Refractory Osteomyelitis

Most people who break a bone get it set and after a month or two they’re back to normal.  In some cases, however, complications develop that cause great pain and sometimes loss of the limb.  Complications can follow fractures or other types of injuries or surgeries.  Osteomyelitis is an inflammatory condition with a bacterial infection involving the bone tissue.  The disease also involves ischemia as well as infection.  Refractory refers to failure to heal despite surgical and antibiotic therapy.

When bone is injured, special bone cells called osteoclasts work to repair the damage.

The osteoclasts carve paths through bone around the break and enable the dead bone to be reabsorbed by the body.  Other bone cells create new bone; these are the osteoblasts.

If the osteoclasts can’t break down the dead and infected bone, new bone can’t be laid down.

The osteoclasts need oxygen to function properly, but injury often results in hypoxia.  The hypoxia occurs because many small blood vessels are destroyed.  Osteomyelitis has been linked to a lack of blood vessels at the site of a bone infection.

HBOT contributes to healing bone disorders by stimulating both osteoclasts and the osteoblasts.  This helps with the reabsorption of the dead cells and the creation of new bone cells.  HBOT also stimulates the production of new blood vessels so the growing bone gets a steady supply of nutrients and oxygen.  The blood vessels also bring in infection fighting white blood cells to the area.  One mechanism for HBOT’s effectiveness may be the increase of oxygen that maximizes the killing efficiency of phagocytes.

Increase in oxygen levels has a direct lethal effect on strict anaerobic organisms and on some micro-aerobic organisms.  During HBOT there is an increase of superoxide levels and hydrogen peroxide production.  Anaerobic organisms are killed by these substances. HBOT also works synergistically with many classes of antibiotics.

HBOT is also important in wound healing.  The fibroblasts, which make the collagen matrix, need a certain level of oxygen to synthesize collagen and to migrate to the wound area.  Once the collagen matrix is laid down new capillaries can grow and sustain wound healing.

Osteomyelitis is a bacterial infection that usually involves both the outer layer of the bone and the inner bone marrow layer.  Staphylococci bacteria are often involved.  The bacteria enter during an injury or surgery.  Bacteria can spread to bone tissue from a nearby infection or indirectly through the bloodstream.  Osteomyelitis is always a concern with compound fractures and also precautions must be taken whenever the bone marrow is exposed during surgery.

Osteomyelitis starts as an acute condition but may develop into a chronic syndrome. Conventional treatment involves several weeks of bed rest and antibiotics and possibly surgery to remove dead bone and infected soft tissue and possibly fill holes and/or implant devices to keep the bone or joints from moving.

Refractory osteomyelitis is the term for the cases that do not respond to treatment.

Osteomyelitis may develop after tooth extraction even when preventative antibiotics are taken.  It causes a lack of oxygen and some bone has very little blood supply.  HBOT forces oxygenation and helps by strengthening osteoclasts (that absorb dead bone cells), enhances the immune system’s white blood cells, and helps create new blood vessels, so the body is able to get rid of diseased bone and replace it with healthy bone.

HBOT given before infections occurred did not prevent infections subsequently; researchers have concluded that it works for osteomyelitis because it enhances the immune system and not because it kills the bacteria directly.

Reports of controlled HBOT studies emphasize that it is an important supplemental treatment to surgery and antibiotics.  The success rate using HBOT ranges from 60% to 85%, and with a lower rate of recurrence.  Neubauer’s protocol is 2.4 ATA once a day for a minimum of 60 treatments.

Dr. Jefferson C. Davis, a leading figure in hyperbaric medicine (according to Neubauer59) studied two groups of patients in 1977 and in 1986 at the Southwest Texas Methodist Hospital.  In over half of all the patients, 68 out of a total of 136 patients, the infections cleared up completely and remained cured long after a five-year follow-up period.

59Neubauer, 86.