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Three Part Question

In patients with [acute fractures of the metatarsals] does the use of [hyperbaric oxygen] enhance [fracture healing and reduce the time to return to normal activity].

Clinical Scenario

A footballer presents to the ED having sustained a foot injury in a blatant and unnecessary foul on the edge of the opponents penalty box. The X-ray confirms a fracture of the 4th meta-tarsal which you decide can be treated conservatively. The patient mentions to you that he has heard of certain footballers with similar injuries having 'oxygen therapy' to speed up their recovery. You wonder if there is any evidence to support this form of treatment.

Search Strategy

Cochrane Database Issue 2, 2006.
Medline 2003 - May 2006.
[bone fracture.mp. or exp Fractures, Bone/ or exp "Bone and Bones"/ or bone break.mp. or fracture.mp. or exp Fracture Healing/] AND [oxygen.mp. or exp Oxygen/ or exp Oxygen Inhalation Therapy/ or exp Hyperbaric Oxygenation/ or hyperbaric oxygen.mp. or barotherapy.mp. or exp Atmosphere Exposure Chambers/ or HBOT.mp.] limit to (humans and enlglish language and yr = "2003–2006")
1 Cochrane review found. Search strategy to 2003.
25 papers found in Medline search.
None relevant to question.

Search Outcome

There was one Cochrane review first published in January 2005 (searched to 2003). Therefore, Medline was searched from 2003. A total of 206 papers were found in the Medline search, but none were relevant to the question.

Relevant Paper(s)

Author, date and country	Patient group	Study type (level of evidence)	Outcomes	Key results	Study Weaknesses
Bennett et al, 2005, Australia	RCTs comparing HBOT with no, or sham HBOT in any patient with a bone fracture	Systematic review.	1. Bone union, 2. time to bone union	No RCTs were found to support or refute the use of hyperbaric oxygen in fracture healing	None

Comment(s)

HBOT consists of intermittently administering 100% oxygen at pressures greater than 1 atm in a pressurised vessel. HBOT aims to increase the supply of oxygen to the fracture site and subsequently improve healing. There is one Cochrane Systematic Review addressing this clinical question. This review found only one small RCT which had no clinically important outcome measures. The conclusion of the review was there is no evidence from RCTs to support the use of this treatment, which may, rarely, result in serious long-term adverse effects, that is barotrauma to the ears, lungs, and sinuses.

Clinical Bottom Line

There is insufficient evidence to support the use of hyperbaric oxygen therapy for fracture healing.

Level of Evidence

Level 1 - Recent well-done systematic review was considered or a study of high quality is available.

References

1. Bennett MH, Stanford R, Turner R. Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union. Cochrane Library 2006, Issue 2.