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

Summary

The combination of internal and external fixation with nanosilver-based antibacterial dressings (NSAD) and vacuum-assisted closure (VAC) technology demonstrates strong antibacterial activity, reduced healing time, high healing rates, shorter hospital stays, lower medical expenses, and decreased patient pain in the treatment of Gustilo Type I and II open tibial fractures.

Abstract

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.

Introduction

Open tibial fractures (OTFs) are among the most frequent long-bone injuries and usually result from high-energy trauma such as traffic accidents or falls^1,2. Because the fracture site directly communicates with the external environment, these injuries are often accompanied by severe contamination, soft-tissue loss, and a high risk of infection or nonunion^3,4. According to the Gustilo-Anderson classification, OTFs are divided into three types based on the extent of soft-tissue damage and wound contamination: Type I (minimal tissue injury and clean wound....

Protocol

This clinical protocol was approved by the Ethics Committee of Hengshui People's Hospital (Approval No. 2019-2-013). All participants or their legal guardians provided written informed consent before inclusion. The study adhered to the Declaration of Helsinki and institutional guidelines for human research ethics.

Preparation of silver-carbon (Ag-C) nanocomposite
To synthesize the Ag-C nanocomposite, 3.0 g of potassium sodium tartrate was weighed precisely and placed in a 50 mL quartz crucible inside a tube furnace. The sample was heated to 400 °C at a rate of 15 °C/min and maintained for 6 h, then allow....

Results

Characterization of Ag-C nanocomposite
Transmission electron microscopy (TEM) revealed that the commercial nanosilver particles (NSP) exhibited an average size of 13.56 ±3.85 nm with irregular agglomeration, while the synthesized Ag-C nanocomposite showed a slightly larger average diameter of 14.38 ±4.65 nm and uniform spherical morphology (Figure 5A-F). The Ag-C particles displayed better monodispersity and smoother boundaries than NSP,.......

Discussion

Gustilo type I and II open tibial fractures (OTFs) are often caused by high-energy trauma such as traffic accidents or falls, leading to extensive bone and soft-tissue injury^1,19. The communication between the fracture and the external environment facilitates bacterial invasion, resulting in high infection rates and delayed healing^20,21. Conventional treatment involving internal or external fixation alone.......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
AgNO3 solution	Yarong Instrument	196305000
ammonia water	Xilong Chemical	480905
chitosan	Aladdin Biochemical Technology	428850500
commercial nanosilver particles	Aladdin Biochemical Technology	NA
deionized water	Thermo Fisher Scientific(USA)	345470250
external fixators and locking plates	Zimmered Medical Instrument	NA
glacial acetic acid solution	Dongbang Chemical Group	Mar-26
glycerol	Aladdin Biochemical Technology	036646.K7
H1850 desktop centrifuge	Xiangyi Laboratory Instrument Development	203270008
heating sleeve	Yarong Instrument	A57027
HJ-4A multi-head heating stirrer	Guohua Electric Appliance	02774-1
medical silicone drainage tubes	B. Braun Medical Inc(USA)	491288/491310
NaHCO3	Aladdin Biochemical Technology	123360250
NaOH solution	Macklin Biochemical	210-5
OTF-1200X hollow tube furnace	Kejing Technology	OTF-1200X-ALD
permeable adhesive film	3M Company(USA)	537722zd
poloxamer	Aladdin Biochemical Technology	104082
potassium sodium tartrate	Sinopharm Group	202860051
tryptone soy broth	Thermo Fisher Scientific	CM0129B
vortex mixer	Dynamic Industrial	88882010