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.
