Hyperbaric oxygen treatment of scaphoid fractures: Hyperbaric oxygen group and control group, each with 30 cases. All patients underwent manipulative reduction and plaster immobilization. The hyperbaric oxygen therapy group received treatment based on the above (massively multiplayer tank air pressure at 0.25MPa), inhaling pure oxygen for 60 minutes with a 10-minute break each time, treated once per day for 10 days, and each patient was given three courses of treatment. The cure criteria were an X-ray examination after three months showing a lot of continuous callus, disappearance of the fracture line; absence of wrist pain, tenderness, and weakness in holding objects.
In March 2002, Section 24 (2) of the Fourth Military Medical University's Military Medical College reported the results: In the hyperbaric oxygen group, 29 out of 30 patients were cured (96.9%); in the control group, 22 out of 30 cases were cured (73.3%). Statistically, the results showed a significant difference (: 4.706, P < 0.05).
Discussion: Fracture healing requires abundant nutrition and adequate blood supply, as confirmed by domestic and foreign scholars. Bassett et al. reported that fibroblast proliferation and collagen formation are enhanced under hyperbaric oxygen conditions, promoting bone formation; under low oxygen partial pressure, cartilage forms. Bassett and others found in embryonic bone culture studies that under high-pressure and high-oxygen partial pressure conditions, cartilage-like tissue quickly forms into bone tissue. Under conditions of low gravity and oxygen partial pressure, fibrous and cartilaginous tissues form instead, indicating the importance of oxygen presence in the development of osteoblasts. Scaphoid fractures are difficult to heal due to their blood supply characteristics. Affecting blood circulation in scaphoid fractures can lead to aseptic necrosis of the fracture site. If the scaphoid has two feeding vessels, it is less likely to undergo necrosis after a fracture, but if it only has one feeding vessel, depending on its entry point into the navicular bone area and the fracture location, necrosis may occur at one or both ends. It has been reported that in a hyperbaric oxygen environment, oxygen content can significantly increase, raising the oxygen tension within tissues and correspondingly increasing the oxygen diffusion rate and distance within the tissues, thereby improving local oxygen supply at the fracture site. Vascular contraction occurs early in fractures, and the effect of hyperbaric oxygen allows for a reduction in local tissue blood flow, reduced vascular permeability, and elimination of edema. Additionally, hyperbaric oxygen accelerates angiogenesis and promotes collateral circulation at the fracture and soft tissue injury sites. Due to increased blood and oxygen supply, improving the local nutrient supply leads to rapid growth of the callus, thereby promoting fracture healing. He Biao and H reported better efficacy of hyperbaric oxygen on high-altitude traumatic fractures. Xu Kejian reported that hyperbaric oxygen treatment for spinal dysplasia is based on the above principle. Hyperbaric oxygen therapy for fractures is effective, but early treatment is very important. Wang Jiang stated that hyperbaric oxygen facilitates alkaline phosphatase metabolic processes in fracture treatment. This is based on the active function of osteoblasts within six weeks after a fracture. After six weeks, the function of bone cells tends to decay, and hyperbaric oxygen loses its treatment basis, making it less significant. The early group of 30 scaphoid fracture patients received three courses of hyperbaric oxygen therapy in addition to the control group treatment. After three months of treatment, X-rays proved that 29 cases (96.9%) were cured; in the control group of 30 cases, only 22 cases were cured (73.3%), indicating that early use of hyperbaric oxygen therapy is better than the control group. For old scaphoid fractures, hyperbaric oxygen treatment has been applied, but the results are poor.