Objective: The purpose of this study is to explore the application advantages and nursing effects of external fixator combined with negative pressure closed drainage in the treatment of patients with open tibia and fibula fractures accompanied by soft tissue defects. Methods: The study included 46 patients with open tibia and fibula fractures and soft tissue defects who were treated with an external fixator combined with negative pressure closed drainage in our hospital from January 2024 to June 2025 as research samples. They were divided into an experimental group and a conventional group of 23 cases each using the random number table method. The conventional group received routine nursing measures. The experimental group adopted an individualized nursing intervention plan. The two groups of cases were compared in terms of fracture healing time, soft tissue repair time, probability of complications, and total effectiveness of treatment. Results: The fracture healing time and soft tissue repair time in the experimental group were shorter than those in the conventional group (P < 0.05). At the same time, the probability of complications in the experimental group was lower than that in the conventional group, and the total clinical nursing effectiveness of patients in the experimental group was higher than that in the conventional group (P < 0.05). Conclusion: Individualized nursing intervention for patients with open tibia and fibula fractures and soft tissue defects who are treated with external fixator combined with negative pressure closed drainage can speed up the patient’s recovery process and reduce the risk of complications, improve the efficiency of clinical care for patients, and has good clinical research value.