OBJECTIVES: To identify risk factors for methicillin-susceptible (MSSA) and methicillin-resistant DESIGN: Retrospective cohort study. SETTING: Level 1 trauma center. PARTICIPANTS: 1,254 adults who underwent operative fixation of 1,298 extremity or pelvis fractures between 8/1/2014 - 7/31/2017. METHODS: We calculated rates of RESULTS: Of the 1,040 screened first procedures, 262 (25.19%) were performed on CONCLUSIONS: MRSA carriage was associated with a significant risk of SSI after operative fracture fixation. Many carriers did not undergo decolonization, suggesting that a simplified decolonization protocol is needed.