Placement of Antibiotic Powder in Wounds During the Emergency Room

Inclusion Criteria: * Subject or Legal Authorized Representative (LAR) is willing and able to provide written 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 study intervention. Exclusion Criteria: * Time from injury \> 24 hours. * Subjects who have received acute operative care (e.g., washout in the operating room or fixation) of the open fracture at an outside facility. * Subject or LAR speaks neither English nor Spanish. Note that subjects that are unable to participate in the consent process (e.g. intoxication, poly-trauma, will be 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 will be 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 she states that she is likely to be pregnant, a pregnancy test will be performed; if negative, the subject will be eligible for enrollment. * Prisoners. * Participation in other clinical research involving investigational antimicrobial products within 30 days of randomization.