–922PubMedCrossRefGoogle Scholar
  76. 28.
    MacLennan JD (1962) The histotoxic clostridial infections of man. Bacteriol Rev 26: 177–276PubMedGoogle Scholar
  77. 29.
    Demello FG, Haglin JJ, Hitchcock CR (1973) Comparative study of experimental Clostridium perfringens infection in dogs treated with antibiotics, surgery and hyperbaric oxygen. Surgery 73: 936–941PubMedGoogle Scholar
  78. 30.
    Riseman JA, Zamboni WA, Curtis A, Graham DR, Konrad HR, Ross DS (1990) Hyperbaric oxygen therapy for necrotizing fasciitis reduces mortality and the need for debridements. Surgery 108: 847–850PubMedGoogle Scholar
  79. 31.
    Hunt TK, Pai MP (1972) The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis. Surg Gynecol Obstet 135: 561–567PubMedGoogle Scholar
  80. 32.
    Hunt TK, Nunikoski J, Zederfeldt BH, Silver IA (1977) Oxygen in wound healing enhancement: cellular effects of oxygen. In: Davis JC, Hunt TK (eds) Hyperbaric oxygen therapy. Undersea Medical Society, Bethesda, pp 111–122Google Scholar
  81. 33.
    Manson PN, Im MJ, Myers RAM (1980) Improved capillaries by hyperbaric oxygen in skin flaps. Surg Forum 31: 564–567Google Scholar
  82. 34.
    Kivisaari J, Niiniskoski J (1975) Effects of hyperbaric oxygenation and prolonged hypoxia on the healing of open wounds. Acta Chir Scand 141: 14–19PubMedGoogle Scholar
  83. 35.
    Smith G, Stevens J, Griffiths JC et al. (1961) Near avulsion of foot treated by replacement and subsequent prolonged exposure of patients to oxygen a two atmospheres pressure. Lancet 2: 1122–1123PubMedCrossRefGoogle Scholar
  84. 36.
    Slack WK, Thomas DA, De Jode LRJ (1966) Treatment of trauma, ischemic disease of limbs and varicose ulceration. In: Brown IW Jr, Cox BG (ed) Proc Third International Congress on Hyperbaric Medicine. Washington; DC: National Academy of Sciences, National Research Council, pp 621–624Google Scholar
  85. 37.
    Szekely 0, Szanto G, Takats A (1973) Hyperbaric oxygen therapy in injured subjects. Injury 4294–300Google Scholar
  86. 38.
    Monies-Chas I, Hashmonai M, Hoerer D et al. (1977) Hyperbaric oxygen treatment as an adjunct to reconstructive vascular surgery in trauma. Injury 8: 274–277CrossRefGoogle Scholar
  87. 39.
    Loder RE (1979) Hyperbaric oxygen therapy in acute trauma. Ann R Coll Surg Engl 61: 472PubMedGoogle Scholar
  88. 40.
    Schramek A, Hashmonai M (1977) Vascular injuries in the extremities in battle casualties. Br J Surg 64: 644–648PubMedCrossRefGoogle Scholar
  89. 41.
    Bouachour G, Cronier P, Gouello JP, Toulemonde JL, Talha A, Alquier P (1994) Result of a randomized prospective clinical trial of hyperbaric oxygen therapy versus placebo in crush injuries. HBO improves wound healing and reduces the need or surgery. In: Cimsit M (ed) Proc XXth Annual Meeting of EUBS on Diving and Hyperbaric Medicine. Istanbul, p 172Google Scholar
  90. 42.
    Sheffield PJ, Workman WT (1985) Noninvasive tissue oxygen measurements in patients administered normobaric and hyperbaric oxygen by mask. Hyperb Oxygen Rev 6: 47–62Google Scholar
  91. 43.
    Mathieu D, Wattel F, Bouachour G, Billard V, Defoin JF (1990) Post-traumatic limb ischemia. Prediction of final outcome by transcutaneous oxygen measurements in hyperbaric oxygen. J Trauma 20: 307–314CrossRefGoogle Scholar
  92. 44.
    Bouachour G, Gouello JP, Perrotin F, Alquier P (1994) Usefulness of transcutaneous oxygen monitoring in hyperbaric oxygen in patients with crush injuries. Results of a randomized prospective study. In: Cimsit M (ed) Proc XXth Annual Meeting of EUBS on Diving and Hyperbaric Medicine. Istanbul p 393Google Scholar
  93. 45.
    Strauss MB (1988) Cost-effective issues in HBO therapy: complicated fractures. J Hyperb Med 3: 199–205Google Scholar

Copyright information

© Springer-Verlag Italia, Milano 1996

Authors and Affiliations

  • F. Malerba
    • 1
  • G. Oriani
    • 2
  • A. Farnetti
    • 1
  • G. Bouachour
    • 3
  • P. Cronier
    • 4
  1. 1.II Orthopaedic and Traumatologic DivisionGaleazzi Orthopaedic InstituteMilanItaly
  2. 2.Anaesthesia, Intensive and Hyperbaric Care DepartmentGaleazzi Orthopaedic InstituteMilanItaly
  3. 3.Service de Réanimation Médicale, Unité de Médecine HyperbareCentre Hospitalier UniversitaireAngers Cedex 01France
  4. 4.Service de chirurgie Reconstructrice et TraumatologiqueCentre Hospitalier UniversitaireAngers Cedex 01France

Personalised recommendations