Intervention description {11a}
fracture, fracture hematoma
STERILE
A certified unmasked study nurse will prepare 5-ml aqueous gentamicin (16 mg/ml) and 5-ml normal saline solutions. The solutions are prepared in identical syringes labeled with the solution expiration date and either “solution A” or “solution B” according to the masking key before they are stored in a locked study fridge adjacent to the operating theater. The masking key is only accessible to the study nurse. Solutions are stored at 4 °C for up to 48 h, per pharmacist guidelines, and a solution preparation log is maintained to ensure the integrity of the study solutions.At the conclusion of the index surgical procedure (wound debridement, skeletal stabilization, as appropriate), the surgeon confirms that the wound can be closed primarily. At that point, the patient is randomized using the Research Electronic Data Capture (REDCap) randomization tool. The appropriate study solution is then injected into the closed wound using a 22-gauge needle down to the bone through an anteromedial approach at the level of the fracture site using a sterile technique (Fig. Example of injection administration. Step 1: Assess ability to close wound primarily. If able, proceed with watertight closure. Step 2: Palpate the fracture site with the needle to ensure study solution enters the fracture hematoma. Step 3: Inject full study solution