O'Toole RV, Degani Y, Carlini AR, et al. - A prospective observational at a single site as a substudy of the VANCO trial was ascertain if using topical vancomycin powder in fracture surgery may result in low levels of vancomycin in the serum and not result in nephrotoxicity. Researchers randomized 58 individuals with tibial plateau and pilon fractures to the treatment arm at the principal investigator's site. The results of this study demonstrated that, despite its relatively widespread usage, little data exist regarding the systemic levels and nephrotoxicity correlated with the topical use of vancomycin powder in orthopedic fracture surgery. This prospective data highlight that there likes to be little clinical concern regarding toxicity correlated with systemic absorption of vancomycin powder in this specific clinical application.