Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union

  • Review
  • Intervention




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.


The aim of this review was 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 methods

We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (April 2008), the Cochrane Register of Controlled Trials (CENTRAL) (The Cochrane Library Issue 2, 2008), MEDLINE (OVID 1966 to April week 3, 2008), CINAHL (OVID 1982 to April week 3, 2008), EMBASE (OVID 1980 to week 17 2008), the locally developed Database of Randomised Controlled Trials in Hyperbaric Medicine (available at www.hboevidence.com) from inception to May 2008, and reference lists of articles.

Selection criteria

We aimed to include all randomised controlled trials that compared the effect of HBOT with no HBOT (no treatment or sham).

Data collection and analysis

We planned independent data collection by two authors using standardised forms.

Main results

No trials met the inclusion criteria. We excluded one trial that compared HBOT with no treatment because no clinical outcomes were reported.

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.

Plain language summary

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 or HBOT has been suggested as a way to enhance healing and treat non-union. HBOT 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.

This review found only one small randomised controlled trial. However, this trial reported no clinically important outcomes. There is, therefore, no evidence from randomised trials to support or refute the use of HBOT to avoid or treat poorly healing broken bones. It should be noted that HBOT may, albeit rarely, result in serious long-term adverse effects.