Inclusion Criteria:  Age>18 years old  Open tibial shaft fracture meeting the following criteria:  Orthopaed Trauma Association (OTA) Type 42 Primarily closable wound Gustilo-Anderson (GA) Type I, II, or IIIA  Exclusion Criteria:  Time from injury to presentation > 48 hours Time from injury to surgery > 7 days Aminoglycoside allergy GA IIIB or IIIC open fractures Bilateral open tibial fractures Severe brain (GCS<12) or spinal cord injury Severe vascular injury Severe burns (>10% Total Body Surface Area (TBSA) or >5% TBSA with full thickness or circumferential injury) Pathologic fracture History of active limb infection, ipsilaterally Unlikely to complete follow-up