Hyperbaric Oxygenation in Treatment of Femoral Pseudoarthrosis Caused by Osteomyelitis

Post-traumatic osteomyelitis is a common complication of open fractures. Most infections can be resolved by aggressive wound debridement, antibiotics, and normal wound drainage. However, the eradication of infection can be challenging in patients with chronic infection. The pseudarthrosis caused in this way is maintained and difficult to treat even when the infection is cured. Persistent infection may sometimes require suppressive therapy or even limb amputation to control the disease. Improvements in medical treatment have led to increased survivorship and reduced disability in these patients, posing new challenges in their posttraumatic care. This case report describes the use of HBO therapy as an adjunct treatment in a compromised host with recurrent post-traumatic osteomyelitis and refractory pseudarthrosis despite aggressive wound debridement, removal and replacement of the affected bone by autologous bone graft, and several courses of intravenous and oral antibiotic therapy. Hyperbaric oxygen therapy may be considered as an adjunct to standard treatment protocols for refractory osteomyelitis in compromised hosts.