Orthopaedics

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation

    Adult

    Shoulder and elbow conditions

    • Clinically indicated e.g. suspected septic arthritis
      • Evidence of acute inflammation e.g: haemarthrosis, tense effusion
    • Irreducible glenohumeral dislocation with or without fracture
    • Upper limb vascular compromise
    • Elbow conditions - Dislocation with or without fracture
    • Elbow conditions - Trauma with acute neurological or vascular compromise

    Wrist and hand

    • Uncontrolled sepsis including hand infections
    • Upper limb radiculopathy in the presence of suspected cervical spine infection
    • Acute development of peripheral nerve compression symptoms following trauma or acute event
    • Suspected flexor sheath infection
    • Suspected Septic arthritis

    Bone & Soft Tumour

    • Suspected malignancy

    Hip and knee

    • Suspected septic arthritis
    • Knee extensor mechanism rupture
    • Fracture
    • Evidence of acute inflammation for example
      • haemarthrosis
      • tense effusion
    • Suspected infection or sudden pain in arthroplasty
      • if joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call.  Do not commence antibiotics unless delay to specialist review is likely

    Foot and ankle

    • Suspected septic arthritis
    • Infected diabetic ulceration (systemic signs/symptoms)
    • Displaced fracture of the ankle or hindfoot
    • Acute achilles tendon rupture (if no fracture clinic available)
    • Avulsion fracture of achilles tendon from calcaneus

    Back and/or Neck Pain

    • Cauda equina syndrome
    • High energy spinal trauma
    • Suspected epidural abscess or discitis

    Request for advice /eConsult

    • Where diagnosis of the following Minimum referral consult conditions is equivocal, eConsult is available to provide timely advice in regard to diagnosis, investigations, or management or
    • May be provided on receipt of a referral if eConsult is deemed to better meet the needs of the patient.

    Trauma and fractures

    • Acute cervical myelopathy
    • Acute back or neck pain secondary to neoplastic disease or infection
    • Spinal injuries
    • Suspected open fracture
    • Fracture requiring manipulation or operation
    • Suspected acute bone or joint infection
    • Acute high energy fracture with/without neurological abnormality
    • Injury associated with vascular compromise
    • Clavicle fracture
    • Osteoporotic / pathological fracture new abnormal neurology
    • Joint dislocations
    • Open injuries with possible tendon or joint involved
    • Nail bed injuries or retained foreign body
    • Knee extensor mechanism rupture
    • Acute peripheral nerve injury
    • Suspected acute compartment syndrome

    Hand Trauma

    • Acute ligament injury
    • Tendon rupture
    • Open 'tooth knuckle' injury

    Upper and lower limb trauma

    • Open, unstable or suspected fractures

    Other referrals to emergency not covered within these conditions

    • Suspected open fracture
    • Fracture requiring manipulation or operation
    • Suspected acute bone or joint infection
    • Acute high energy fracture with/without neurological abnormality
    • Injury associated with vascular compromise
    • Clavicle fracture
    • Osteoporotic / pathological fracture new abnormal neurology
    • Suspected infection or sudden pain in arthroplasty
    • If joint infection is suspected refer immediately to emergency or contact the orthopaedic registrar on call
      • do not commence antibiotics unless delay to specialist review is likely
    • Joint dislocations
    • Open injuries with possible tendon or joint involved
    • Nail bed injuries or retained foreign body
    • Knee extensor mechanism rupture
    • Acute peripheral nerve injury
    • Suspected acute compartment syndrome

    Timing of first review appointments at orthopaedic outpatient's/fracture clinic

    • if there is documentation indicating adequate alignment and satisfactory initial treatment of fracture – to be seen within 14 days of referral
    • all other fracture cases, delayed presentation of tendon and nerve injuries - to be seen within 7 days of referral

    Paediatric

    Limping child/reluctant to weight bear

    • Limping child with signs of:
      • Being unwell, flushed, lethargic, fever, flat, anorexic and/or
      • Irritable and stiff joint and/or
      • Not improving
    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma
    • Suspicion or concern of non-accidental injury

    NB See Slipped upper femoral epiphysis (SUFE) CPC

    Heel Pain

    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma
    • Suspicion or concern of non-accidental injury

    Osgood-Schlatter Disease

    • Suspected infection or bone disease

    Perthes Disease

    • For guidelines regarding when to refer to emergency, please see HealthPathways.
    • Systemically unwell, febrile or suspicion of septic arthritis
    • Concern of infection or trauma

    Slipped upper femoral epiphysis (SUFE)

    • All suspected or confirmed SUFE should be referred to the ED or local orthopaedic on call registrar service no matter the chronicity

    Scoliosis / Kyphosis

    • Systemically unwell
    • Abnormal neurological reason

    Back pain

    • Systemically unwell
    • Abnormal neurological reason

    Tumour – bone and soft tissue

    • Suspected malignancy

    Infection: bone/joint

    • If clinically confirmed or suspected bone infection who present with;
      • fever
      • unexplained limp and/or abnormal posture or gait
      • reluctance to use the limb or will not weight bear if lower limb affected
      • musculoskeletal pain ± presence of local bone or joint tenderness, swelling or erythema
      • complete or partial limitation of movement on examination.
    • All cases with pain, or abnormal labs or abnormal bone scan
  • The following are not routinely provided in a public Orthopaedics service.

    Adult Service

    • Aesthetic or cosmetic surgery
    • Disability assessment (refer to HealthPathways)
    • Referrals for assessment prior to application for the Australian Defence Force or Queensland Police Service

    Paediatric Service

    • Nil noted

Last updated: 20 December 2021

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