Hyperbaric oxygen therapy in the management of post-traumatic osteomyelitis: A case series of 11 patients and long-term outcomes

Aim Osteomyelitis is a rare but serious complication of bone fractures, often requiring complex and prolonged treatment. If not properly managed, it can lead to severe disability and chronic infection. This study evaluates the effectiveness of adjunctive hyperbaric oxygen therapy (HBOT) in chronic post-traumatic osteomyelitis, including refractory cases (6/11) and chronic non-refractory cases (5/11) with relevant comorbidities. Materials and Methods We conducted a single-center case series of 11 consecutive patients with chronic post-traumatic osteomyelitis treated with combined surgical debridement, antibiotic therapy and adjunctive HBOT between 2014 and 2024. Five cases (N. 5, 6, 7, 9, 11) did not fulfill criteria for “refractory” disease (no documented failure after ≥6 weeks of targeted antibiotics plus indicated debridement) and were classified as chronic, non-refractory osteomyelitis at baseline. Patients were selected based on clinical urgency and comorbidities. Outcomes were assessed based on infection resolution, wound healing, and absence of recurrence during a minimum follow-up of 12 months. Results All 11 patients achieved complete infection resolution and wound healing without recurrence. The adjunctive use of HBOT was well tolerated and appeared particularly effective in patients with diabetes or cardiovascular disease. These results may be attributed to HBOT's known mechanisms: enhanced oxygen delivery to hypoxic tissue, improved neutrophil-mediated bacterial clearance, and disruption of biofilms. Conclusions: HBOT, when integrated into a multidisciplinary treatment strategy, may significantly improve outcomes in patients with complex osteomyelitis. In this mixed cohort of chronic (refractory and non-refractory) post-traumatic osteomyelitis, adjunctive HBOT within a multidisciplinary strategy was associated with infection control at ≥12-month follow-up, with benefits particularly evident in patients with comorbidities. Its benefits were most evident in patients with systemic comorbidities, suggesting a valuable role for HBOT in high-risk clinical scenarios. All patients achieved clinical healing without recurrence, suggesting a possible association between HBOT and favorable outcomes.