Antibiotic powder sprinkled in wounds may cut infection risk after severe leg fractures

Copied word for word from the study's registry entry, so the wording is the study team's rather than ours.

Inclusion Criteria: * All "high energy" tibial plateau fractures treated operatively with plate and screw fixation. * We define "high energy" tibial plateau fractures as patients who are either: * Initially treated with an external fixation (with or without limited internal fixation) and treated definitively more than 3 days later after swelling has resolved. * Any open type I, II, or IIIA fracture, regardless of timing of definitive treatment. * Any tibial plateau fracture associated with ipsilateral leg compartment syndrome fasciotomy wounds. * All "high energy" pilon (distal tibial plafond) fractures treated operatively with plate and screw fixation. We define "high energy" pilon fractures as patients who are either: * Initially treated with an external fixation (with or without fibula fixation or limited internal fixation) and treated definitively more than 3 days later after swelling has resolved. * Any open type I, II, or IIIA fracture, regardless of timing of definitive treatment. * Any tibial pilon fracture associated with ipsilateral leg compartment syndrome fasciotomy wounds. * Ages 18 to 80 years * Patients may have co-existing non-tibial infection, with or without antibiotic treatment. * Patients may have risk factors for infection including diabetes, immunosuppression from steroids or other medications, HIV, or other infections. * Patients may have a head injury * Patients may have a portion of the fixation (e.g. fibula fixation in pilon or percutaneous screws across a tibial plateau fracture) prior to definitive plate fixation, at the initial surgery before randomization. * Patients may have other orthopedic and non-orthopaedic injuries. * Patients may have pre-existing musculoskeletal injuries, be non ambulators, or have spinal cord injuries. * Women and minorities are included Exclusion Criteria: * The study injury: tibial plateau, pilon, is already infected at time of study enrollment. * Patient speaks neither English nor Spanish. * Patients who have already had definitive fixation prior to enrollment in the study. * Severe problems with maintaining follow-up (e.g. patients who are homeless at the time of injury or those how are intellectually challenged without adequate family support). * Patients with allergies, drug administration reactions, or other sensitivities to Vancomycin (such as a history of Redman's Syndrome). * Pregnancy. * The study injury is a type IIIB or IIIC open fracture.