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Orthopaedics

Find assessment and management information on Orthopaedics conditions at:

Emergency Immediate transfer to the Emergency Department

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.

Adult


Shoulder and Elbow conditions

  • Clinically indicated e.g. suspected septic arthritis
    • Evidence of acute inflammation e.g: haemarthrosis, tense effusion
  • Irreducibe 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

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

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

Back Pain

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

Bone and Soft Tissue (Sarcoma)

  • Suspected mailgnancy

Trauma and fractures

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

  • 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

    • 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

     

    Are you referring to the right service?

    • All orthopaedic oncology referrals should be directed to Princess Alexandra Hospital
    • All referrals in relation to spinal condition should be directed to Princess Alexandra Hospital or Logan Hospital.

    Urgent referrals Arranging urgent review

    To arrange a VERY URGENT outpatient appointment, please phone the relevant hospital’s switchboard and ask to speak to the Orthopaedic Registrar on-call.

    Out of scope services

    The following are not routinely provided in a public Orthopaedics 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

    Notes

    • 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.

    Out of catchment

    Metro South Health is responsible for providing public health services to the people who reside within its boundaries. Special consideration is made for patients requiring tertiary care or services that are not provided by their local Hospital and Health Service.  If your patient lives outside the Metro South Health area and you wish to refer them to one of our services, inclusion of information regarding their particular medical and social factors will assist with the triaging of your referral.

    Last updated 16 February 2024