Paediatric Orthopaedics

Who we are

Children’s musculoskeletal conditions are assessed and managed by specialist children’s Physiotherapists and nurses, Paediatricians (community and secondary care), Children’s Occupational Therapists, Orthotists and Children’s Orthopaedics.
In Tayside, our Children’s Orthopaedic Service is led by Mr Donald Campbell.
Occasionally onward referral to National Clinical Networks including the Scottish National Spine Service, Surgical Conditions Affecting Newborns in Scotland (SCANS), the Scottish National Brachial Plexus Injury Service, Selective Dorsal Rhizotomy (SDR) in Scotland, and the Scottish Sarcoma Network (SSN) are required.

Who to Refer

Emergency Referrals:

Indications for emergency referral of a child to Orthopaedics include Trauma (fractures, dislocations, ligament injuries), musculoskeletal Infections and possible Slipped Upper Femoral Epiphysis.
Trauma cases will typically be managed through A&E or through our minor injuries units. Infection or suspected infection cases (septic arthritis, osteomyelitis, surgical site infection) may present through Primary Care, A&E or through Paediatrics. Further specific advice is outlined in the link sections below.
Confirmed or suspected acute Slipped Upper Femoral Epiphysis should be referred as an emergency to our on call service if picked up on a GP requested radiograph. Unstable acute slips require urgent surgery.

Suspected Cancer Referrals

Red flags include severe pain, constant pain, night pain, systemic upset, lethargy, unexplained swelling and systemic upset.
For suspected musculoskeletal cancer cases, urgent referral to our Children’s Orthopaedic Service should be made via SCI Gateway choosing the referral priority “Urgent – Suspected Cancer”.

Urgent Outpatient Referrals
Reasons for Urgent referral include severe unexplained musculoskeletal pain, musculoskeletal pain with any red flags, suspected cancer (see above), a symptomatic musculoskeletal tumour, subacute osteomyelitis (Brodie’s abscess), rapid progressive deformity, late presenting DDH, Perthe's Disease or any other reason considered urgent by the GP or referring clinician.

Routine Outpatient Referrals

Referrals can be made through SCI Gateway for non-urgent advice where required. We are happy to advise on appropriate Primary Care management and investigations.
Where referral is made for a clinic consultation, advice may be given on tests or investigations within Primary care where appropriate or the referral may be redirected to another specialty (e.g. paediatrics, physiotherapy, orthotics) where more appropriate.
Where a routine referral is made to the Children’s Orthopaedic Service, appropriate x-rays should be arranged to assist with vetting of the referral. Scoliosis cases should be only arranged by orthopaedic clinics due to the radiation dose, however clinical photographs in the referral can be extremely helpful to assess shoulder asymmetry, rib hump etc. Where there is an obvious musculoskeletal deformity, Clinical photography should be added to the referral to aid appropriate vetting.

How to Refer

Emergencies/Urgent Advice - Call on-call orthopaedic service Ninewells
Urgent Suspected Cancer/Urgent outpatient/Routine outpatient/Routine advice - SCI Gateway/

Useful Resources

NICE CKS Acute Childhood Limp
NICE CKS Developmental Rheumatology in Children (flat feet, tip-toeing, curly toes, knock knees, bow-legs etc etc)
Paediatric Musculoskeletal Matters CPD resources for GPs