THIRD EUROPEAN CONSENSUS CONFERENCE ON
HYPERBARIC MEDICINETHE ROLE OF HBOT IN ACUTE MUSCULO-SKELETAL TRAUMAMILANO, 4-8 September 1996
RECOMMENDATIONS OF THE JURY*

HBO therapy has to be considered as an adjunctive treatment modality.
Optimal surgery and resuscitation have to be done before or simultaneously.

QUESTION 1- Can HBOT prevent post-traumatic bone hypoxia andpost-traumatic edema ?
Until now there is not sufficient evidence to definitively state that HBO can prevent bonehypoxia, and edema. However there is experimental and clinical evidence supporting that
HBO act to correct post-traumatic tissue edema and delayed bone healing. (Type 2statement)

QUESTION 2- Which is the role of HBOT in prevention ofreperfusion injury ?
There is some experimental evidence showing a positive effect of HBO in preventing
reperfusion injury, but there is not sufficient clinical evidence. However, no study
showed a detrimental effect of HBO in increasing the oxydative stress, in injured tissue.
(Type 3 statement)
It is strongly recommended that well conducted clinical studies have to be undertaken,
because of the existing experimental evidence. (Type 1 recommendation).

QUESTION 3- Which is the role of HBOT in prevention of posttraumatic superimposed infections ?
The procedure of choice is surgery (repeated if necessary), but HBO can berecommended as an adjunctive treatment to enhance antibiotic efficacy, to improve
tissue oxygenation and prevent superinfections. (Type 2 statement)

QUESTION 4 and 5- Which is the role of HBOT in improving tissue
salvage after acute and subacute musculo-skeletal trauma?
In case of severe tissue damage, with dubious vitality, there is experimental and clinicalevidence that HBO improves tissue salvage and clinical outcome. (Type 2 statement)

QUESTION 6- What is the role of HBOT in improving the final
clinical outcome in acute and subacute musculo-skeletal trauma?
In cases of open fractures with extensive soft tissue and/or vascular damage(corresponding with type III B/C of Gustillo's classification) adjunctive HBOT isrecommended. (Type 2 recommendation)
In less severe cases HBOT adjunctive to surgery can be used in compromised hosts.
(Type 3 recommendation)
In every cases HBO is considered, measurement of transcutaneous oxygen pressure isrecommended as an index for the definition of the indication and of the evolution oftreatment. (Type 2 recommendation)
The cost of the use of adjunctive HBO will be at least compensated by the decrease inmorbidity in these patients (e.g. lower amputation rate). (Type 2 statement)

Classification of open fractures and place for HBO
as determined by the third ECHM Consensus Conference
TypeInjury

Complication
Rate

CommentHBO

I

small (< 1 cm)
laceration frominside tooutsideless than 1 %often managed withoutformal surgicaldebridement

No HBOIIlaceration
more than 1
cm long
without or withminimal soft
tissue injury

less than 5 %excellent results withimmediate surgicaldebridement and later
delayed primary closure

No HBO

complication rates little
infection 4 %different from types I
amputation 0 %and II fracturesNo HBO

crush injury
component;IIIadequate soft
Subtype A
tissuecoverage
inadequate(loss ofIII
sufficient) soft
Subtype B tissue to coverbone and close
wound

infection 52 %amputation 16%

external skeletal fixationand free grafts have
HBO (type 2
greatly advanced therecommendation)
management of thesefractures; complication
rates remain highIII
arterial injury
Subtype C

infection 42 %amputation 42%

these complication rates
HBO (type 2
exist after arterial repair recommendation)