Healing fragile bones: a case report on hyperbaric oxygen therapy in pycnodysostosis

Pycnodysostosis is a rare lysosomal storage disorder characterised by short stature, craniofacial dysmorphisms, dental anomalies, and increased bone fragility due to osteoclast dysfunction caused by cathepsin K gene mutations. This case report describes a 43-year-old female pycnodysostosis patient with recurrent subtrochanteric fractures and delayed bone healing following multiple surgical interventions, including femoral osteotomy and bone grafting. Despite these efforts, bony union was not achieved. The patient underwent 39 sessions of hyperbaric oxygen therapy (HBOT), administered at 243.2 kPa for 120 minutes daily, five days per week. Post-treatment radiographs revealed significant fracture healing, with improvements continuing one month after therapy. Visual analogue pain scores decreased from 4 to 1, and quality of life (SF-36) improved. HBOT enhances tissue oxygenation, stimulating osteogenesis, neovascularization, and immune responses, while optimising osteoclast function, making it a promising treatment for pycnodysostosis-related fracture complications. Although ideal, a controlled trial of HBOT in this rare disorder is probably unachievable. Nevertheless, this report highlights HBOT as a potentially useful adjunctive treatment for enhancing healing of refractory fractures in pycnodysostosis patients.