Fractures - 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

• rapid assessment referrals to fracture clinic - for fractures requiring rapid assessment, to be seen within 7 to 10 days, including:
  
  • acute fractures that have been reduced and immobilised
    
  • toddler fractures
    
• fracture healing delay or non-union

Exclusions

• buckle fractures of the wrist – immobilise in wrist splint for 4 weeks
  
• hand fractures – refer to Hand Trauma - Paediatric Plastic and Reconstructive Surgery CPC
  
• skull fractures, following emergency department presentation – refer to Brain Trauma - Paediatric Neurosurgery CPC
  
• craniofacial fractures – refer to Craniomaxillofacial – Paediatric Plastic and Reconstructive Surgery CPC

Triage categories

Please refer early as treatment may change with a delayed referral

Category 1 (appointment clinically indicated within 30 days)

• rapid assessment – to be seen within 7-10 days:
  
  • undisplaced fracture
    
  • fracture that has been reduced and immobilised satisfactorily
    
  • delayed presentation joint dislocation
    
• delayed presentation nerve or tendon injury

Category 2 (appointment clinically indicated within 90 days)

• fracture healing delay or non-union
• mal-union affecting function

Category 3 (appointment clinically indicated within 365 days)

• mal-union not affecting function

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.

Please refer early as treatment may change with a delayed referral

• clinical history including
  
  • symptoms
    
  • date/time of injury
    
  • mechanism of injury
    
  • severity or evolution of injury
    
• neurovascular examination, Category 1 only
  
• management to date, e.g. immobiliser, splint, cast
  
• other joint involvement
  
• previous orthopaedic conditions and operations
  
• x-ray results – anterior to posterior (AP) and lateral views. Please state x-ray provider, location and date of imaging on referral. Instruct patient to bring imaging films/results to clinic appointment.

Clinical management advice

• Refer fractures immediately, patient must be seen within 7 to 10 days.
  
• Delayed referral may affect treatment/management plan.
  

Clinical resources

• Royal Children’s Hospital Melbourne — Paediatric Fractures Guidelines

Consumer resources

• Women’s and Children’s Hospital — Simple wrist fracture in a splint (PDF 156KB)
  
• Women’s and Children’s Hospital — Supracondylar fracture — simple (PDF 179KB)
  
• Women’s and Children’s Hospital — Fractured clavicle (broken collarbone) (PDF 277KB)

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.