Study hypothesis :Hyperbaric Oxygen may prevent complications and improve outcomes in severe lower limb trauma. We propose to investigate this hypothesis by conducting an International multi centre randomised control trial of standard trauma/orthopaedic care with or without a concurrent course of hyperbaric oxygen treatments.
A randomised controlled trial was undertaken on using hyperbaric oxygen in addition to standard orthopaedic trauma care in severe lower leg injury, defined as an open tibial fracture with severe soft tissue injury. The control arm subjects received standard hospital trauma care whilst the intervention group received standard trauma care with the addition of hyperbaric oxygen therapy with the aim of providing 12 HBOT sessions over the first 9 days of hospital care. The primary outcome measure was the incidence of wound necrosis AND/OR wound infection as assessed at Day 14, with secondary outcomes of wound closure, wound complications, infections and delayed bone union at 12 months plus quality of life and functional questionnaire outcomes at 12 months and 2 years. The detailed study protocol was published in in June 2015 and the results were published in September 2022. Both publications are Open Access (See References section for publication details)
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
TREATMENT
Masking
DOUBLE
Enrollment
120
Subjects in the HBO treatment group will receive a course of hyperbaric oxygen therapy (HBO) in addition to normal trauma and general care. A total of 12 HBO sessions will be delivered over approximately 8 days. HBO treatment will be provided at 2.4 atmospheres absolute (ATA) pressure for approximately 90 minutes of oxygen therapy. Treatments should be twice daily for the first three days. Minor variability will be allowed with respect to timing and profile of each session.
John Muir Clinical Research Center
Concord, California, United States
Royal Hobart Hospital
Hobart, Tasmania, Australia
The Alfred
Melbourne, Victoria, Australia
Universitatsklinikum Graz
Graz, Austria
Acute phase complication rate
The incidence of acute complications after injury. A composite measure defined as the occurrence within two weeks of trauma of one or both of: significant soft tissue necrosis developing after the initial surgery or significant wound infection.
Time frame: up to 14 days post trauma
Amputation rate
operative procedure records of a limb amputation related to the trauma under study
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Late infection
records of diagnosis of wound infection or osteomyelitis or implant infection at defined times
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Radiological union
electronic image copies of radiographs recorded by treating hospitals
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Quality of life score
Short Form 36 quality of life questionnaire (algorithm produces a score in the range of 0-100 with higher score better)
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Functional outcome score
lower limb function component of Short Musculoskeletal Function Assessment ((each question is scored 1-5 with lower score better)
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Pain score
Subjects self reported pain using a 0-10 visual analogue scale
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
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Hospital del Trabajador
Santiago, Chile
City Hospital of Ostrava
Ostrava, Czechia
Indraprastha Apollo Hospital
New Delhi, Sarita Vihar, India
Policlinico Umberto 1, University of Rome
Rome, Italy
Hospital Pedro Hispano
Senhora da Hora, Matosinhos, Portugal
Karolinska Hospital
Stockholm, Sweden
Delayed union of fracture
Any diagnosis of delayed union or non union or performance or scheduling of bone graft for union problems
Time frame: 12 months post trauma
Wound persistence
A record of whether any injury related wound remains open at review. Excludes new surgical wounds.
Time frame: 3, 6, 9, 12, 18 and 24 months post trauma
Problem Wounds
Blinded evaluation of whether post traumatic wounds met the criteria for "Problem Wounds" as a result of requiring readmission to hospital, prolonged wound care, additional surgery or antibiotics that complicated or deteriorated patient recovery
Time frame: 12 months post trauma