Clinical Efficacy of Combined Internal and External Fixation with Nanosilver Dressing and Vacuum Closure for Gustilo Type I/II Open Tibial Fractures.

Gustilo type I and II open tibial fractures (OTFs) are associated with significant soft tissue injury and a high risk of infection, often resulting in prolonged healing and postoperative complications when treated using conventional internal or external fixation. This study introduces a clinically validated approach that integrates nanosilver antibacterial dressing (NSAD) and vacuum-assisted closure (VAC) with closed reduction and intramedullary nail fixation (CRINF) to improve wound and fracture healing outcomes. A total of 300 patients with Gustilo type I/II OTFs were enrolled and randomly assigned into three groups (n = 100 per group): Group 1 received CRINF with conventional wound care, Group 2 received CRINF with VAC, and Group 3 received CRINF with NSAD and VAC. Clinical outcomes, including infection rate, wound and fracture healing time, hospital stay, medical cost, and postoperative pain, were compared among the groups using chi-square and ANOVA tests, with significance defined as p < 0.05. Group 3 exhibited the lowest complication rate and the most favorable recovery profile, with an average wound healing time of 41 days and a fracture healing time of 7.2 months, both significantly shorter than in the control groups (p < 0.05). The wound and fracture healing rates were 97% and 94%, respectively, while patients experienced shorter hospital stays (10-15 days), lower total medical costs (~1500 yuan), and reduced pain levels. These findings demonstrate that combining NSAD and VAC with CRINF offers an effective and safe clinical protocol for managing Gustilo type I and II OTFs, substantially reducing postoperative complications and accelerating recovery.