Upper limb trauma
+ Emergency
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
- 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
- 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
Spine, Neck, Back Pain
NB: contact the Orthopaedic/Neurosurgery/Spine Registrar on-call for advice.
- High risk of irreversible deficit if not assessed urgently
- Spinal infections
- Significant spinal nerve root compression or spinal cord compression with progressive neurological signs/symptoms e.g.
- Spinal cord compression with severe or rapidly progressing neurological deficit
- Cauda equina syndrome
- Bilateral nerve pain (leg pain below knees)
- Bladder / bowel dysfunction
- Perineal anaesthesia
- Progressive weakness
- Bone infection
+ Useful management information
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
- Do not delay referral for open, unstable fractures — refer to emergency or contact the orthopaedic registrar on-call.
- Please refer early as treatment may change with a delayed referral
- Chronic disease requires to be optimized prior to referral or the patients may not proceed to surgery
Management
- Assess and document neurovascular status
- Check XR post manipulation (if applicable)
- Immobilise fractured limb in a sling, shoulder immobiliser or cast as appropriate
+ Minimum referral criteria - Does your patient meet the minimum referral criteria?
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Category 1 |
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| Category 2 (appointment within 90 calendar days) |
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| Category 3 (appointment within 365 calendar days) |
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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
+ Standard referral information To be included in all referrals
Patient's Demographic Details
- Full name (including aliases)
- Date and country of birth
- Residential and postal address including whether patient resides at an aged care facility
- Telephone contact number/s – home, mobile and alternative
- Medicare number (where eligible)
- Name of the parent or caregiver (if appropriate)
- Name of delegate and contact details (Department of Corrective Services)
- Preferred language and interpreter requirements
- Identifies as Aboriginal and/or Torres Strait Islander
- Any special needs, access requirements and/or disability relevant to the referral
Referring Practitioner Details
- Full name
- Full address
- Contact details – telephone, fax, email
- Provider number
- Date of referral
- Signature
- Nominated general practitioner’s details (if known), if the nominated general practitioner is different from the referring practitioner
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
- All conservative options that have been pursued unsuccessfully prior to referral
- Body mass index (BMI)
- Details of any associated medical conditions which may affect the condition or its treatment (e.g. diabetes, BMI), noting these must be stable and controlled prior to referral
- Any special care requirements where relevant (e.g tracheostomy in place, oxygen required)
- Current medications and dosages
- Drug allergies
- Alcohol, tobacco and other drugs use
- A comprehensive capture of information in relation to MSH Referral Criteria
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 functioning – low/medium/high
- 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
Essential referral informationWithout this information the referral will be rejected
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+ Additional referral information
No additional information
Out of Catchment
West Moreton Health is responsible for providing public health service to people who reside within its boundaries. Due to high demand it is not possible to accept referrals from outside this catchment area. If your patient lives outside the West Moreton 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: Friday, May 25, 2018
