Orthopaedic on-call (Guidelines)

The orthopaedic registrar on-call rota is changing to a non-resident on-call service to better meet service and training needs.

• Routine advice: usual manner from 07:00 to 00:00.
• 2200 onwards: Contact through switchboard.
• Contact Orthopaedic middle grade on-call between 00:00 and 07:00 for life and limb threatening problems ONLY.

Code-Red Trauma call/ Trauma call

• Acute compartment syndrome
• Neurovascular compromise from fracture/ dislocation*
• Cauda Equina Syndrome
• Open fractures**
• Dislocated native joints that are irreducible in ED
• Paediatric fractures that require manipulation / admission
• Septic joints (after blood tests and X-ray)

*Simple fractures:

• Should follow normal VFC (Virtual Fracture Clinic) protocols.

If it is felt orthopaedic intervention will be required (manipulation in plaster room or fixation/wound treatment in theatre):

• Photocopy the ED notes and leave at ED front desk for collection at 0700 by the orthopaedic registrar.
• The patient will be contacted that morning with a plan.

**Fingers and hands open fracture/ wounds:

• Should have X-ray and can be managed with betadine/saline bath
• Co-amoxiclav (cefuroxime, if penicillin allergy)
• Tetanus booster and application of sterile dressing in ED. 
• If no clinical concern of sepsis, follow pathway above i.e. leave notes at front desk for collection by Orthopaedic Registrar.

Direct admission (NOT Code-Red)

The following patients can be admitted directly to the ward overnight to be clerked by Orthopaedic FY1 before 22:00 or ANP after 22:00:

• Neck of femur fracture in elderly who are haemodynamically stable, following Big 6 assessments
• Femur fracture (post Thomas splint and haemodynamically stable)
• Tibia fracture (post above knee backslab and neurovascular intact)
• Tibia plateau fracture (post cricket splint / above knee backslab and neurovascular intact)
• Patients with dislocated hip prosthesis who are haemodynamically stable and neurovascular intact
• Undisplaced/ minimally displaced pelvis/ acetabulum fracture in elderly following fall from standing height and are haemodynamically stable. Isolated pubic rami fractures and proximal humerus fracture are not for orthopaedic admission.
• Closed ankle fracture dislocation that have been adequately reduced and placed in cast/ backslab but not safe for discharge
• SCIWORA: Spinal precautions until MRI scan the following day. Any doubts, contact Registrar/Consultant on-call

Arrange admission:

• Contact the Orthopaedic Co-ordinator (Ext 3001)
  The Orthopaedic Co-ordinator will inform the ANP (bleep 5200) and flow team (Ext 2004).
• Do NOT contact Hospital at Night team / FY1 directly.
• Peripheral hospitals:
  
  • Admit the patients to the ward locally overnight, if can safely do so and inform ambulance services of early morning transfer.
  • Contact Orthopaedic on-call after 07:00 to organise transfer.
  • Any concerns: contact Orthopaedic on-call through switch board.