Supplemental Perioperative Oxygen to Reduce Surgical Site Infection After High Energy Fracture Surgery

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 and treated more than 7 days later after swelling has resolved. * Gustilo Type I, II, and IIIA open fracture, regardless of timing of definitive treatment. * All "high energy" pilon (distal tibial plafond) 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 fibula fixation or limited internal fixation) and treated definitively more than 7 days later after swelling has resolved. * Gustilo Type I, II, and IIIA open fracture, regardless of timing of definitive treatment. * All "high energy" calcaneus fractures treated operatively with plate and screw fixation in a staged fashion. We define "high energy" calcaneus fractures as patients who are either: * Treated definitively more than 7 days later after swelling has resolved. * Gustilo Type Type I, II, and IIIA \[30,31\] open fracture, regardless of timing of definitive treatment. * Ages 18 to 80 years * Patients may have co-existing infection not at study fracture site, 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 be treated initially with a temporary external fixator prior to randomization. * 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 any initial surgery before randomization for definitive fixation. * Patients may have other orthopedic and non-orthopaedic injuries. * Patients may have pre-existing musculoskeletal injuries, be non ambulators, or have spinal cord injuries. Exclusion Criteria: * Tibial plateau, pilon, or calcaneus already infected at time of study enrollment. * Type IIIB, or IIIC open \[30,31\] fractures * Patient speaks neither English nor Spanish. * Transfer patients who have already had definitive fixation. * 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 who are intubated at the time of consent. * Patients whose oxygen requirements at the time of surgery would prevent them from participating in either study group will be excluded. * History of COPD or any other chronic respiratory disease that renders the patient oxygen dependent at baseline. * Current or history of Bleomycin use (chemotherapy use associated with oxygen toxicity). * Patient is currently pregnant.