Orthopaedics

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