Hyperbaric oxygen therapy potentially can provide enhanced oxygen delivery to peripheral tissues affected by vascular disruption, cytogenic and vasogenic edema, and cellular hypoxia caused by extremity trauma. After appropriate resuscitation, macrovascular repair, and fracture fixation/stabilization, adjunctive hyperbaric oxygen therapy can enhance tissue oxygen content. In patients with crush injury or early compartment syndrome, hyperbaric oxygen therapy may reduce the penumbra of cells at risk for delayed necrosis and secondary ischemia. Animal experiments and human case series suggest the benefits of such therapy, and recent randomized, prospective studies on trauma patients have confirmed its efficacy in those with extremity trauma.

This article focuses on the use of hyperbaric oxygen therapy (HBOT) in the treatment of open fractures and crush injuries. Based on the clinical evidence and cost analysis, medical institutions that treat open fracture and crush injuries are justified in incorporating HBOT as a standard of care. Both Medicare and Undersea and Hyperbaric Medical Society guidelines list crush injuries as an approved indication for HBOT. Emergency physicians should familiarize themselves with this emerging treatment modality because of their role in the early management of these injuries. Emerg Med Clin North Am. 2007 Feb;25(1):177-88.