Paediatric Fractures (Fracture Clinic)

Emergency department referrals

All urgent cases must be discussed with the on call Registrar to obtain appropriate prioritisation and treatment. Contact through:

Redcliffe Hospital (07) 3883 7777

Urgent cases accepted via phone must be accompanied with a written referral and a copy faxed immediately to the Central Patient Intake Unit: 1300 364 952.

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.

Severe pain that cannot be controlled
Evidence of neurovascular compromise (e.g., numbness, loss of circulation)
Skin is broken or there is a risk of infection
The child is unable to move the affected limb
Child refuses to walk on the limb

NB: Assuming neurovascular status is confirmed as normal on examination, many patients with fractures will not need emergency care.

Does your patient wish to be referred?

Minimum referral criteria

Does your patient meet the minimum referral criteria?

Category 1

Appointment within 30 days is desirable

Stable greenstick fracture without any significant deformity or swelling
Small fractures that are properly aligned and without any evidence of angulation or displacement (e.g., small fractures of the fingers or toes)
Hairline or stress fractures without any significant swelling, bruising, or functional impairment
Minor clavicle fracture without skin tenting or neurovascular compromise
Non-displaced fractures of the hand or wrist, without any open wound or neurovascular compromise
A child currently in out of home care (OOHC) or at risk of entering or leaving OOHC, where they have previously been on a waiting list for this problem and were removed without receiving a service

Category 2

Appointment within 90 days is desirable

No category 2 criteria

Category 3

Appointment within 365 days is desirable

No category 3 criteria

If your patient does not meet the minimum referral criteria

Consider other treatment pathways or an alternative diagnosis.

If you still need to refer your patient:

Please explain why (e.g. warning signs or symptoms, clinical modifiers, uncertain about diagnosis, etc.)
Please note that your referral may not be accepted or may be redirected to another service

Other important information for referring practitioners

Refer to HealthPathways or local guidelines
Children in rural and regional areas frequently sustain fractures, many of which can be effectively managed via telehealth. With the support of a nurse practitioner or medical officer, care can be provided remotely, reducing the need for travel to specialist units.
Next of kin or person(s) who is legally responsible for patient consent, with the exception of children under guardianship orders with the Department of Child Safety, Seniors, and Disability Services, should be present at the first outpatient appointment.
If you have a reason to suspect a child in Queensland is experiencing harm, or is at risk of experiencing harm, you need to contact Child Safety Services
Statement of intent – the prioritisation of health services for children and young people in the child protection system

Referral requirements

A referral may be rejected without the following information.

Essential referral information

Date and Time of Injury: When the fracture occurred
Mechanism of Injury: How the fracture happened (e.g., fall, sports injury, direct impact)
Xray
Confirmation of OOHC (where appropriate)

Out of catchment

Metro North 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 North 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.

Clinical Modifiers (where relevant)

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

Reason for Referral (essential)

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 Information (essential)

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