Chronic Osteomyelitis : Infection of the Bone

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 therapy.

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 ways.

  1. Helps to strengthen the bone cells called osteoclasts that reabsorb dead bone, allowing the osteoclasts to remove bony debris more effectively.
  2. 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.
  3. Helps the body to create new blood vessels called capillaries.

As a result of these three factors, the body is able to get rid of the diseased bone and replace it with healthy bone.

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

Non-Union Fracture

When a bone is broken, it is referred to as a fracture. There are five basic types of fractures:

  1. Greenstick - the break does not go all the way through the bone and occurs more often in children rather than adults.
  2. Simple - there is a clean break of the bone with little damage to surrounding tissues.
  3. 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.
  4. 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.
  5. 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 our website.

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.

Hyperbaric Medicine Practice by Eric P. Kindwall, M.D. & Harry T. Whelan, M. D.
Textbook of Hyperbaric Medicine by K. K. Jain, M. D.
Hyperbaric Oxygen Therapy by Richard Neubauer, M.D. & Morton Walker, DPM

All Rights Reserved @ Hi-Tech Hyperbaric Medical Centre, Malaysia.