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
Tumour – bone and soft tissue
