1. This AUC only applies to high energy extremity trauma patients who are being considered for surgical intervention.
  2. This AUC only applies to adult patients without current infection at site of extremity trauma.
  3. This AUC only covers the initial presentation.
  4. The appropriate surgical interventions have been determined for the given injury; surgical stabilization has been achieved.
  5. All patients will be monitored for ongoing infection and allergy after treatment.
  6. Consultations with trauma, vascular, plastic surgeons, infectious disease and internal medicine should be considered as indicated for appropriate cases when available.
  7. If necessary, transfer to a trauma center with soft tissue coverage capability should be initiated when practical for open fractures requiring soft tissue coverage.
  8. Specific antibiotic management is beyond the scope of this AUC, but institutional or other appropriate antibiotic administration protocols should be followed according to the needs of the patient.
  9. Risk factors including glucose control, nutrition optimization, Staphylococcus aureus colonization, smoking cessation, and immune modulating agents are acknowledged and addressed as is practical given acute nature of trauma.
  10. It is possible that more than one treatment is appropriate for a patient.



  1. Patients without high energy extremity trauma



  • High Energy Extremity Trauma includes:
    • All Injury types listed below are limited to the context of extremity fractures
  1. Most open fractures
  2. Certain closed fractures (comminuted, intra-articular, soft tissue compromise)
  3. Degloving injury/Morel-Lavallee lesions
  4. Gunshot injury (low and high velocity)
  5. Crush injury
  6. Blast injury
  7. Moderate to high energy force 
  • Primary Closure: refers to non-surgical incisions

  • Closed Fracture Debridement: refers excisional debridement of significant muscle necrosis


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.

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