Abstract and Introduction
Abstract
High-energy extremity trauma rates can be difficult to precisely state given the complexity of contributing combined mechanisms; however, the rate of open fractures in the United States is 11.5 to 13 per 100,000 people. The management of high-energy extremity fractures presents many challenges for treating surgeons, including elevated risk of surgical site infections (SSIs). In recent studies, higher risk closed injuries are associated with deep SSI rates as high as 19% after surgical treatment and for severe open injuries, which rate surpasses 30%. Fracture-related infections are associated with notable costs and decreased long-term functional outcomes. Identified risk factors for the development of deep SSIs are primarily related to the severity of injury and its location. The quality of the vast literature identifying available interventions to decrease the risk of developing SSIs is highly variable, and it is unclear how consistently these interventions are applied.
Introduction
In March 2022, the American Academy of Orthopaedic Surgeons and the Major Extremity Trauma and Rehabilitation Consortium published the Appropriate Use Criteria (AUC) for the Prevention of Surgical Site Infection After Major Extremity Trauma to optimize patient care by leveraging both evidence-based medicine and clinical expertise in the preoperative, intraoperative, and postoperative management of high-energy trauma extremity fractures to reduce the risk of surgical site infection (SSI).[1–6] Initially, 10 assumptions and one exclusion were agreed upon before applying the completed AUC to a patient scenario. Definitions were also developed to facilitate appropriate utilization of the AUC. On acceptance of these stated assumptions, the AUC can be used to assist clinicians in identifying perioperative and intraoperative management interventions that are appropriate, may be appropriate, or are rarely appropriate in specific clinical presentations, highlighted in the following cases.
J Am Acad Orthop Surg. 2023;31(10):497-504. © 2023 American Academy of Orthopaedic Surgeons
