Before these appropriate use criteria are consulted, it is assumed that:

  1. Provisional treatment (e.g provisional reduction and immobilization) may have been attempted as necessary. The AUC tool is intended to address definitive treatment.
  2. It is assumed that the patient is appropriately risk stratified and otherwise optimized to undergo surgery.
  3. An adequate physical exam of the patient has been conducted.
  4. It assumed that adequate Radiographs have been obtained and examined by the clinician.
  5. The patient history is available and has been reviewed by the clinician.
  6. Informed consent has been obtained from the patient or medical decision maker.
  7. It is assumed that the surgeon is trained and capable of performing all operative techniques
  8. The fracture is not so complex, and/or the patient’s comorbidities or social situation such a factor, as to represent an exception to these scenarios (e.g. C3.3 fracture that might be optimally treated with a distraction plate).
  9. It is assumed that the surgery, when indicated, will be performed in a timely fashion to allow ideal treatment of the fracture.
  10. It is assumed the surgeon will perform the surgery in the most appropriate location (i.e., ASC, outpatient, inpatient) based on the health of the patient and other injuries rather the nature of the fracture.  Open fractures and associated injuries may dictate that surgery should be inpatient.
  11. The facility has each type of implant/equipment available and capable support personnel. 
  12. Median Neuropathy will be addressed appropriately (i.e. carpal tunnel release as indicated)



Volunteer physicians from multiple medical specialties created and categorized these Appropriate Use Criteria. These Appropriate Use Criteria are not intended to be comprehensive or a fixed protocol, as some patients may require more or less treatment or different means of diagnosis. These Appropriate Use Criteria represent patients and situations that clinicians treating or diagnosing musculoskeletal conditions are most likely to encounter. The clinician’s independent medical judgment, given the individual patient’s clinical circumstances, should always determine patient care and treatment. Practitioners are advised to consider management options in the context of their own training and background and institutional capabilities when selecting recommended treatment options.

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