Ankle Sprain - Paediatric CPC

For clinical advice, please telephone the relevant specialty service.

Northern Adelaide Local Health Network

• Lyell McEwin Hospital (08) 8182 9000

Southern Adelaide Local Health Network

• Flinders Medical Centre (08) 8204 5511

Women's and Children's Health Network

• Women’s and Children’s Hospital (08) 8161 7000

Inclusions

• repeated/recurrent ankle sprains with little improvement

Exclusions

• acute ankle sprain – refer to ‘Clinical Management Advice’
• simple ankle sprains should be referred for non-surgical management, e.g. physiotherapy, and if no improvement after 6 weeks refer to Orthopaedics for review

Triage categories

Patients are expected to have undertaken a trial of non-operative management, for example physiotherapy, prior to referral.

Category 1 (appointment clinically indicated within 30 days)

• ankle sprain with no improvement after 6 weeks

Category 2 (appointment clinically indicated within 90 days)

• complex ankle sprain - repeated/recurrent ankle sprain with instability

Category 3 (appointment clinically indicated within 365 days)

• recurrent ankle sprains, for example lateral ligament injuries

Essential referral information

Completion required before first appointment to ensure patients are ready for care. 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.

• clinical history including:
  • date of injury
  • mechanism of injury
  • symptoms including onset and duration, i.e. pain, swelling and/or instability
  • functional impact, range of motion (ROM)
• management history 
  • non-operative management, e.g. physiotherapy
  • use of immobiliser, splint, cast
• x-ray only if unable to weight bear - anterior to posterior (AP) and lateral views - include provider, location and date of imaging, and instruct patient to bring imaging films/results to clinic appointment. Ultrasound or magnetic resonance imaging (MRI) is not required.

Clinical management advice

• First line treatment for ankle sprain:
  • if unable to weight bear – x-ray, NO ultrasound or magnetic resonance imaging (MRI) required
  • if no fracture – refer to physiotherapy for range of motion (ROM) +/- moon boot/ankle brace or strapping
  • if no fracture on x-ray and no improvement after 10 days, repeat x-ray
  • if no improvement after 6 weeks of non-surgical intervention, e.g. physiotherapy, refer to Orthopaedic Surgery
• Patient can weight bear as tolerated in whatever device used and can swim as tolerated
• If wearing boot/brace, wear only when walking, if required for pain/comfort

Referral requirements for specific sites

• Physiotherapy at Women’s and Children’s Hospital (WCH) do not accept referrals from General Practitioners (GPs) – refer instead to community or private physiotherapy.
• Physiotherapy at Flinders Medical Centre (FMC) and Lyell McEwin Hospital (LMH) do accept referrals from GPs for paediatric orthopaedic conditions.

Consumer resources

• Royal Children’s Hospital Melbourne – Ankle sprains

Reason for request

• to establish a diagnosis
• for treatment or intervention
• for advice and management
• for specialist to take over management
• for a specified test/investigation the General Practitioner cannot order
• for other reason (e.g. rapidly accelerating disease progression)
• transfer of care from another tertiary service
• clinical judgement indicates a referral for specialist review is necessary.

Patient 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

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.
• Relevant social history, including identifying if you feel your patient is from a vulnerable population, under guardianship/out-of-home care arrangements and/or requires a third party to receive correspondence on their behalf.
• Triage of a specialist outpatient referral is based on clinical decision making to allocate an appropriate urgency categorisation.
  
• Where appropriate and where available, the referral may be streamed to an associated public allied health and/or nursing service. Access to some specific services may include initial assessment and management by associated public allied health and/or nursing, which may either facilitate or negate the need to see the public medical specialist.
• A change in patient circumstance (such as condition deteriorating or pregnancy) may affect the urgency categorisation and should be communicated as soon as possible.
• All new referrals will be triaged by a consultant and appointment times scheduled according to clinical urgency.

Adolescents transitioning from paediatric to adult specialist services require a formal handover from paediatric specialist clinician to adult specialist clinician as well as a formal referral from the referring specialist to ensure initial transfer of care is completed.

The role of the referring clinician (e.g. General Practitioner, Nurse Practitioner) in this process is to provide support to patients as part of holistic care. All ongoing referrals to specialists can subsequently be provided by the referring clinician once the transfer of care has occurred.