A prospective review was undertaken examining referrals from A& E to fracture clinic with the objective to examine diagnosis and timing of fracture clinic appointment made by A& E with that suggested by an Orthopaedic Specialist Registrar (SpR).

Over a 4 week period, xrays of all fracture clinic referrals from A& E were assessed daily by an Orthopaedic SpR. Time to presentation, site of injury, A& E diagnosis, and A& E time to clinic review, were noted alongside the diagnosis and suggested time to review clinic by the Orthopaedic SpR.

A total of 233 patients were referred. Less than 5% were excluded as non-bony injury and were given an A& E review instead. Overall the majority (85%) of cases had no significant difference in time to clinic review requested by that of the A& E staff and of that requested by the orthopaedic staff. In 4.3% of cases, time to review was increased by more than 4 days whereas 11.3% of cases were seen 5 or more days earlier than that initially requested. There was a variance in diagnosis between A& E and Orthopaedic staff in 24 (10.4%) of cases. The actual time to clinic was within 5 days of that requested by the orthopaedic SpR in 84.7% of patients.

A& E appropriately refer cases to fracture clinic, and in a timely fashion. Review of all A& E referrals by Orthopaedic staff would seem not to be a cost efficient use of time.