When should I consider referring a patient with a suspected fracture for orthopedic evaluation?

Consider referring a patient with a suspected fracture for orthopedic evaluation in the following situations:

• If there is uncertainty about fracture stability, such as with unimalleolar ankle fractures, arrange orthopedic follow-up within 2 weeks ¹.
• If the fracture is complicated by open wounds, skin tenting, vascular injury, fracture dislocation, or a split of the bone (e.g., proximal humerus fractures), consider surgical referral ¹.
• If there is evidence or suspicion of neurovascular damage following trauma, including loss of sensation, weakness, absent or asymmetric pulses, or compartment syndrome, urgent referral is indicated ⁴.
• If a fracture cannot be excluded clinically, especially in the context of knee injuries or suspected significant soft tissue injury, refer for immediate specialist assessment ⁴.
• If there is a displaced fracture that may require manipulation or surgical fixation (e.g., dorsally displaced distal radius fractures), consider orthopedic referral within recommended timeframes (e.g., within 72 hours for intra-articular distal radius fractures) ¹.
• If there is suspicion of non-accidental injury in children with fractures, especially femoral fractures in non-ambulatory children, referral and safeguarding assessment are essential before discharge ¹.
• If the patient has a suspected fracture with associated complications such as tendon rupture, haemarthrosis, septic arthritis, or large intramuscular haematoma, refer to emergency or orthopedic services ².
• If the fracture is associated with significant soft tissue injury, gross instability, or inability to weight bear, referral is warranted ⁴.

In general, use clinical judgement and local pathways to determine the urgency and destination of referral, ensuring patients with suspected complex or unstable fractures receive timely orthopedic evaluation ¹,⁴.