Prevalence of Dysbaric Osteonecrosis in Professional Divers and Analysis of Influencing Factors.

INTRODUCTION

Dysbaric osteonecrosis (DON) is an occupational hazard that can lead to joint deformity in professional divers who represent the young workforce. This study aimed to determine the prevalence of DON in professional divers and to investigate the factors that would justify requests for magnetic resonance imaging (MRI) as part of periodic fitness-to-dive examinations, particularly in asymptomatic cases.

METHODS

In this retrospective study, medical records and imaging data of 120 professional divers who underwent routine fitness-to-dive evaluations between June 2018 and March 2024 were reviewed. Both X-rays and MRI scans were assessed for signs of osteonecrosis. Demographic data, diving profiles, clinical history, and biochemical parameters were analyzed to identify potential risk factors associated with DON.

RESULTS

Dysbaric osteonecrosis was identified in 10 out of 120 divers (8.3%). The most affected anatomical region was the right humerus. MRI detected 9 of 10 DON cases, while X-rays identified only one. Statistically significant risk factors for DON included a cumulative diving duration exceeding 900 hours, weekly diving time over 15 hours, diving depths beyond 35 meters, and diving experience greater than 9.5 years. A previous history of decompression sickness (DCS) and a prior diagnosis of DON were also strongly associated with current lesions. MRI demonstrated significantly higher sensitivity compared to radiography (p < 0.0001).

DISCUSSION: MRI is considerably more sensitive than conventional radiography in detecting DON, particularly in its early stages. Routine MRI screening may be beneficial for divers with prolonged or intense diving exposure or a history of decompression-related complications, enabling early diagnosis and timely intervention to prevent long-term sequelae.