Local Antibiotic Therapy to Reduce Infection After Operative Treatment of Fractures at High Risk of Infection: A Multicenter Randomized, Controlled Trial (VANCO)

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.