Clinical effect of cross-joint external fixation bracket combined with vacuum sealing drainage in emergency treatment of fracture patients with limb soft tissue injuries

Wang Chong; Wei Juncheng; An Hepeng

doi:10.3969/j.issn.1009-4237.2024.08.009

Abstract：Objective To observe the efficacy of cross joint external fixation bracket combined with vacuum sealing drainage(VSD)in emergency management of fracture patients with limb soft tissue injuries.Methods Al-together 90 patients with fractures and limb soft tissue injuries who were admitted to the Department of Emergency of Heibei Petro China Center Hospital from Mar.2020 to Mar.2022 were retrospectively selected,including 49 males and 41 females aged 18-63(mean 39.7)years.The injury causes were falls from height in 15,road traffic injuries in 24,hit by heavy objects in 20,machine crushing in 17,and others in 14.Among them,26 injured the lower limbs,25 the feet,24 the ankles,and 15 other areas.Based on Gustilo classification,there were 40 cases of type Ⅱand 50 type Ⅲ,with 17 comminuted fractures,13 transverse fractures,16 long oblique fractures,22 spiral fractures,and 22 others.According to the treatment methods,patients were divided into group A(n=43,cross-joint external fixation bracket±routine debridement and dressing change)and group B(n=47,cross-joint external fixation bracket+VSD).The treatment outcomes,clinical indicators,and incidence of complications were compared between the two groups.At the same time,the levels of inflammatory factors before and 6 months after treatment were compared.Results There was no significant difference in operation time between groups A and B(min,68.8±5.6 vs.67.1±4.4,P＞0.05).The total clinical effective rate in group B(93.6％,44/47)was higher than that in group A(67.4％,29/43,P＜0.05),together with much shorter hospitalization time(d,15.6±1.9 vs.25.8±2.3),wound healing time(d,13.1±2.1 vs.22.9±2.0),debridement time(min,41.8±7.6 vs.54.6±5.7)and fracture healing time(d,91.1±7.1 vs.103.1±9.2),and much less frequency of dressing change(2.9±0.8 vs.6.9±1.1)and in-cidence of wound infection(4.4％vs.20.0％,all P＜0.05 compared with group A).At 6 months after treatment,the infection indicators showed much lower levels of high-sensitivity C-reactive protein(mg/L,8.4±2.1 vs.13.5±3.8),interleukin(IL)-6(pg/mL,18.2±2.5 vs.24.4±4.8),and IL-8(pg/mL,23.3±3.1 vs.32.9±5.7)in group B than in group A and much higher levels of IL-10(pg/mL,37.5±3.9 vs.29.4±3.7,all P＜0.05).The to-tal incidence of postoperative complications such as infection,skin graft displacement,fluid accumulation,and hema-toma in group B was 4.2％(2/47),significantly lower than the 14.0％(6/43)in group A(P＜0.05).Conclusion The application of the cross-joint external fixation bracket combined with VSD in emergency management of frac-ture patients with limb soft tissue injuries can improve the therapeutic effect,promote fracture healing,and simultane-ously reduce infection and other complications.