Orthopaedic and Trauma Surgery

• Orthopaedic & Trauma Surgery deals with the management of patients with musculoskeletal conditions which might benefit from surgical management or other specialist procedures (e.g. difficult joint injections).
• We deal with many different musculoskeletal disorders including fractures, joint disorders, tendon disorders, ligament injuries, cartilage injuries, joint contractures, skeletal deformity, bone & joint infections, musculoskeletal tumours, musculoskeletal swellings, muscle disorders and some peripheral nerve disorders.
• Orthopaedic Surgery is part of Musculoskeletal Services within NHS Tayside which also comprises our specialist Musculoskeletal (MSK) Allied Health Professional (AHP) services, Amputation and Wheelchair Services.
• Our Outpatient Clinics run at various sites across NHS Tayside including Ninewells Hospital (Orthopaedic Outpatients, Fracture Clinic, Children’s Outpatients, TORT Centre), Perth Royal Infirmary and Stracathro Hospital. 

Click for list of Clinical Staff.

• Some acute cases e.g. fractures, dislocations, significant soft tissue injuries, bone or joint infections, possible cancer, clearly require urgent referral for specialist assessment and management and can be referred to our on-call service, fracture clinic or urgently to our subspecialty clinics as illustrated. More information below in 'How to Refer'.
  
• Many musculoskeletal conditions are self-limiting and can be managed appropriately in primary care by a GP or First Contact Physiotherapist +/- our MSK Physiotherapy Service. 
• Where a non-acute condition requires specialist Orthopaedic referral for advice, assistance with management or possible surgical intervention, referrals to our specialist clinics and services can be made with the help of the following referral guides. These include management and referral advice for many of the common musculoskeletal conditions and presentations by subspecialty (Please note if no live link content still pending - links will be made live as new content added). 

• Children's Orthopaedics
• Shoulder & Elbow Surgery
• Hand Surgery (shared with plastic surgery)
• Hip Surgery
• Knee Surgery
• Foot & Ankle Service 
• Lumbar Spine Surgery (shared with Neurosurgery)
• Musculoskeletal Tumours (not spine)
• Musculoskeletal Infections
• Cervical spine problems are managed by our Neurosurgery department.

• Occasionally, referrals have insufficient information to vet accurately or appropriately. Some referrals may be more appropriately seen by rheumatology, neurosurgery, plastic surgery, or specialist allied health professional services. Appropriate clinical work-up (history examination, relevant preliminary investigation) facilitates more efficient referral management. Where there is insufficient information to guide referral management, we may ask for further information or investigation to assess the need for referral. 
• Where a referred patient may be more appropriately seen by another speciality, the referral may be redirected appropriately. 
• We are happy to accept referrals where the diagnosis of an MSK problem is unclear. Such patients should have appropriate work-up and should have been seen by a physiotherapist unless there is a suspicion of cancer or infection where direct orthopaedic referral is required. 
• Referred patients may be appointed to attend one of our elective orthopaedic surgical clinics or to one of our specialist physiotherapy, podiatry or orthotics clinics where this is considered appropriate.
• When it is clear that surgery is either not appropriate or that there is no surgical solution for a problem, referrals may be returned to the referring clinician with an explanation of the decision making and advice to the referrer where appropriate. 

Emergency Referrals to Trauma and Orthopaedics

• Primary care referrals to the Orthopaedic Emergency on-call service for urgent assessment or advice for acute cases such as possible fracture, dislocation, significant soft tissue injury or musculoskeletal infection can be made via the Ninewells Hospital switchboard on 01382 660111 and are taken by the on-call consultant (pager 3169) during daytime hours and by the on-call registrar (pager 4561) out-of-hours.
• For hand injuries or suspected hand infection, referral for advice or assessment should be made to the on-call Hand Surgery Registrar via the Ninewells switchboard.
• Referrals to the Emergency On-Call Service from Accident & Emergency and inpatient referrals from other specialties within NHS Tayside are made by contacting the on-call orthopaedic registrar on Pager 4561.

Urgent Referrals to the Fracture Clinic

• Accident & Emergency can book patients with fractures, reduced dislocations or significant soft tissue injuries (e.g. suspected knee ligament injuries, locked knees, Achilles tendon ruptures) which do not require emergency surgery onto the Virtual Fracture clinic for review. Those with acute knee injuries can be booked onto on of our specialist knee clinics or a fracture clinic.
• Where a fracture or significant soft tissue injury (e.g. knee ligament injury, locked knee) requiring a specialist opinion is diagnosed in primary care (or has returned from holiday with a fracture or injury), referrals to the fracture clinic can be made by either by emailing our outpatient department via Tay.orthopaedicoutpatientdept@nhs.scot or by making an urgent referral to “Trauma & Orthopaedics” through Sky Gateway. The case will either be reviewed in the Virtual Fracture Clinic and the patient contacted with a management plan or a face-to-face fracture clinic appointment will be made.

Referrals to Elective Orthopaedic Subspecialty Outpatient Clinics
For non-emergency/elective cases, referrals to our subspecialty clinics can be made for advice, assessment or consideration of surgery. Ideally, referrals should be made through SCI-Gateway although we do accept paper referrals sent to our department for clinicians without access to SCI-Gateway.

Referrals to Elective Hand service. For non-emergency/elective cases, referrals to the joint plastic surgery/orthopaedic hand service clinics can be made for advice, assessment or consideration of surgery. Ideally, referrals should be made through SCI-Gateway although we do accept paper referrals sent to our department for clinicians without access to SCI-Gateway.

Named Referrals to specific consultant or other clinician may be appropriate if the patient has previously been seen by that clinician for the same problem, however an appointment with that consultant cannot be guaranteed. For referrals regarding a new problem, a named referral request cannot be guaranteed.

Suspected Cancer. For assessment / opinion on tumours or possible cancer, we do not have a specialist tumour clinic. Referrals should be made to the appropriate subspecialty clinic according to the location of the tumour or age of the patient (paediatric patients). Where there is a possibility or suspicion of malignancy, the 'urgent - suspected cancer' priority option should be selected on Sky Gateway or the written referral marked appropriately (see referral guidance on Referrals of Musculoskeletal Tumours.

NHS Inform MSK Self-help index