Trauma and orthopaedic surgery referrals

COVID-19 and Trauma & Orthopaedic Surgery referrals

In common with most other specialties, we are changing the way we work over the next few months and in particular who we see in outpatient clinics.
The elderly, the immunocompromised, those with IHD, men and smokers appear to be at greater risk of infection with COVID-19. Elective surgery is being greatly curtailed.
We therefore plan to restrict outpatients to urgent referrals.
The following criteria are advisory – there is always an on call orthopaedic registrar, general orthopaedic consultant, spinal orthopaedic consultant and paediatric orthopaedic consultant who are available for advice on a daily basis via NNUH switchboard (01603 286286):
Suspected Cauda Equina – Continue to refer urgently to the on call team (bleep 0996).
Neck or back pain with deteriorating myelopathic symptoms – please refer urgently via the console.
Mechanical back pain – no referrals will be accepted. Please give advice about life-style changes (weight loss, keep exercising) and commence/continue best medical therapy.
Patients with “red flag” symptoms (new or deteriorating neurological symptoms, bladder or bowel disturbance, systemic symptoms such as pyrexia, night sweats, unexplained weight loss) should be referred urgently via the console or emergently to the on call spinal team if cauda equina is suspected (bleep 0996).
Suspected skeletal neoplasia (primary or secondary) – please refer urgently via console.
Suspected acute infection in native or prosthetic joint – continue to refer urgently to the on call team (bleep 0996).
Paediatric Orthopaedics – please continue to refer in usual manner via console. One of the paediatric team will triage referrals as we recognise it can be challenging to pick up potentially serious orthopaedic pathology in children.
Osteoarthritis (primary or secondary to inflammatory arthritis) – no routine referrals will be accepted. This includes patients with hip, knee, foot & ankle, shoulder, elbow, wrist & hand osteoarthritis. Please give advice about life-style changes (weight loss, keep exercising) and commence/continue best medical therapy. Patients with “red flag” symptoms or X-ray reports suggestive of infection or cancer (primary or secondary) should be referred on an urgent basis via the console. Patients with severe, confirmed osteoarthritis who are unable to perform basic activities of daily living and have deteriorating symptoms can be referred urgently via the console.
Acute knee injuries – Young (16-45) patients with acute knee injuries & an effusion should ideally be referred for an urgent MRI & an urgent referral made via the referral console.
Minor musculoskeletal injuries – patients with musculoskeletal injuries sustained in the community should attend A&E in the normal way & will be directed to the orthopaedic fracture clinic via the A&E minor injuries unit. Patients who consult their GPs with such injuries can be directed to the fracture clinic where an orthopaedic consultant will be present 8am-6pm Mon-Fri. Please telephone 01603 289483 during these hours to make
such a referral & a same or next-day appointment can be scheduled.