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Tumour – bone and soft tissue

PAEDIATRIC

If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) 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

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

Hip and knee

  • Suspected septic arthritis
  • Knee extensor mechanism rupture
  • Suspected 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
  • Acute achilles tendon rupture

Spine

  • If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
  • Actual or threatened cauda equina syndrome
    • bilateral nerve pain (leg pain below knees)
    • unexplained or unexpected loss of bladder or bowel function
    • perineal anaesthesia
    • progressive weakness
  • Spinal tumour with significant pain and/or neurological deficit
  • Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
  • Spinal trauma with significant pain and/or neurological deficit
  • Spinal fractures demonstrated on imaging
  • Clinical suspicion of spinal infections
  • High risk of irreversible deficit if not assessed urgently

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
  • Compound ‘tooth knuckle’ injury

Upper and lower limb trauma

  • Open, unstable or suspected fractures

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

Perthes disease

  • Perthes if systemically unwell, febrile

Slipped upper femoral epiphysis (SUFE)

  • Confirmed SUFE if systemically unwell, febrile or on suspicion of SUFE

NB No matter the chronicity all should be referred to ED or local orthopaedic registrar on call

Scoliosis / Kyphosis

  • Systemically unwell
  • Abnormal neurological reason

Back pain

  • Systemically unwell

Tumour – bone and soft tissue

  • Suspected malignancy

 

 

  • Refer to local Healthpathways or local guidelines
  • Do not needle biopsy suspected tumour

Minimum Referral Criteria

  • Category 1
    (appointment within 30 calendar days)
    • Benign tumours
  • Category 2
    (appointment within 90 calendar days)
    • No category 2 criteria
  • Category 3
    (appointment within 365 calendar days)
    • No category 3 criteria

1. Reason for request Indicate on the referral

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

2. Essential referral information Referral will be returned without this

  • Clinical history and examination including key points: -
    • evolution and duration of symptoms
    • treatment prescribed
    • current and past medical history and medications, anthropometry
    • relevant family history
  • XR
  • FBC, U&E, ESR, CRP, LFT

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

Patient's Demographic Details

  • Full name (including aliases)
  • Date of birth
  • Residential and postal address
  • Telephone contact number/s – home, mobile and alternative
  • Medicare number (where eligible)
  • Name of the parent or caregiver (if appropriate)
  • Preferred language and interpreter requirements
  • Identifies as Aboriginal and/or Torres Strait Islander

Referring Practitioner Details

  • Full name
  • Full address
  • Contact details – telephone, fax, email
  • Provider number
  • Date of referral
  • Signature

Relevant clinical information about the condition

  • Presenting symptoms (evolution and duration)
  • Physical findings
  • Details of previous treatment (including systemic and topical medications prescribed) including the course and outcome of the treatment
  • Body mass index (BMI)
  • Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes), noting these must be stable and controlled prior to referral
  • Current medications and dosages
  • Drug allergies
  • Alcohol, tobacco and other drugs use

Reason for request

  • To establish a diagnosis
  • For treatment or intervention
  • For advice and management
  • For specialist to take over management
  • Reassurance for GP/second opinion
  • For a specified test/investigation the GP can't order, or the patient can't afford or access
  • Reassurance for the patient/family
  • For other reason (e.g. rapidly accelerating disease progression)
  • Clinical judgement indicates a referral for specialist review is necessary

Clinical modifiers

  • Impact on employment
  • Impact on education
  • Impact on home
  • Impact on activities of daily living
  • Impact on ability to care for others
  • Impact on personal frailty or safety
  • Identifies as Aboriginal and/or Torres Strait Islander

Other relevant information

  • Willingness to have surgery (where surgery is a likely intervention)
  • Choice to be treated as a public or private patient
  • Compensable status (e.g. DVA, Work Cover, Motor Vehicle Insurance, etc.)
  • Please note that where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service.  Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.

  • A change in patient circumstance (such as condition deteriorating, or becoming pregnant) may affect the urgency categorisation and should be communicated as soon as possible.

  • Please indicate in the referral if the patient is unable to access mandatory tests or investigations as they incur a cost or are unavailable locally.