Blaesius F, et al. - This study was undertaken to investigate the impact of intrawound vancomycin powder in reducing deep surgical site infections. Researchers designed an open-label randomized clinical trial enrolling adult patients with an operatively treated tibial plateau or pilon fracture who met the criteria for a high risk of infection from January 1, 2015, through June 30, 2017, with 12 months of follow-up (final follow-up assessments completed in April 2018) at 36 US trauma centers. They enrolled a total of 980 patients (mean [SD] age, 45.7 [13.7] years; 617 [63.0%] male) with 91% of the expected person-time of follow-up for the primary outcome. The data illustrated that intrawound vancomycin powder at the time of definitive fracture fixation reduced the risk of a gram-positive deep surgical site infection, consistent with the activity of vancomycin among patients with operatively treated tibial articular fractures at a high risk of infection.