Orthopaedics

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

• Suspected septic arthritis
• Upper limb radiculopathy in the presence of suspected cervical spine infection
• Acute development of peripheral nerve compression symptoms following trauma or acute event

• 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

• Suspected septic arthritis
• Acute achilles tendon rupture

• 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

• 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

• Acute ligament injury
• Tendon rupture
• Compound ‘tooth knuckle’ injury

• 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