Orthopaedics - public patients

• Clinically indicated e.g. suspected septic arthritis
  • Evidence of acute inflammation e.g.: haemarthrosis, tense effusion

• Suspected septic arthritis
• Upper limb radiculopathy in the presence of suspected cervical spine infection
• Acute development of peripheral nerve compression symptoms following trauma or acute event

• Suspected septic arthritis
• Knee extensor mechanism rupture
• Suspected fracture
• Evidence of acute inflammation for example
  • haemarthrosis
  • tense effusion
• 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

• Suspected septic arthritis
• Acute Achilles tendon rupture

• If any of the following are present or suspected, refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.
• Actual or threatened cauda equina syndrome
  • bilateral nerve pain (leg pain below knees)
  • unexplained or unexpected loss of bladder or bowel function
  • perineal anaesthesia
  • progressive weakness
• Spinal tumour with significant pain and/or neurological deficit
• Clinical signs spinal nerve root compression or spinal cord compression with rapidly progressive neurological signs/symptoms
• Spinal trauma with significant pain and/or neurological deficit
• Spinal fractures demonstrated on imaging
• Clinical suspicion of spinal infections
• High risk of irreversible deficit if not assessed urgently

• 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
• 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

• Acute ligament injury
• Tendon rupture
• Compound ‘tooth knuckle’ injury

• Open, unstable or suspected fractures

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

Essential information (Referral will be declined without this)

• General referral information
• History of:
• symptoms
• rate of deterioration of the condition
• Aggravating and relieving factors
• Pain assessment –waking up at night, analgesic consumption
• Interference with activities of daily living and working ability
• Neurological deficit
• Weight bearing x-rays
• USS for any tendinopathy (not required for Achilles rupture if examination confirms)

Additional referral information (useful for processing the referral)

• Management to date (including insoles and physiotherapy)
• High risk foot clinic or podiatrist reports

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Backslab or moon boot for acute or suspected Achilles tendon rupture. Review in fracture clinic.
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of:
• symptoms
• rate of deterioration of the condition
• Pain assessment –waking up at night, analgesic consumption, aggravating and relieving factors
• Interference with activities of daily living and working ability
• Nerve irritation signs (Tinels foot sign or hyperaesthesia)
• Neurological deficit
• XR results - AP and lateral ankle/foot including weight bearing/standing views

Additional referral information (useful for processing the referral)

• Management to date (including insoles and physiotherapy)
• High risk foot clinic or podiatrist reports

Other useful information for management (not an exhaustive list)

• refer to Healthpathways or local Guidelines
• Obesity is associated with an increase in complications associated with surgery- consider dietitian and weight reduction monitoring if BMI is a concern
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery.

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of:
  • symptoms
  • rate of deterioration of the condition
• Aggravating and relieving factors
• Pain assessment – waking up at night, analgesic consumption
• Interference with activities of daily living and working ability
• Nerve irritation signs (Tinels foot sign or hyperaesthesia)
• Neurological deficit
• XR results - AP and lateral ankle/foot including weight bearing/standing views

Additional referral information (useful for processing the referral)

• Management to date (including insoles and physiotherapy)
• High risk foot clinic or podiatrist reports (if available)

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Footwear advice/walking aids e.g. modification footwear/heel cups/heel raise (where available)
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of symptoms, rate of deterioration of the condition
• Aggravating and relieving factors
• Pain assessment –waking up at night, analgesic consumption
• Interference with activities of daily living and working ability
• Neurological deficit
• Nerve irritation signs
• XR results - AP and lateral ankle/foot including weight bearing/standing views

Additional referral information (useful for processing the referral)

• Management to date (including insoles and physiotherapy)
• High risk foot clinic or podiatrist reports

Other useful information for management (not an exhaustive list)

The Mater offers a collaborative multidisciplinary high risk foot service for diabetic patients who have been assessed as having or developing foot complications. This may be an appropriate alternate referral pathway for your patient. Referrals to this service are managed through the Diabetes and Endocrine pathway.

• Refer to HealthPathways or local guidelines
• Obesity is associated with an increase in complications associated with surgery – consider dietitian & weight reduction monitoring if BMI is a concern
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of:
• symptoms, length and severity of symptoms / degree of disability/ability/mobility e.g. details of functional impairment. Level of ability to do daily activities/waking
• recurrent infections (related to referred joint) 
• Smoking status
• HbA1C (diabetic patient referral only)
• FBC, ESR, CRP results (if indicated by medical history)
• Previous joint surgery (THR/TKR)
• Height, weight and BMI
• Examination for ROM and fixed deformity
• Harris Hip Score
• XR results - AP pelvis AP affected hip showing proximal 2/3 femur and lateral affected hip.  

Additional referral information (useful for processing the referral)

• MRI results if avascular necrosis is suspected (where available and not cause significant delay)

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Consider pre‐operative optimisation of patient with diagnosed and undiagnosed diabetes, prior to referral
• Consider pre-operative optimisation of anaemia, as defined by a haemoglobin of < 13.0g/dL in men and 12.0g/dL in women, prior to referral
• Smoking is a contraindication to hip and knee arthroplasty surgery
• Better health self-management program
• Obesity is associated with an increase in complications associated with surgery – consider dietitian & weight reduction if BMI is >35
• Chronic disease requires to be optimised prior to referral, or the patients may not proceed to surgery
• Young adult <40 years suspected labral tear with acute mechanism and mechanical symptoms refer allied health care

Clinical resources

• Diagnosis and management of hip and knee osteoarthritis: RACGP, Clinical guidelines, Diagnosis and management of hip and knee osteoarthritis

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of:
  • symptoms
  • date
  • recurrence of injury and mechanism
  • severity or evolution of injury
• Pain and other symptoms including haemarthrosis / effusion, locking, instability
• True locking (versus intermittent stiffness)
• XR results - knee weight bearing AP, lateral and skyline. 

Additional referral information (useful for processing the referral)

• MRI results for suspected locked knee or significant internal or ligamentous derangement (where available and not cause significant delay)
• Hip and knee questionnaire (patient to complete) 

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Timing of first review appointments at orthopaedic outpatients:
  • 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
• For suspected infection of native or prosthetic knee do not start antibiotics until discussed with on call registrar. If systemic illness associated, then refer direct to ED.
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery
• Obesity is associated with an increase in complications associated with surgery – consider dietitian & weight reduction monitoring if BMI is >35

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• History of symptoms: pain, true locking, instability, swelling, recurring infections
• Injury details (if any): date, mechanism, severity, recurrence and evolution of injury
• Smoking status
• HbA1C (diabetic patient referral only)
• FBC, ESR, CRP results (if indicated by medical history)
• Previous joint surgery
• Results of clinical ligament and meniscus tests if completed
• Height, weight and BMI
• XR results - knee, weight bearing AP, lateral and skyline of both knees

Additional referral information (useful for processing the referral)

• Management to date
• Investigations for inflammatory arthropathy
• Has non-operative management been completed?
• Hip and knee questionnaire (patient to complete) 

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Consider pre‐operative optimisation of patient with diagnosed and undiagnosed diabetes, prior to referral
• Consider pre-operative optimisation of anaemia, as defined by a haemoglobin of < 13.0g/dL in men and 12.0g/dL in women, prior to referral
• Smoking is a contraindication to hip and knee arthroplasty surgery
• Better health self-management program
• Obesity is associated with an increase in complications associated with surgery – consider dietitian & weight reduction monitoring if BMI >35.  Mandatory for BMI >40.
• Chronic disease requires to be optimised prior to referral, or the patients may not proceed to surgery
  • Osteoarthritis of the knee clinical care standard
  • ACSQHC OA of the Knee decision support tool

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Please note Mater is not accepting referrals for Elbow conditions. Please refer to your local HHS or consider private options.

At Mater Hospital Brisbane, this condition is managed by the Neurosurgery Service. Please refer to their referral guidelines and name the referral to their head of department. 

At Mater Hospital Brisbane, this condition is managed by the Plastics and Reconstructive Surgery Service. Please refer to their referral guidelines and name the referral to their head of department.

Essential information (Referral will be declined without this)

• General referral information
• History of:
  • symptoms
  • date
  • time
  • mechanism
  • severity or evolution of injury
• Neurovascular examination (Cat 1 only)
• Management to date (immobiliser, splint, cast etc.)
• XR results - Instruct patient to bring imaging films/results to clinic appointment

Other useful information for management (not an exhaustive list)

• 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
• Refer to HealthPathways or local guidelines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

At Mater Hospital Brisbane, this condition is managed by the Neurosurgery Service Please refer to their referral guidelines and name the referral to their head of department. 

Essential information (Referral will be declined without this)

• General referral information
• 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.  Instruct patient to bring imaging films/results to clinic appointment

Other useful information for management (not an exhaustive list)

• 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 optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• USS results (for clarification of presence of cyst)

Additional referral information (useful for processing the referral)

• Management to date

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Please note Mater does not accept referrals for complex wrist conditions - see out of scope section above.

Essential information (Referral will be declined without this)

• General referral information
• History of fall or trauma
• Functional assessment (ROM)
• XR results - AP and lateral wrist. (Consider scaphoid views). Instruct patient to bring imaging films/results to clinic appointment.

Additional referral information (useful for processing the referral)

• Management to date
• FBC ESR & CRP results if inflammation is suspected

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• History of inflammatory disease – consider referral to rheumatology
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Management to date
• Describe chronicity
• Determine if there is normal passive ROM in the MP, PIP, and DIP joints

Other useful information for management (not an exhaustive list)

• Refer to HealthPathways or local guidelines
• Chronic disease requires to be optimized prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Detailed clinical examination with sensory mapping, presence of neurological deficit and functional assessment (include impacts on ADL and employment)
• Management to date (include allied health input and steroid injections)
• Duration and rate of progression of symptoms
• Nerve Conduction Studies (NCS) required for Cat 1 cases only (where available and does not cause significant delay to patient accessing outpatient service)
• CT spine (only where suspecting central compression pathology)

Additional referral information (useful for processing the referral)

• XR results - AP and lateral (of region) (if available)
• Nerve conduction studies (where available and not cause significant delay)
• OT/Physio report when available

Other useful information for management (not an exhaustive list)

• Refer to Healthpathways or local guidelines
• CTS can be referred to the following specialities but will be triaged in a unified manner by all specialities concerned:
  • Orthopaedics
  • Plastic and Reconstructive surgery
  • Neurosurgery
  • General Surgery
• Chronic disease requires to be optimised prior to referral, or the patients may not proceed to surgery

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

Essential information (Referral will be declined without this)

• General referral information
• Relevant condition information
• Relevant pathology and imaging reports

Categorisation

Available appointments are provided to our patients based on clinical priority. A process of categorisation ensures safety and equity of access.

For complex fingers and hands e.g. all conditions below the carpus, arthritis, tumour, ligament injury, tendon injury, 1st CMC arthritis, including Basal Thumb Arthritis and Dupuytren’s Contracture - Please refer to the Mater Plastics and Reconstructive Surgery Service.

• Aesthetic or cosmetic surgery
• Disability assessment (refer to HealthPathwyas)
• Referrals for assessment prior to application for the Australian Defence Force or Queensland Police Service
• Spinal surgery e.g. any spinal pathology that may require surgery - Please refer to the Mater Neurosciences Centre Brisbane
• Complex fingers and hands e.g. all conditions below the carpus, arthritis, tumour, ligament injury, tendon injury, 1st CMC arthritis - Please refer to the Mater Plastics and Reconstructive Surgery Service
• Complex wrist e.g. arthritis, scapholunate ligament injury, scapholunate advanced collapsed (SLAC) wrist, scaphoid non-union advanced collapse (SNAC), Kienboch’s disease - please refer to your local HHS
• Elbow e.g. instability, arthritis - please refer to your local HHS
• Orthopaedic Oncology - please refer to your local HHS