Placement of Antibiotic Powder in Wounds During the Emergency Room

Inclusion Criteria:

• Subject or Legal Authorized Representative (LAR) is willing and able to providewritten informed consent.

• Adult 18 years of age or older.

• Open fracture of the humerus, radius, ulna, femur, tibia, and/or fibula.

• 24 hours or less has elapsed from the estimated time of injury to studyintervention.

Exclusion Criteria:

• Time from injury > 24 hours.

• Subjects who have received acute operative care (e.g., washout in the operating roomor fixation) of the open fracture at an outside facility.

• Subject or LAR speaks neither English nor Spanish. Note that subjects that areunable to participate in the consent process (e.g. intoxication, poly-trauma, willbe enrolled into the observational arm where passive data collection will occur).

• High-potency antibiotic powder or solution applied to the wound prior to enrollment.Simple ointment (i.e., bacitracin ointment) or antibiotic-impregnated dressings willbe permitted.

• Documented allergies or serious reactions to vancomycin. History of uncomplicated "red man syndrome" will not be considered a reason for exclusion.

• Pregnant subjects. If the subject is a female of childbearing potential, and shestates that she is likely to be pregnant, a pregnancy test will be performed; ifnegative, the subject will be eligible for enrollment.

• Prisoners.

• Participation in other clinical research involving investigational antimicrobialproducts within 30 days of randomization.