Osteomyelitis represents an inflammatory
process with a bacterial infection involving bone. The disease
involves ischemia as well as infection, and it my be acute, sub
acute, or chronic. The term "chronic osteomyelitis" refers to
failure to heal despite adequate surgical and antibiotic
Staphylococci (staph) bacteria is a common form
of bacteria that is often involved. Staphylocossus Epidermis and
Pseudomonas Aeruginosa are also bacteria that are cultured from the
wound site. The germs that cause osteomyelitis can enter the bone
during an injury. It is an ever-present hazard following compound
fractures and must be guarded against whenever the bone is exposed.
Germs can reach the bone from a nearby infection or indirectly
through the bloodstream.
HBOT is an adjunctive therapy and should be
used with appropriate antibiotics, surgical debridement, and
reconstructive surgery. Osteomyelitis can either be acute or
chronic. All cases are initially acute. The signs of acute infection
are severe pain, swelling, redness at the site of the infection or
high fever and general malaise. Chronic osteomyelitis may follow the
acute form or may develop over time, when the acute form is not
completely cured by treatment. Its symptoms include bone pain,
tenderness, local muscle spasm, and fever. Long-term osteomyelitis
may go on for years, with periods of worsening or waning symptoms,
in spite of treatment.
Osteomyelitis causes a lack of oxygen
in the tissues and some bone itself has few blood vessels. HBOT
forces oxygenation which helps fight this disease in three
- Helps to strengthen the bone cells called osteoclasts that
reabsorb dead bone, allowing the osteoclasts to remove bony debris
- Enhances the function of the immune system's white blood
cells which depend on oxygen. For this reason, HBOT is especially
effective when used with antibiotics as it potentiates the action
of the antibiotics.
- Helps the body to create new blood vessels called
As a result of these three factors, the
body is able to get rid of the diseased bone and replace it with
Oxygen is also important in wound healing. When
the environment of the fibroblast has an oxygen tension of less than
10mmHg, the cell can divide, but it can no longer synthesize
collagen. It also cannot migrate to where it is needed for healing.
When the oxygen tension is increased, the fibroblast can again carry
out these wound healing functions. The collagen produced by these
cells forms a protective fibrous matrix, and new capillaries grow
into this matrix. Wound healing is a dynamic process and an adequate
oxygen tension is mandatory for this process to proceed to a
successful conclusion. HBOT provides oxygen to promote collagen
production, angiogenesis and ultimately wound healing in the
ischemic or infected wound. Adequate supply of oxygen is vital in
the treatment of osteomyelitis
When a bone is broken, it is referred to as a
fracture. There are five basic types of fractures:
Greenstick - the break does
not go all the way through the bone and occurs more often in
children rather than adults.
Simple - there is a clean
break of the bone with little damage to surrounding tissues.
Comminuted - or closed
fracture is where the bone is broken in more than two places and
healing is usually slow because the blood supply is interrupted
but the skin remains intact.
Compound - the broken end of
the bone pierces the overlying skin and can cause considerable
tissue damage. This type of fracture carries a high risk of
infection and associated complications such as osteomyelitis.
Pathological - where a bone
is already weaken from disease and normal stresses may cause a
spontaneous fracture to occur.
Most simple bone fractures can heal itself with
adequate rest, immobilization and time. When bone fails to heal it
is call a non-union fracture and for this condition, HBOT could be
used. It stimulates the production of collagen, a tough, fibrous
material that fills in the space between the two broken ends of the
bone. Under hyperbaric conditions, new capillaries are stimulated to
grow bringing in more oxygen and nutrients to the area. In turn the
body produces more osteoblasts and osteoclasts which cause new bone
growth and helps to take away old dead bone.
HBOT provides the tissues with
a high concentration of oxygen and the oxygen profusion distance
around the arteries and veins is increased. This stimulates cell
recovery, reduces swelling, causes tissues to release the build up
of toxic wastes from the cells, suppresses infection, potentiates
the use of antibiotics which in turn, speeds up the healing process.
This is especially important in healing tibia/fibular fractures
which have a poor blood supply. Diabetes is another complication to
the healing process of fractures. See Diabetic Wounds information on
HBOT also helps bone grafts -
pieces of bone transplanted to a fracture site, to "take" and heal
with less complications. By adding HBOT to conventional surgical
methods it helps to improve bone regeneration for a faster recovery
time. HBOT is used when osteomyelitis (bone infection) has
complicated or stopped the healing process. See Osteomyelitis
information on our website.
Practice by Eric P. Kindwall, M.D. & Harry T. Whelan, M.
Textbook of Hyperbaric Medicine by K. K. Jain, M.
Hyperbaric Oxygen Therapy by Richard Neubauer, M.D. &
Morton Walker, DPM