{"id":4268,"date":"2022-05-03T11:47:20","date_gmt":"2022-05-03T10:47:20","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricorthopaedics\/"},"modified":"2024-12-30T14:23:49","modified_gmt":"2024-12-30T14:23:49","slug":"paediatricorthopaedics","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/paediatricorthopaedics\/","title":{"rendered":"Orthopaedics"},"content":{"rendered":"\n<title>Paediatric Orthopaedics<\/title>\n\n\n\n<h4 class=\"wp-block-heading\">Service<\/h4>\n\n\n\n<p>The Edinburgh Children&#8217;s Orthopaedics (ECO) Team looks after children and young people with MSK conditions both locally in Lothian and as a tertiary referral centre from the rest of Scotland. We are a team of orthopaedic surgeons, specialty doctors, specialist physiotherapists and orthopaedic practitioners. We are primarily based at RHCYP and have clinics at St Johns Hospital, Fife and The Astley Ainsley Hospital.&nbsp; <\/p>\n\n\n\n<p>We accept referrals for patients aged 0-15 (up until their 16<sup>th<\/sup> birthday) but for certain conditions, we may continue to see young people after their 16<sup>th<\/sup> birthday, and we are able to see patients up until their 18<sup>th<\/sup> birthday, at the patient&#8217;s request.\u00a0<\/p>\n\n\n\n<p><strong>M.A. &amp; M-J.S. 01-04-24<\/strong><br><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Emergency<\/h4>\n\n\n\n<p>We offer a 24 hour a day emergency service for<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>fractures and acute MSK injury, including suspected non-accidental injury<\/li>\n\n\n\n<li>suspected bone and joint infection<\/li>\n<\/ul>\n\n\n\n<p>Please send the patient direct to RHCYP ED. Prior contact with the orthopaedic registrar is not required. ED will initially manage the acutely limping child.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Urgent<\/h4>\n\n\n\n<p>Please refer the following patients for urgent review in clinic<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Suspected bone or soft tissue cancer<\/li>\n\n\n\n<li>Fracture diagnosed or managed outwith NHS Lothian<\/li>\n\n\n\n<li>Complications of recent orthopaedic surgery<\/li>\n\n\n\n<li>Suspected developmental dysplasia of the hip (DDH)<\/li>\n\n\n\n<li>Newly diagnosed clubfoot (congenital talipes equinovarus)<\/li>\n<\/ul>\n\n\n\n<p>The following conditions are potentially urgent, but can be diagnosed\/ excluded radiologically<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Perthes\n<ul class=\"wp-block-list\">\n<li>X-ray: frog leg lateral both hips<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Slipped capital femoral epiphysis (SCFE)\n<ul class=\"wp-block-list\">\n<li>X-ray: frog leg lateral both hips<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>DDH\n<ul class=\"wp-block-list\">\n<li>Under 9 months old request USS both hips or refer urgently and we will arrange imaging<\/li>\n\n\n\n<li>Over 9 months old request X-ray: AP pelvis both hips<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>Soft tissue swelling\n<ul class=\"wp-block-list\">\n<li>USS<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p>Normal imaging can often avoid the need for orthopaedic clinic referral. Direct access to Radiology for requesting imaging at RHCYP can be found on SCI Gateway (RHCYP &gt; Clinical Radiology &gt; Radiology). Radiology requests can be discussed with the Duty Radiologist: 0131 536 0805.<\/p>\n\n\n\n<p>If in doubt about the urgency of a referral, please contact the orthopaedic registrar via RHCYP switchboard: 0131 536 1000<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Routine<\/h4>\n\n\n\n<p>Chronic MSK conditions which do not require to be seen within 4 weeks can be referred routinely by letter \/ SCI Gateway to orthopaedics. Please refer Edinburgh and West Lothian patients, and we will determine if they are to be seen at RHCYP or SJH. We will frequently triage patients to be seen by physiotherapists, and patients can also be referred directly to physiotherapy. We may offer advice rather than an appointment, and please state if you would prefer this on the referral.<\/p>\n\n\n\n<p>Several conditions \/ normal variants do not need to be seen by orthopaedics, and more information can be found in Primary Care Management<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>In-toeing<\/li>\n\n\n\n<li>Bilateral tip toe walking<\/li>\n\n\n\n<li>Flat feet<\/li>\n\n\n\n<li>Lesser toe conditions<\/li>\n\n\n\n<li>Bowed legs (genu varum)<\/li>\n\n\n\n<li>Knock knees (genu valgum)<\/li>\n<\/ul>\n\n\n\n<p>Please&nbsp;<strong>do not<\/strong>&nbsp;refer the following<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Plagiocephaly \u2013 seen by Physiotherapy \/ Paediatric Neurosurgery<\/li>\n\n\n\n<li>Ingrown toenails \u2013 seen by Paediatric General Surgery<\/li>\n\n\n\n<li>Suspected inflammatory joint disease \u2013 please refer to Paediatric Rheumatology<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>\u200bLower limb<\/p>\n\n\n\n<p>If the patient presents with knee pain,&nbsp;<strong>always examine the hip<\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Limp<\/li>\n\n\n\n<li>Perthes<\/li>\n\n\n\n<li>Slipped capital femoral epiphysis (SCFE)<\/li>\n\n\n\n<li>Transient synovitis<\/li>\n\n\n\n<li>DDH<\/li>\n\n\n\n<li>Bowed legs (genu varum)<\/li>\n\n\n\n<li>Knock knees (genu valgum)<\/li>\n\n\n\n<li>Knee pain (following trauma)<\/li>\n\n\n\n<li>Anterior knee pain<\/li>\n\n\n\n<li>Osgood-Schlatter, Sinding-Larsen-Johansson<\/li>\n\n\n\n<li>Patella instability (subluxation\/ dislocation)<\/li>\n\n\n\n<li>In-toeing<\/li>\n\n\n\n<li>Out-toeing<\/li>\n\n\n\n<li>Flat feet (pes planus)<\/li>\n\n\n\n<li>Heel pain (Severs disease)<\/li>\n\n\n\n<li>Positional talipes<\/li>\n\n\n\n<li>Metatarsus adductus<\/li>\n\n\n\n<li>Curly or over\/under lapping toes<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Upper limb<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Trigger finger \/ thumb<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">Head, neck, chest, spine<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Plagiocephaly \/ brachycephaly<\/li>\n\n\n\n<li>Pectus excavatum \/ carinatum<\/li>\n\n\n\n<li>Scoliosis<\/li>\n\n\n\n<li>Back pain<\/li>\n<\/ul>\n\n\n\n<h4 class=\"wp-block-heading\">General<\/h4>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Growing pain<\/li>\n\n\n\n<li>Clicky joints<\/li>\n\n\n\n<li>Hypermobility<\/li>\n<\/ul>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p>Our website:<strong>&nbsp;<\/strong><a href=\"https:\/\/children.nhslothian.scot\/departments-services\/?_sft_category=orthopaedics\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/children.nhslothian.scot\/departments-services\/?_sft_category=orthopaedics&nbsp;<\/a><\/p>\n\n\n\n<p>Information on DDH including healthy swaddling and baby carriers:&nbsp;<a href=\"https:\/\/hipdysplasia.org\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/hipdysplasia.org\/<\/a><\/p>\n\n\n\n<p>Information on conditions including DDH, clubfoot, Perthes and SCFE:&nbsp;<a href=\"https:\/\/www.stepsworldwide.org\/conditions\/\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/www.stepsworldwide.org\/conditions\/<\/a><\/p>\n\n\n\n<p>Short guides to all conditions:&nbsp;<a href=\"https:\/\/posna.org\/Physician-Education\/Study-Guide\" target=\"_blank\" rel=\"noreferrer noopener\">https:\/\/posna.org\/Physician-Education\/Study-Guide<\/a><\/p>\n\n\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>Paediatric Orthopaedics Service The Edinburgh Children&rsquo;s Orthopaedics (ECO) Team looks after children and young people with MSK conditions both locally in Lothian and as a tertiary referral centre from the rest of Scotland. We are a team of orthopaedic surgeons, specialty doctors, specialist physiotherapists and orthopaedic practitioners. We are primarily based at RHCYP and have<\/p>\n","protected":false},"author":2,"featured_media":0,"parent":3664,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[526],"class_list":["post-4268","page","type-page","status-publish","hentry","category-paediatricorthopaedics"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"NHS Lothian","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/nhs-lothian\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/paediatric\/paediatricorthopaedics\/\" rel=\"tag\">Paediatric Orthopaedics<\/a>","rttpg_excerpt":"Paediatric Orthopaedics Service The Edinburgh Children&rsquo;s Orthopaedics (ECO) Team looks after children and young people with MSK conditions both locally in Lothian and as a tertiary referral centre from the rest of Scotland. We are a team of orthopaedic surgeons, specialty doctors, specialist physiotherapists and orthopaedic practitioners. We are primarily based at RHCYP and have","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4268","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=4268"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4268\/revisions"}],"predecessor-version":[{"id":22299,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/4268\/revisions\/22299"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/3664"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=4268"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=4268"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}