TABLE I.

Types of Acute Orthopaedic Injuries Recommended as “Surgically Necessary” for Elective-Urgent Procedures, Stratified by Joint^*

Joint Location	Acute Injury Details	Justification
Shoulder	Locked labral tears Unstable glenohumeral joints following dislocation Grade 4-5 acromioclavicular joint separations with severe pain or tenting of the skin Acute/severe rotator cuff tears Pectoralis major ruptures	Irreducible joint dislocations, patients with high risk of recurrent instability/dislocation causing further injury, young patients with chondral injuries that are repairable, large tendon ruptures that are susceptible to retracting and becoming irreparable with delayed surgical treatment, any injury with neurovascular compromise
Elbow	Distal biceps tendon tears Unstable elbow subluxations or dislocations Locked osteochondral defects of the elbow Triceps tendon tears	Young patients with chondral injuries that can be repaired, any patient who has high risk of compromised or unrepairable tendon rupture with delayed surgical treatment
Hand/wrist	Carpal subluxations or dislocations Unstable scaphoid fractures Acute tendon tears Unstable wrist/carpal or phalangeal subluxations or dislocations	Unstable scaphoid fractures that cannot be treated in a cast/conservatively, patients with high risk of recurrent instability of carpal, metacarpal, or phalangeal dislocations/subluxations that would lead to loss of function
Foot/ankle	Dislodged or unstable osteochondritis dissecans lesions Ankle dislocation or subluxation Syndesmosis disruption Jones fracture Acute tendon tears (e.g., Achilles) Acute unstable ligament tears	Young patients with chondral injuries that are repairable, irreducible joint dislocations, severe/acute unstable ankle sprains with low likelihood of success with nonoperative management, fractures susceptible to nonunion with conservative treatment
Knee	Locked knees Bucket-handle tears of the menisci Young patients with vulnerable/repairable meniscal tears Meniscal root tears Acute osteochondral fractures Lingering knee instability due to a patellar dislocation or multi-ligament knee injury Acute tendon ruptures (patellar or quadriceps) Dislodged osteochondritis dissecans lesions Anterior/posterior cruciate ligament osseous avulsion fractures Manipulations after total knee replacement or ligament reconstructions	Young patients with chondral injuries or acute meniscal tears that would lead to long-term decreased function, meniscal root tears at risk for cartilage wear progression, patients with bucket-handle meniscal tears, acute patellar dislocation with loose body/chondral fracture, knee dislocation, high risk of lower function or unrepairable tendon rupture with delayed surgical treatment, locked knee
Hip	Dislocated/unstable arthroplasties Hip subluxation or dislocation that is not reducible or is unstable post-reduction Acute proximal hamstring ruptures Acute disability due to a locked hip secondary to intra-articular loose body/bodies or an incarcerated labrum	Irreducible hip subluxation/dislocation, high risk of unrepairable proximal hamstring rupture with delayed surgical treatment, locked hip
Spine	Neurological deficit or impending deficit that can be prevented by decompression Spinal instability such as fractures	Cauda equina syndrome, loss of bladder/bowel control, persistent nerve compression, unstable vertebral fracture or spondylolisthesis that could lead to permanent dysfunction

^*Accordingly, this list is advisory in nature. It is not nor should be considered a medical directive or standard of care in and of itself.