Non-union is a major concern in patients with long bone open fractures. Different strategies are available to reduce this risk, but high quality evidence remains elusive. The authors randomized 51 patients to receive PLEX-DBG (an antibiotic bone graft) or standard of care. Most patients had Gustilo III fractures. There was a significantly higher rate of callus formation in the PLEX-DBG group compared to the control group. Time to healing was also significantly shorter, as was pain-free weight-bearing at 12 weeks and 16-20 weeks. Overall, this antibiotic-loaded bone graft appears promising in reducing infection rates and improving function following long bone open fracture.