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.