Upper limb trauma

ADULT

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols 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

    • Open, unstable or suspected fractures
    • Refer to HealthPathways or local guidelines
    • 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 optimised while waiting for appointment or the patients may not proceed to surgery
Minimum Referral Criteria
Category 1
(appointment within 30 calendar days)
  • Undisplaced fracture
  • Fracture that has been reduced and immobilised satisfactorily
  • Delayed presentation nerve or tendon injury
  • Delayed presentation joint dislocation
Category 2
(appointment within 90 calendar days)
  • Fracture delayed or non-union
  • Mal-union affecting function
Category 3
(appointment within 365 calendar days)
  • Mal-union not affecting function

Please insert the below information and minimum referral criteria into referral

1. Reason for request Indicate on the referral

  • 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

2. Essential referral information Referral will be returned without this

  • Previous orthopaedic conditions and operations
  • History of – symptoms, date, time, mechanism, severity or evolution of injury
  • Neurovascular examination (Cat 1 only)
  • Treatment to date (Immobiliser, splint or cast etc.)
  • Other joint involvement
  • XR results - scaphoid views only if out of plaster.

3. Additional referral information Useful for processing the referral

  • No additional information

4. Request

  • Patient's Demographic Details

    • Full name (including aliases)
    • Date of birth
    • Residential and postal address
    • Telephone contact number/s – home, mobile and alternative
    • Medicare number (where eligible)
    • Name of the parent or caregiver (if appropriate)
    • Preferred language and interpreter requirements
    • Identifies as Aboriginal and/or Torres Strait Islander

    Referring Practitioner Details

    • Full name
    • Full address
    • Contact details – telephone, fax, email
    • Provider number
    • Date of referral
    • Signature

    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
    • 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

    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
    • 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.)

  • If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or follow local emergency care protocols or seek emergent medical advice if in a remote region.

    • Please note that where appropriate and available, the referral may be streamed to an associated public allied health and/or nursing service. This may include initial assessment and management by associated public allied health and/or nursing, which may either expedite 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.

Last updated: 13 February 2024

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