Acute Application of Antibiotic Powder in Open Fracture Wounds

Inclusion Criteria: * Subject or proxy willing and able to provide written informed consent. * Age between 18 years and 80 years (inclusive), with an upper or lower extremity Gustilo Type II, IIIA, or IIIB open fractures requiring debridement and internal fixation. * Open extremity fractures * Time from injury to study intervention 24 hours or less Exclusion Criteria: * Individuals under the age of 18 years or over 80 years * Type I or IIIC open fractures * Over 24 hours from time of injury * Subjects who have received acute operative care of the open fracture at an outside facility prior to presenting at the Emergency Department. * Open fractures distal to the wrist and midfoot * History of chronic infection in the extremity involved. * Subjects who are currently pregnant * Subjects who are Prisoners * Subjects with a known allergy to vancomycin or tobramycin * Subjects with a condition or social circumstances that would reduce adherence and follow-up. * Subjects Participating in other clinical research involving investigational antimicrobial products within 30 days of randomization.