Using oxygen at high pressure (in a compression chamber) for the treatment of broken bones

Broken bones (fractures) are very common and sometimes may take a long time to heal or in some cases may fail to heal. The resulting non-union can result in long-term pain and loss of function. The use of hyperbaric oxygen therapy (HBOT) has been suggested as a way to enhance healing and treat non-union. Hyperbaric oxygen therapy involves the delivery of oxygen at high pressure to patients in a specially designed chamber (like those used for deep sea divers suffering pressure problems after resurfacing). The aim is to increase the supply of oxygen to the fracture site, which theoretically should improve healing. It should be noted that hyperbaric oxygen therapy may, albeit rarely, result in serious long-term adverse effects.

This review found no evidence from randomised trials to support or refute the use of hyperbaric oxygen therapy to avoid or treat poorly healing broken bones. However, in this update, we found three ongoing randomised trials that are likely to provide some evidence to inform on the use of hyperbaric oxygen therapy in the future.

Authors' conclusions: 

This systematic review failed to locate any relevant clinical evidence to support or refute the effectiveness of HBOT for the management of delayed union or established non-union of bony fractures. Good quality clinical trials are needed to define the role, if any, of HBOT in the treatment of these injuries. There are three randomised controlled trials underway and we anticipate these will help provide some relevant clinical evidence to address this issue in the future.

Read the full abstract...

Hyperbaric oxygen therapy (HBOT) consists of intermittently administering 100% oxygen at pressures greater than one atmosphere absolute (ATA) in a pressure vessel. This technology has been used to treat a variety of diseases and has been described as helping patients who have delayed healing or established non-union of bony fractures. This is an update of a Cochrane Review first published in 2005, and previously updated in 2008.


The aim of this review is to assess the evidence for the benefit of hyperbaric oxygen treatment (HBOT) for the treatment of delayed bony healing and established non-union of bony fractures.

Search strategy: 

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (July 2012), the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library 2012, Issue 7), MEDLINE (1946 to July Week 1 2012), EMBASE (1974 to 2012 July 16), CINAHL (1937 to 17 July 2012), the Database of Randomised Controlled Trials in Hyperbaric Medicine (accessed July 2012), the WHO International Clinical Trials Registry Platform (17 July 2012) and reference lists of articles.

Selection criteria: 

We aimed to include all randomised controlled trials comparing the clinical effects of HBOT with no HBOT (no treatment or sham) for healing of bony fractures and fracture non-unions.

Data collection and analysis: 

Two review authors independently screened electronic search results, and all three authors independently performed study selection. We planned independent data collection and risk of bias assessment by two authors using standardised forms.

Main results: 

No trials met the inclusion criteria. In this update, we identified three ongoing randomised controlled trials. Among the eight excluded studies were three randomised trials comparing HBOT with no treatment that included patients with fractures. One of these trials had been abandoned and the other two did not report on fracture healing outcomes.