Published 4/15/2022

FACT SHEET: Clinical Practice Guideline and Appropriate Use Criteria for the Prevention of Surgical Site Infections after Major Extremity Trauma

ROSEMONT, Ill. (April 15, 2022)The American Academy of Orthopaedic Surgeons (AAOS) recently released a Clinical Practice Guideline (CPG) and an Appropriate Use Criteria (AUC) to help healthcare professionals prevent surgical site infections (SSIs) in adults who have experienced major extremity trauma.

The CPG and AUC were developed in collaboration with the Major Extremity Trauma Research Consortium (METRC) and funded by a Department of Defense research grant.

Major extremity trauma is defined as any of the following: an open fracture, a major, high-energy closed fracture, a degloving injury, Morel lesions, low- and high-velocity gunshot injuries, a crush injury, a blast injury, and moderate- to high-energy force injuries.

This CPG covers 14 strong- and moderate-strength recommendations for preoperative, perioperative and postoperative interventions to decrease SSIs following major extremity trauma. It also offers options, which were formulated with either low-quality evidence, no evidence or conflicting evidence, for the use of incisional negative pressure wound therapy for high-risk surgical incisions, the implementation of an orthoplastic team, patient outcomes related to the use of hyperbaric oxygen, preoperative skin preparation, and select modifiable and administrative risk factors.

The treatment scenarios provided by this AUC stem from the recommendation in the CPG issued by AAOS, detailed above. The AUC online tool provides clinicians algorithms on how to optimally evaluate the condition for patients presenting with high-energy extremity trauma who are being considered for surgical intervention. The AUC applies only to patients without the presence of SSI at the extremity trauma site.

The new CPG and AUC is intended to be used by all qualified and appropriately trained providers and surgeons involved in treating patients with major extremity trauma; however, healthcare professionals other than orthopaedic surgeons, including but not limited to adult primary care physicians, adult medicine specialists, physical therapists, hand therapists, occupational therapists, physician assistants, social workers, case managers, psychologists, and nurse practitioners who routinely see this patient population in various practice settings may benefit from this tool. These new tools are not intended for use as a benefits determination document.

The evidence-based guideline and AUC tools offer accepted approaches to treatment and/or diagnosis and are not intended to be a fixed protocol. Patient care and treatment should always be based on a clinician’s independent medical judgment, given the individual patient’s specific clinical circumstances.

The full CPG and AUC for the prevention of surgical site infections after major extremity trauma is available through AAOS’ OrthoGuidelines website and free mobile app. For more information on the development process for AAOS clinical practice guidelines, please reference the Clinical Practice Guideline Methodology.

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Contact AAOS Media Relations 

Deanna Killackey 


Lauren Riley