VSRF+ Orthopaedics Referral Form. Triage Categories/ Appointment Wait Time Emergency/After Hours:

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Caroline Sutton
6 years ago
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Northern Health Orthopaedic Pre referral Management Guidelines Orthopaedic Consultants: Mr A. Bonomo Mr R. Hau Mr A. Chia Mr D. Robin Ms J. Gentle Mr A. Chehata Mr R.

1 Northern Health Orthopaedic Pre referral Management Guidelines Orthopaedic Consultants: Mr A. Bonomo Mr R. Hau Mr A. Chia Mr D. Robin Ms J. Gentle Mr A. Chehata Mr R. Unni Osteoarthritis Hip & Knee Service (OAHKS): Ms R Coyne Mr A Harms Clinic/Appointment : The Northern Hospital (TNH) 185 Cooper St, Epping Tel: Fax: Fracture Clinic/General Orthopaedics, Tuesday at TNH Fracture Clinics/General Orthopaedics Monday/Wednesday VSRF+ Orthopaedics Referral Form Referral must contain detailed information on: - History - Medications - Investigations (patient to bring results/films as ) Conditions seen: Fractures of upper/lower limb Closed wrist fractures Shoulder conditions osteoarthritis, rotator cuff, instability/dislocation & pain/stiffness Elbow conditions tendonitis, painful/stiff/locking Wrist & hand conditions stenosing tenovaginitis and ganglia Osteoarthritis Hip and Knee Previous arthroplasty hip and knee-loosening, wear and infection Locked/unstable knee Ankle and feet pain and deformity Conditions not seen: Neck Pain, Back Pain & Sciatica - refer to hospital with spinal service Tumours- refer to St Vincent's Hospital Paediatrics: Clubfoot/Calcaneo Valgus Foot/Flat Feet / Intoeing/ Perthes/ SUFE/ synovitis hip - refer to RCH Wrist and Hand conditions Contractures and Dupuytrens refer to Plastics Triage Categories/ Appointment Wait Time Emergency/After Hours: Call the Emergency Department GP Hotline on /8610 to access the Senior ED Consultant 0 to 4 weeks Speak to the on-call Orthopaedic Registrar during business hours on for urgent queries Category 2 (Semi Urgent) 12 to 18 months All non urgent referrals will be triaged by Orthopaedic Consultant and appointments booked accordingly All non urgent appointments for Osteoarthritis of Hip and Knee will be triaged by OAHKS in collaboration with the consultant Category 3 (Routine) It is unlikely that an appointment will be available under 18 months Page 1 of 8

2 ACUTE TAUMA (FRACTURES): Fractures of the Upper Limb Acute fractures will be assessed by the Fracture Clinic within 2 weeks Hand Fractures Acute fractures can be assessed by the Fracture Clinic or in Plastics Outpatients within 2 weeks - x-ray out of plaster (AP and Lateral and Axillary views proximal - humerus) and instruct patient to bring films to specialist appt. - Please also request Scaphoid Views if scaphoid fracture is suspected if fracture is reduced or manipulated, any check x-rays should be reviewed by the Doctor requesting the imaging prior to referral x-ray of hand AP and lateral views and additional check x-ray post manipulation if applicable immobilise fractured limb in a sling, shoulder-immobiliser or plaster cast as - immobilise in a suitable splint or thumb-spica cast as Refer URGENTLY to Fracture Clinic for acute fractures (fractures < 2 weeks old) assessed as requiring further or specialist management Immediate (Emergency): Refer patient directly to the Emergency Department if open or displaced fracture If fracture is distal to the wrist and closed with no laceration then referral is classified as Urgent and seen within 2 weeks in the Plastics Wound Clinic. Page Plastics Registrar on if any concerns Fractures of the Lower Limb Acute fractures will be assessed by the Fracture Clinic within 2 weeks - X-ray out of plaster (AP and lateral views) and instruct patient to bring films to Fracture clinic appointment. Please request Sky line views of the knee if indicated - Please note, any check X-rays post immobilisation should be reviewed by the Doctor requesting the imaging prior to referral - immobilise fractured limb in an plaster cast and instruct patient to remain non weight bearing using crutches Refer Urgently to Orthopaedic Fracture Clinic for acute fractures (fractures < 2 weeks old) assessed as requiring further or specialist management Page 2 of 8

3 SHOULDERS Shoulder Osteoarthritis - x-ray (shoulder AP, 30 caudal AP, lateral and axillary lateral views) and instruct patient to bring films to specialist appt - advise patient regarding activity modification - pain medication / hydrotherapy - if patient experiencing: - significant pain - disability - sleep disturbance - unresponsive to therapy after 6 months, AND - patient is a candidate for joint replacement surgery (arthroplasty) Please note: non-surgical candidates may be assessed and managed in the Rheumatology clinic until fit for surgery or improved: - if pain does not warrant joint replacement please refer to Rheumatology Clinic Rotator Cuff Tendinitis and Tears, and AC Joint Problems - clinical history and examination including neurological examination - x-ray (AP, 30 caudal AP, lateral, axillary lateral views) and instruct patient to bring x-rays to specialist appt - US scan (tear: please instruct patient to bring in US REPORT) - anti inflammatory medication if - pain medication - consider cortisone injection Refer urgently to Orthopaedic Clinic if following trauma: - evidence of an acute tear that fails to respond well to 6 weeks of physiotherapy, OR - confirmed supraspinatus tear and patient < 70 years - Evidence of weakness and history of trauma suggestive of an acute rotator cuff is more urgent - if patient with chronic tear fails to respond to treatment Page 3 of 8

4 Instability or Recurrent Dislocation of Shoulder - standard history and examination including neurological examination - x-rays (AP & lateral & axillary lateral views) and instruct patient to bring films to appointment - provide advice to avoid dislocation - shoulder rehabilitation program (physiotherapy) Refer urgently to Orthopaedic Clinic if patient has rotator cuff tear post dislocation Refer to Orthopaedic Clinic if patient experiencing recurring instability and/or pain and has functional impairment and not responding to the rehabilitation program after 3 months ELBOWS Tennis/Golfer s Elbow (tendonitis) Painful, Stiff or Locking Elbow - clinical history and examination - plain x-rays - standard clinical history and examination - consider FBE, ESR & CRP if inflammation suspected - plain x-rays - course of anti inflammatory medication if - modify activity avoid aggravating activity - tennis elbow brace - consider cortisone injection - anti inflammatory medication if Refer if not responding to treatment after 12 months - refer if loose bodies visualised on x-ray - refer after 6 months if not responding to treatment WRIST & HAND Stenosing Tenovaginitis (e.g. trigger finger, de Quervains) Refer to Orthopaedics or Plastics Standard history and examination Consider injection with steroids Refer if functional impairment or if unresponsive to treatment after one injection Page 4 of 8

5 Ganglia - standard history and examination Refer to Orthopaedics or General Surgery Carpel Tunnel Refer to Orthopaedics or General Surgery - standard history and examination - nerve conduction studies Consider aspiration (18g needle) and injection of steroid - consider one steroid injection - splinting Refer for symptomatic ganglia. Cosmesis alone usually is not a reason for referral - if muscle wasting or associated with pregnancy For all other presentations HIPS Osteoarthritis of the Hip Refer all Non Urgent OA Hip conditions to the Northern Health Osteoarthritis Hip & Knee Service (OAHKS) using the OAHKS Referral Form History: - Patient to complete the OAHKS Hip and Knee Questionnaire (ensure it is attached to referral) - x-ray views of hip: Charnley??, AP, lateral, weight bearing - anti inflammatory/pain medication - advice re walking aide walking stick (opposite hand)/ forearm crutches/ walking frame Category 2 (Semi Urgent) The NH OAHKS service coordinates the management of patients with hip or knee OA and helps prioritise patients on outpatient and elective surgery waitlists. Appointments will be allocated upon receipt of referral; approximate wait time is 3 months. For queries regarding very urgent cases contact the OAHKS Musculoskeletal Coordinator on Refer to GP Access webpage for more information on the OAHKS program and referral form (general information/forms) Page 5 of 8

6 Previous Hip Arthroplasty Loosening, Wear or Infection History and Examination Clinical history and examination. Key points: - new pain - limp or affected gait - look for translucency on x-ray Immediate (Emergency): Suspected infection should be referred IMMEDIATELY do not commence antibiotics Call GP Hotline on to access the Senior ED Consultant - Weight bearing x-ray (AP pelvis and lateral hip views) and instruct patient to bring to appointment - FBE, ESR and CRP to exclude infection Refer urgently to Orthopaedic Clinic if pain in previous hip arthroplasty Phone Orthopaedic Registrar on call on if concerned Refer to Orthopaedic Clinic if patient is experiencing: - significant pain - disability - sleep disturbance - unresponsive to therapy AND - patient is a surgical candidate - symptoms rapidly deteriorate and are causing severe disability Page 6 of 8

7 KNEES Osteoarthritis of the Knee Refer all Non Urgent OA knee conditions to the Northern Health Osteoarthritis Hip & Knee Service (OAHKS) using the OAHKS Referral Form History: - Patient to complete the OAHKS Hip and Knee Questionnaire (ensure it is attached to referral) - Weight-bearing x-rays of both knees, including: - skyline view of the patella - lateral view - AP weight-bearing views Note: ultrasound is not a useful diagnostic investigation for knee injuries - medication: Anti inflammatory medication and analgesia as - activity modification - weight reduction if required - walking aids as The NH OAHKS service coordinates the management of patients with hip or knee OA and helps prioritise patients on outpatient and elective surgery waitlists. Click here for more information on the OAHKS program Appointments will be allocated upon receipt of referral; approximate wait time is 3 months. For queries regarding very urgent cases contact the OAHKS Musculoskeletal Coordinator on Previous Knee Arthroplasty Loosening, Wear or Infection History and Examination: Clinical history and examination. Key points: - new pain - limp - grating - look for translucency on x-ray - weight bearing x-ray (AP lateral both knees) and instruct patient to bring to appointment - - FBE, ESR and CRP to exclude infection Page 7 of 8 Immediate (Emergency): Suspected infection should be referred IMMEDIATELY do not commence antibiotics Call GP Hotline on to access the Senior ED Consultant Refer urgently to Orthopaedic Clinic if pain in previous knee arthroplasty Phone Orthopaedic Registrar on call on if concerns Refer to Orthopaedic Clinic is patient experiencing: - significant pain - disability - sleep disturbance - unresponsive to therapy AND - patient is a surgical candidate

8 Locked Knee/Knee Instability History and Examination: Clinical history and examination. Key points: - check ROM - confirm true lock - medication: anti inflammatory and analgesia as - walking aids as required particularly if not a true lock Refer to Orthopaedic Clinic if true locked knee, note clearly on referral Refer if patient experiencing significant pain, problems relating to mobility, sleep disturbance, and unresponsive to therapy over several weeks ANKLES & FEET Arthritis/Pain and Deformity History: - standard history and examination. - weight bearing X-rays of feet and ankles - ultrasound to exclude tibialis posterior tear - medications: analgesia & NSAIDs if - comfortable or modified footwear - orthotics. - walking aids - consider steroid injections for intermetatarsal bursal/neuroma Refer for routine assessment if severity of symptoms warrants after three months conservative treatment Achilles Tendon Pathology Standard history and examination - x-ray (AP and lateral ankle/foot including weight bearing /standing views - ultrasound for tendinosis and bursitis - heel cups/raise - avoid steroid injections Refer for routine assessment in three months if conservative treatment fails or if patient has tender nodule Heel pain - standard history and examination - weight bearing X-rays (AP and lateral foot) NB x-rays allow exclusion of some diagnoses - orthotics - podiatry - silicone heel pad - medications- NSAIDs, analgesia as - consider steroid injections for plantar fasciitis Refer for routine assessment after failure to respond to three months of conservative treatment Plantar spurs on an x-ray do not imply plantar fasciitis Page 8 of 8

BALLARAT HEALTH SERVICES SPECIALIST CLINICS

BALLARAT HEALTH SERVICES SPECIALIST CLINICS GP REFERRAL CRITERIA ORTHOPAEDICS 2012 Edition Specialist Clinics GP Referral Guidelines Orthopaedics Ballarat Health Services offers both MBS-billed Clinics