Vol. 9, Issue 4, Part A (2025)

Drains are required in areas where extensive dissection has been performed in a closed space as seen in the case of open reduction and internal fixation (ORIF) of lower extremity fractures which might be acute fractures, non-union and malunion. In ORIF, reduction and fixation are achieved using open technique requiring extensive surgical approaches and soft tissue dissection leading to haematoma/seroma formation and need for wound drain. These wound drains are not without outcome. Hence, the need for this study; “Early outcome of use of active versus closed passive wound drains in ORIF of lower extremity fractures”.

Objective: Evaluation of early outcome of use of active versus closed passive wound drains in ORIF of lower extremity fractures. Secondly, to compare the incidence of wound infection, wound dehiscence, postoperative pain and cost between active versus closed passive wound drains.

Methods: This study was a prospective randomized comparative study for 48 patients with closed fractures of lower extremities undergoing ORIF. Patients were randomized into two groups- group A and B. Group A had ORIF with insertion of Emvac-active wound drain while group B had ORIF with insertion of urine bag-closed passive wound drains. A structured proforma was used to collect relevant data from the accident and emergency, clinic, intraoperatively, postoperatively and follow up. Pain was assessed postoperatively using Numeric Rating Scale (NRS) while surgical site infection was assessed using Southampton grading. Drain was removed 48 hours after surgery or once its effluent has stopped draining.

Results: The mean age of participants was 45.53 ± 18.23 with a range of 19-76 years. There was no statistically significant difference seen in mean age, postoperative surgical site infection using Southampton grading from 3^rd postoperative day to 28^th day between the 2 studied groups. There was also no statistically significant difference between group A and group B in postoperative pain using NRS from 12 hours to 14 days postoperatively. There was also no significant difference in degree of wound dehiscence, average quantity of effluent and soaking of wound dressing between the 2 groups postoperatively. However, there was highly statistically significant difference with regards to the average cost of wound drain alone between the active versus closed passive wound drain group with a t- test of 39.890 and a p value of < 0.001.

Conclusion: It can be concluded from this study that there was no statistically significant difference in incidence of wound infection, wound dehiscence, quantity of effluent, soaking of wound dressing, length of hospital stay and postoperative pain. But there was statistically significant difference in the cost of wound drain alone between the two studied groups.