Lindstrom
Hyperbaric oxygenation improved tibialis posterior peak flow signals following nailing of tibial shaft fractures.
Clinical Bottom Line: 1. Hyperbaric oxygenation increases the flow in the tibialis posterior artery following nailing of tibial shaft fractures. 2. Transcutaneous oxygen tensions were not improved in the hyperbaric group as compared to the control.
Appraised by: Mike Bennett, Dept. of Diving and Hyperbaric Medicine Prince of Wales Hospital; Tuesday, 17 November, 1998
Clinical Scenario: A patient with a tibial shaft fracture requiring an intramedullary nail.
Three-part Question: In patients with tibial shaft fractures requiring intramedullary nailing, does the application of hyperbaric oxygenation as compared to air breathing, result in any improvement in healing of these fractures? Search Terms: Fractures/tibial shaft, hyperbaric oxygenation.
The Study: Non-blinded randomised controlled trial with intention-to-treat. Adult patients with unilateral closed tibial shaft fracture as an isolated injury, with minimal soft tissue injury, and requiring intramedullary nailing. Control group (N = 10; 10 analysed): Lower extremity split plaster cast, intramedullary nailing with reaming under spinal anaesthesia. Experimental group (N = 10; 10 analysed): As above plus hyperbaric oxygenation at 2.5ATA for 90 minutes daily for five days. Measurements at 4-6 hours after treatment.
The Evidence:
Outcome Time to outcome Air group HBO group P-value
Tibialis posterior 3 days 7.5 14 <0.001 peak signal (cm/s)
Transcutaneous oxygen 3 days 3.8 4.2 NS tension (kPa)
Comments: 1. No clinical data on healing or recovery given. 2. Transcutaneous oxygen tensions improved in the HBO group after day 2 postoperatively. 3. The clinical importance of this finding remains unclear. 4. Non-blinded study.
Expiry date: April 2003 References: 1. Lindstrom T, Gullichsen K, Lertola K, Niinikoski J. Effects of hyperbaric oxygen therapy on perfusion parameters and transcutaneous oxygen measurements in patients with intramedullary nailed tibial shaft fractures. Undersea and Hyperbaric Medicine 1998; 25:87-91.
