Skip links and keyboard navigation


If any of the following are present or suspected, please refer the patient to the emergency department (via ambulance if necessary) or seek emergent medical advice if in a remote region.

The list below includes common traumatic injuries that require referral to emergency and should not be referred for elective / fracture clinic categorisation



Shoulder and elbow conditions

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

Wrist and hand

  • Uncontrolled sepsis including hand infections
  • Upper limb radiculopathy in the presence of suspected cervical spine infection
  • Acute development of peripheral nerve compression symptoms following trauma or acute event

Hip and knee

  • 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

Foot and ankle

  • 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

Trauma and fractures

  • 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

Hand trauma

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

Upper and lower limb trauma

  • 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



Limping child/reluctant to weight bear

  • Limping child with signs of:
    • Being unwell, flushed, lethargic, fever, flat, anorexic and/or
    • Irritable and stiff joint and/or
    • Not improving
  • Systemically unwell, febrile or suspicion of septic arthritis
  • Concern of infection or trauma
  • Suspicion or concern of non-accidental injury

NB See Slipped upper femoral epiphysis (SUFE) CPC

Perthes disease

  • Perthes if systemically unwell, febrile

Slipped upper femoral epiphysis (SUFE)

  • Confirmed SUFE if systemically unwell, febrile or on suspicion of SUFE

NB No matter the chronicity all should be referred to ED or local orthopaedic registrar on call

Scoliosis / Kyphosis

  • Systemically unwell
  • Abnormal neurological reason

Back pain

  • Systemically unwell

Tumour – bone and soft tissue

  • Suspected malignancy



The following are not routinely provided in a public Orthopaedics service.

Adult Service

  • Aesthetic or cosmetic surgery
  • Disability assessment (refer to HealthPathways)
  • Referrals for assessment prior to application for the Australian Defence Force or Queensland Police Service

Paediatric Service

  • Nil noted