Upper limb and hand trauma in children

Specialty: Children's Orthopaedic
Age group: Children

Criteria for referral to public hospital service

• Delayed or chronic complications of fractures of the humerus with or that require
  • malunion
  • malalignment
  • stiffness or limited motion
  • Volkmann's ischaemic contracture
  • assessment of orthopaedic fixation and decision regarding removal
  • follow-up assessment for growth disturbance (more than 6 months after the fracture)
• Medial epicondyle fractures of the humerus with increasing separation and elbow instability
• Monteggia fracture-dislocation with
  • any concern with concentric reduction of the radiocapitellar joint
  • loss of position of the ulna fracture
  • persistent neurologic injury
• Radial neck fracture with
  • malunion with concern that remodelling will not correct the deformity
  • development of avascular necrosis (AVN)
  • persistent symptoms or poor recovery of range of motion (more than three months after the fracture)
• Radial shaft fracture with unacceptable alignment or loss of position over one week with concerns for further loss of position
• Distal radial physeal fracture with
  • loss of reduction with greater than 20 degrees angulation on lateral x-ray
  • malunion with concern that remodelling will not correct the deformity
  • follow-up for physeal arrest concerns.

Information to be included in the referral

Information that must be provided

• Reason for referral and expectation or outcome, anticipated by the child, or their carer, and the referring clinician from referral to the health service
• If referral relates to injury, detail: date, mechanism, severity, recurrence and evolution of injury
• Pain history: onset, location, nature of pain and duration
• Findings on physical examination including loss of range of movement and neurological examination
• Child’s age
• x-ray of the affected bone(s) anteroposterior (AP) view, oblique view and lateral view (including details of the diagnostic imaging practice).

Provide if available

• Statement about the parent(s) or guardian’s interest in having surgical treatment if that is a possible intervention
• If the child is neurodiverse, gender diverse or has a disability
• If the child identifies as an Aboriginal and/or Torres Strait Islander
• If the child has a preferred language other than English and if they rely on cultural or linguistic support (e.g. Aboriginal cultural support, an interpreter)
• If the child lives in out-of-home care (foster care, kinship care, permanent care or residential care)
• If younger than 18 years if they may have been harmed, or at risk of harm
• If the child is aged 14 to 18 years, do they consent that their health information is shared with their parent, guardian or carer.

Additional comments

The Minimum information for referrals to non-admitted specialist services lists the information that should be included in a referral request.

Where appropriate and available the referral may be directed to an alternative specialist clinic or service.

Referral to a public hospital is not appropriate for

Not applicable.