Orthopaedic Referral Criteria

Patient should be less than 18 years of age. The following referral specific conditions apply:

• Skeletally mature females > 14 years old and males > 16 years old should be referred to an adult fracture clinic.
• Referrals for Genu Varum (bowlegs)- we do not see patients under 2 years old due to high incidence of self-resolution. Please ensure your patient is receiving appropriate doses of Vitamin D (400IU/day, more if deficient). If the condition has not resolved by 2-3 years of age, please place a referral.
• Genu varum - Blounts greater than 3 years old
• Leg Length Discrepancy (LLD): a) greater than 4cm, any age; b) greater than 2cm, over age 10 or under age 2
• Lesser toe abnormalities: Over age 5; Will only see under age 5 years if there are severe dysfunction concerns.
• Toe-Walking, Idiopathic > 8 years old

 

• Clinical photographs of toe-walkers in standing; clinical photographs of the feet with views from the front, back, insides and outsides and of the soles of the feet are required. Photographs greatly help with timely triage. Referrals without photos attached will be declined.
• Symptomatic flatfoot: Please note what work-up, medications, insoles or physiotherapy has been completed to date to manage symptoms. If none has been initiated, we advise to start with conservative treatment and refer only if remains symptomatic after 6 months of conservative treatment

• Undisplaced fractures of the humerus: Arrange for follow-up with primary care. For proximal or shaft fractures -use a sling for comfort. Distal fractures- use a back slab for comfort and protection for 3 weeks. 
• Undisplaced radius/ulna fractures: if proximal, please use a back slab for comfort and protection for 3 weeks and arrange follow-up in primary care. If Distal- please use a removable splint for comfort, follow-up in primary care is optional. 
• Hand fractures:  please refer to a plastic surgeon. 
• Clavicle fracture:  please immobilize for comfort and arrange follow up in primary care. 
• Back pain: please follow in primary care unless there is an anatomical diagnosis. 
• Sports Medicine/ Adolescent Patellar Instability: We are not currently accepting Sports Medicine type referrals. 
• Foot and Ankle - the following conditions are not accepted:

1. Asymptomatic complaints/cosmetic concerns
2. Syndactyly (attached toes)
3. Clinodactyly (curly toes)
4. Kohler’s
5. Frieberg’s Infarction
6. Asymptomatic pes planus (asymptomatic flatfeet)
7. Acute pain foot and ankle injuries
8. Acute and subacute ankle sprains
9. Isolated nail pathology – please see a community Podiatrist or Chiropodist
10. Metatarsus adductus under 6 months old.
11. Idiopathic Toe walkers under 8 years old – these typically improve at or before 8 years old
12. Lesser toe abnormalities under age 5 years old.  (We will only see under age 5 years if there are severe dysfunction concerns.)

Please provide any applicable imaging or investigation with images and their reports from your current work-up (i.e. x-rays, CT, MRI, labs, etc.) with address/location, name of clinic and date of imaging.

Foot and Ankle conditions: Clinical photographs of toe-walkers in standing; clinical photographs of the feet with views from the front, back, insides and outsides and of the soles of the feet are required. Referrals without photos will be declined.

Accessory navicular: include radiographs – AP Lat Oblique Reverse internal views

Toe-Walking: include neurological exam findings – if there is an underlying not-yet-diagnosed neurological condition, please refer to neurology first. Clinical photographs in standing.

Notes: 

• Hand fractures should be referred to plastic surgery
• Hand polydactyly or syndactyly to be referred to plastic surgery with photographs (front and back of hands)
• Toe walkers: if there is an underlying not-yet-diagnosed neurological condition, please refer to neurology first.