Source: NSW Health, Central Coast Local Health District — Adult Orthopaedic Injury Referral Guide. Transcribed verbatim from the printed pathway; check the current copy on the wall for updates.
Fracture Clinic: order through EMR
Ortho consulted from ED: DAY pager #18204, 0700–2100 · NIGHT contact after 0700 next day unless urgent
Urgent Ortho Review: call 24/7 via switch
| Region | GP | Private Physio | Fracture Clinic | Ortho consulted from ED | Urgent Ortho Review |
|---|---|---|---|---|---|
| General | Isolated, un-displaced, simple fractures | ||||
| Gout, CPPD | Soft tissue and mechanical musculoskeletal injuries | ||||
| Degenerative joint disease | Simple fractures | ||||
| Reduced stable dislocation | Open, complex, comminuted, compound, displaced or intra-articular fractures | ||||
| Complex dislocations | |||||
| NV-compromised injuries | |||||
| Tendon disruptions | Compartment syndrome | ||||
| Compromised limb, compound long bone # | |||||
| Septic joint | |||||
| Necrotising fasciitis | |||||
| Irreducible #/dislocations with NV/skin compromise | |||||
| Shoulder / Clavicle | Chronic rotator cuff | Chronic rotator cuff | |||
| Shoulder dislocation (+clinic) | |||||
| Shoulder bursitis | |||||
| ACJ Gd 1–2 | Traumatic rotator cuff injury | ||||
| Shoulder dislocation (1st time, bony injury, patient requesting) | |||||
| ACJ grade 3+ (Neer classification) | |||||
| Clavicle # | Clavicle # with skin compromise | ||||
| Clavicle # with CCL compromise (Neer classification) | |||||
| Shoulder dislocation with humeral head or neck # | |||||
| ACJ grade 5–6 | |||||
| Scapula # | |||||
| Pec major tendon rupture, SCJ injuries | SCJ posterior dislocation | ||||
| Humerus | — | Long head of biceps tendon rupture | Un-displaced SNoH # | ||
| Un-displaced GT # | Comminuted HoH #, displaced or angulated SNoH # | ||||
| Humeral shaft # | |||||
| Displaced GT # | — | ||||
| Elbow | — | — | Reduced dislocations | ||
| Un-displaced olecranon # | |||||
| Elbow radial head/neck # type 1 (Mason classification) — can also consider GP | Biceps tendon rupture (distal insertion) | ||||
| Elbow dislocation with fracture | |||||
| Supracondylar # | |||||
| Olecranon # | |||||
| Radial head — displaced with articular step (Mason 2+) | |||||
| Infective olecranon bursitis | |||||
| Coronoid process fracture | — | ||||
| Forearm / Wrist | — | Carpal tunnel | |||
| De Quervain's | Simple wrist # | Intra-articular, comminuted, displaced or angulated | |||
| Monteggia and Galeazzi #/dislocations | |||||
| Ulna or radial shaft # | — | ||||
| Hip / Femur | OA hip | Mechanical hip pain | |||
| OA hip | — | NOF #, femur, hip/pelvis | |||
| Stress fracture NOF | |||||
| Pubic rami #s (clinicians' discretion) | |||||
| Acetabular fractures | Unstable pelvic fracture | ||||
| Native hip dislocation | |||||
| Knee | OA knee | OA knee | |||
| Mechanical knee pain | |||||
| Acute knee ligament injury | |||||
| Meniscal injury | Patella dislocation (with MRI via GP for 1st time) | ||||
| Un-displaced patella # | |||||
| Proximal fibula # direct trauma | Tibial plateau or femoral condyle # | ||||
| Quadriceps or patella tendon rupture | |||||
| Displaced patella # or loss of extensor mechanism | |||||
| Infective pre-patella bursitis | Knee dislocation (tibio-femoral) | ||||
| Tib-fib / Ankle | — | Avulsion #s | |||
| Ligamentous sprain | |||||
| Soft tissue injury | Weber A & stable Weber B #s | ||||
| Achilles tendon rupture | |||||
| High ankle sprain | Tibia #s | ||||
| Unstable Weber B #s, Weber C #s | |||||
| Bimalleolar & trimalleolar # | |||||
| Ankle dislocations, subtalar dislocation | |||||
| Syndesmosis injury / Maisonneuve injury | — | ||||
| Foot | Gout, CPPD | ||||
| 5th MT base fractures (zone 1) | Plantar foot pain | ||||
| Calcaneal tendon or bursa pain | |||||
| Avulsion #s | Calcaneus fractures — extra-articular | ||||
| Tarsal or MT fractures | Lisfranc injuries, large talus & calcaneus #s | ||||
| 2+ MT fractures | |||||
| Subtalar dislocation | |||||
| Displaced tarsal bone #s (not avulsion) | |||||
| Jones fracture | Subtalar dislocation — irreducible | ||||
| Tongue-type calcaneus # | |||||
| Toe | Closed 2nd–5th phalanx # | — | Un-displaced 1st toe phalanx # | ||
| All toe dislocation (reduced) | Displaced or open 1st toe phalanx # | ||||
| Nailbed injury | — | ||||
| Laceration | — | — | — | Limb lacerations needing operative closure | |
| Large abscess, lacerations involving joint or tendons, irremovable/contaminated foreign bodies, bites | — |
Fracture Clinic: order through EMR
Ortho consulted from ED: DAY pager #18204, 0700–2100 · NIGHT contact after 0700 next day unless urgent
Urgent Ortho Review: call 24/7 via switch #43
| Region | GP | Hand Therapist | Fracture Clinic | Ortho consulted from ED | Urgent Ortho Review |
|---|---|---|---|---|---|
| General | Isolated un-displaced simple fractures | ||||
| Gout / CPPD | Soft tissue and mechanical musculoskeletal injuries | ||||
| Degenerative joint disease | Simple fractures | ||||
| Reduced stable dislocations | Open, complex, comminuted, compound, displaced or intra-articular fractures | ||||
| Complex dislocations | |||||
| NV-compromised injuries | |||||
| Tendon disruptions | Compartment syndrome | ||||
| Compromised limb | |||||
| Compound long bone # | |||||
| Septic joint | |||||
| Necrotising fasciitis | |||||
| Irreducible #/dislocations with NV/skin compromise | |||||
| Carpal bones | Carpal tunnel | ||||
| De Quervain's | Carpal tunnel | ||||
| De Quervain's | Un-displaced carpal bone fracture | ||||
| Possible occult scaphoid fracture | Displaced fracture | ||||
| CMC dislocation | |||||
| Peri-lunate dislocation | |||||
| Lunate dislocation | Peri-lunate dislocation | ||||
| Lunate dislocation | |||||
| Metacarpal | — | — | 5th MC neck <50° angulation | ||
| Un-displaced & isolated 2nd–5th MC fractures | |||||
| 1st MCPj UCL sprain | |||||
| Sagittal band rupture | Intra-articular MC fractures | ||||
| Displaced or rotational deformity MC fractures (>10° angulation MC 2 & 3; >20° angulation MC 4 & 5) | |||||
| 1st MC fractures | |||||
| Confirmed Stener's | |||||
| MCP dislocations | — | ||||
| Phalanx | Closed tuft fracture | ||||
| Dorsal PIPJ dislocation | |||||
| PIP sprains | |||||
| Trigger finger | |||||
| Volar plate avulsion | Closed tuft fracture | ||||
| Dorsal PIPj dislocation | |||||
| PIPj sprains | |||||
| Trigger finger | |||||
| Volar plate avulsion fractures | Un-displaced phalanx fracture | ||||
| Mallet finger (post-splinting) | Displaced or multiple phalanx fracture | ||||
| FDP avulsion | |||||
| UCL avulsion (thumb) |
30% intra-articular fracture Volar PIPJ dislocations | — | | Lacerations / Nailbed | — | — | — | Tendon injuries Lacerations Nail bed injuries Tenosynovitis Hand cellulitis | Amputations (proximal to DIPj and viable) |
Cell key: # = fracture. Em-dash (—) = no entry on the original poster for that pathway. Times in 24-hour format.