This randomized controlled trial investigates the efficacy of vacuum-assisted closure (VAC) therapy compared to conventional treatment methods for Grade 3A and 3B tibial fractures. Conducted at Dr. Babasaheb Ambedkar Medical College and Hospital, the study involved 30 participants over one year. Results indicated that VAC therapy significantly reduced healing times by six weeks, decreased complication rates, and improved pain and functional outcomes versus conventional treatments. These findings suggest that VAC therapy offers a more effective alternative for managing severe tibial fractures, advocating for its inclusion in standard treatment protocols. The study highlights the need for larger, multi-center trials to further substantiate these results.