Inclusion Criteria:
* All "high energy" tibial plateau fractures treated operatively with plate and screw fixation. We define "high energy" tibial plateau fractures as patients who are either:
* Initially treated with an external fixation and treated more than 7 days later after swelling has resolved.
* Gustilo Type I, II, and IIIA open fracture, regardless of timing of definitive treatment.
* All "high energy" pilon (distal tibial plafond) fractures treated operatively with plate and screw fixation. We define "high energy" tibial plateau fractures as patients who are either:
* Initially treated with an external fixation (with or without fibula fixation or limited internal fixation) and treated definitively more than 7 days later after swelling has resolved.
* Gustilo Type I, II, and IIIA open fracture, regardless of timing of definitive treatment.
* All "high energy" calcaneus fractures treated operatively with plate and screw fixation in a staged fashion. We define "high energy" calcaneus fractures as patients who are either:
* Treated definitively more than 7 days later after swelling has resolved.
* Gustilo Type Type I, II, and IIIA \[30,31\] open fracture, regardless of timing of definitive treatment.
* Ages 18 to 80 years
* Patients may have co-existing infection not at study fracture site, with or without antibiotic treatment.
* Patients may have risk factors for infection including diabetes, immunosuppression from steroids or other medications, HIV, or other infections.
* Patients may have a head injury.
* Patients may be treated initially with a temporary external fixator prior to randomization.
* Patients may have a portion of the fixation (e.g. fibula fixation in pilon or percutaneous screws across a tibial plateau fracture) prior to definitive plate fixation, at any initial surgery before randomization for definitive fixation.
* Patients may have other orthopedic and non-orthopaedic injuries.
* Patients may have pre-existing musculoskeletal injuries, be non ambulators, or have spinal cord injuries.
Exclusion Criteria:
* Tibial plateau, pilon, or calcaneus already infected at time of study enrollment.
* Type IIIB, or IIIC open \[30,31\] fractures
* Patient speaks neither English nor Spanish.
* Transfer patients who have already had definitive fixation.
* Severe problems with maintaining follow-up (e.g. patients who are homeless at the time of injury or those how are intellectually challenged without adequate family support).
* Patients who are intubated at the time of consent.
* Patients whose oxygen requirements at the time of surgery would prevent them from participating in either study group will be excluded.
* History of COPD or any other chronic respiratory disease that renders the patient oxygen dependent at baseline.
* Current or history of Bleomycin use (chemotherapy use associated with oxygen toxicity).
* Patient is currently pregnant.
