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Pediatric Orthopedic Clinic   at
Alberta Children's Hospital
Specialty: Pediatric Orthopaedic Surgery
Connect Care Department: CGY ACH PED ORTHOPAEDICS
Estimated time to routine appointment: Within 12 months
Alberta Health Services - Calgary Zone
SERVICE DESCRIPTION
The pediatric orthopedic clinic provides assessment and treatment for children with acute, chronic, traumatic, complex and congenital issues of the musculoskeletal system.In partnership with a multidisciplinary team the service provides inpatient and outpatient consultation and surgical services to children with bone, joint, ligament and nerve disorders that require a surgical intervention or specialized orthopedic evaluation. The clinic focuses on:
  • consultation for orthopedic surgery
  • pre and post orthopedic surgery, planning, rehabilitation and support
  • education about managing orthopedic conditions
  • consultation and management of traumatic orthopedic injuries
  • orthopedic conditions where patients have not responded to conservative management through primary care services
Important Patient Information (Handout)
The pediatric orthopedic clinic provides assessment and treatment for children with acute, chronic, traumatic, complex and congenital issues of the musculoskeletal system.In partnership with a multidisciplinary team the service provides inpatient and outpatient consultation and surgical services to children with bone, joint, ligament and nerve disorders that require a surgical intervention or specialized orthopedic evaluation. The clinic focuses on:
  • consultation for orthopedic surgery
  • pre and post orthopedic surgery, planning, rehabilitation and support
  • education about managing orthopedic conditions
  • consultation and management of traumatic orthopedic injuries
  • orthopedic conditions where patients have not responded to conservative management through primary care services
Important Patient Information (Handout)
ELIGIBILITY REQUIREMENTS
Children 0 to 17 years old.
Children 0 to 17 years old.
Referral instructions for primary care, community care, private
providers etc. who do not send referrals via Connect Care. 
REFERRAL PROCESS - FOR NON-CONNECT CARE USERS
Complete the referral form and fax it to the service using the contact information in this profile
Complete the referral form and fax it to the service using the contact information in this profile
REFERRAL PROCESS - FOR CONNECT CARE USERS
Send an Internal Referral using the Ambulatory Referral Order to CGY ACH PED ORTHOPAEDICS, type CGY ACH PED ORTHOPAEDICS in the “To Department” section and complete order.
Send an Internal Referral using the Ambulatory Referral Order to CGY ACH PED ORTHOPAEDICS, type CGY ACH PED ORTHOPAEDICS in the “To Department” section and complete order.
ADDITIONAL SERVICE DETAILS
The orthopedic clinic provides specialist evaluations of patients by orthopedic surgeons.
In order to provide timely and appropriate care it is important to follow the referral guidelines as some conditions should be seen initially by other providers. For some conditions failed conservative management is an essential criteria for an appropriate orthopedic referral.
Conservative management or use of alternate community providers must initially be considered for the following:
  • Growing pains
  • Non recurrent sprains and strains
  • Gait abnormalities in patients under age 2.5 years
  • Non-surgical bunions  (patient or parent would not want surgical correction)        
  • Toe walkers                   
  • Buckle fractures                 
  • Flexible flat feet see:Flexible Flatfoot in Children - OrthoInfo - AAOS
  • Normal variant gait variants            
  • Mechanical back pain    
  • Patello-femoral knee pain                 
  • In toeing and out toeing
  • Occult supra condylar elbow
  • Occult scaphoid fracture
  • Bakers cyst
  • Pain NYD
Community resources (include but not limited to):
Alberta Physiotherapy association Physiotherapy Alberta College + Association : The Movement Specialists: Physiotherapist Directory
Calgary Youth physiotherapy Calgary Youth Physiotherapy - Keeping Kids In the Game 
Peak health physiotherapy Kids Physiotherapy | Peak Health & Performance (peakhealthcalgary.com)
The acute knee clinic Acute Knee Injury Clinic | Sport Medicine Centre | University of Calgary (ucalgary.ca),
The knee clinic Knee Injury & Pain Treatment | OPEN During Pandemic | The Knee Clinic,
Kinesis Physiatry clinic Kinesis Medical Centre Inc.
Innovative sport medicine Innovative Sport Medicine | Calgary | Injury Treatment And Rehabilitation
Group 23 Group23 Sports Medicine
U of C Sport Medicine Center Sport Medicine Centre | University of Calgary (ucalgary.ca)
The orthopedic clinic provides specialist evaluations of patients by orthopedic surgeons.
In order to provide timely and appropriate care it is important to follow the referral guidelines as some conditions should be seen initially by other providers. For some conditions failed conservative management is an essential criteria for an appropriate orthopedic referral.
Conservative management or use of alternate community providers must initially be considered for the following:
  • Growing pains
  • Non recurrent sprains and strains
  • Gait abnormalities in patients under age 2.5 years
  • Non-surgical bunions  (patient or parent would not want surgical correction)        
  • Toe walkers                   
  • Buckle fractures                 
  • Flexible flat feet see:Flexible Flatfoot in Children - OrthoInfo - AAOS
  • Normal variant gait variants            
  • Mechanical back pain    
  • Patello-femoral knee pain                 
  • In toeing and out toeing
  • Occult supra condylar elbow
  • Occult scaphoid fracture
  • Bakers cyst
  • Pain NYD
Community resources (include but not limited to):
Alberta Physiotherapy association Physiotherapy Alberta College + Association : The Movement Specialists: Physiotherapist Directory
Calgary Youth physiotherapy Calgary Youth Physiotherapy - Keeping Kids In the Game 
Peak health physiotherapy Kids Physiotherapy | Peak Health & Performance (peakhealthcalgary.com)
The acute knee clinic Acute Knee Injury Clinic | Sport Medicine Centre | University of Calgary (ucalgary.ca),
The knee clinic Knee Injury & Pain Treatment | OPEN During Pandemic | The Knee Clinic,
Kinesis Physiatry clinic Kinesis Medical Centre Inc.
Innovative sport medicine Innovative Sport Medicine | Calgary | Injury Treatment And Rehabilitation
Group 23 Group23 Sports Medicine
U of C Sport Medicine Center Sport Medicine Centre | University of Calgary (ucalgary.ca)
COMMUNICATION PROCESS
  • Referral receipt to referring source within 7 days.
  • Acceptance via appointment details or wait list status letter to referring source and patient within 14 days.
  • Appointment outcome to referral source within 30 days.
 
CLICK + TO VIEW REFERRAL GUIDELINES
Routine Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
Acute injury of anterior cruciate ligament
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine specialist
 
Within 1 month

Imaging: AP/lateral x-ray of knee
 
Within 1 month

MRI of knee
 
Within 1 month
Initial management: Access an emergency or urgent care provider. This should be followed by a comprehesive evaluation from a sports medicine specialist.
Referral to orthopedic clinic should be made by the sports medicine provider.

For more information:An terior Cruciate Ligament (ACL) Injuries - OrthoInfo - AAOS

Adolescent idiopathic scoliosis
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Full Neuro exam
 
Within 1 month

X_Ray - 3ft standing. MUST show Cob angle and Risser score
 
Within 1 month
OVER AGE 10
Cob angle > 20 degrees and Risser score 1-3 (or TOCI score  ). Refer to clinic. Must include XR and completed spine assessment form (available by calling 403 955 7724).

Please also review the algorithm in the following article for guidance and ongoing care if criteria for referral not met.
(PDF) A Quality Improvement Program to Reduce Unnecessary Referrals for Adolescent Scoliosis (researchgate.net)

Bilateral congenital knee dislocation
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Imaging: Ambulatory standing AP/lateral knees.Infant: Ultrasound
 
Within 1 month
For more informatio see: https://posna.org/Physician-Education/Study-Guide/Congenital-Knee-Dislocation

RED FLAGS:
Severe pain and swelling around the knee
Inability to bend the knee

Blount's disease
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

X-ray: Standing AP of lower extremities from hip to ankle with patella pointing forward
 
Within 1 month
Age of patient will determine level of urgency at triage. The child’s age and degree of deformity are some of the determining factors for choosing the treatment. Early treatment is recommentded. Surgery is usually recommended after the age of 4
See: Blount's Disease | Johns Hopkins Medicine

Bone cyst
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Recent x-ray of the bone/joint
 
Within 1 month
Painful rather than incidental finding on x-ray.
Semi-urgent depending on size. Location may also determine level of urgency.

RED FLAG: Proximal femoral head or mid-sharft humerus location may indicate high risk for fracture

Bunion
< 8 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented failed conservative management
 
Within 1 month

x-ray: Ap/ lateral/oblique foot in weight bearing.
 
Within 1 month
Surgical intervention is age and symptom dependent. Ideally patients should have completed growth before surgical correction is considered. Main indications for surgery are pain, reduced physical activity, impact on daily functional mobility.

see: https://academic.oup.com/pch/advance-article/doi/10.1093/pch/pxab074/6415259?login=true

For conservative management in the community consider https://www.albertapodiatry.com/contact-us

Cavovarus deformity of foot
< 9 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Include developmental history
 
Within 1 month

Outcome of full neurological exam to Rule out neurological cause
 
Within 1 month

x-ray: AP/lateral and oblique of bilateral weight bearing feet
 
Within 1 month

Chronic ankle instability
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine provider is preferred
 
Within 1 month

Documented failed conservative management
 
Within 1 month

MRI of ankle
 
Within 1 month

x-ray: AP/lateral and mortice
 
Within 1 month
Initial management: Access an emergency or urgent care provider. This should be followed by a comprehesive evaluation from a sports medicine specialist.

Sprained Ankle - OrthoInfo - AAOS

Consensus in chronic ankle instability: Aetiology, assessment, surgical indications and place for arthroscopy - ScienceDirect

Chronic low back pain
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented failed conservative management
 
Within 1 month

MRI of lumber spine
 
Within 1 month

x-ray: AP/lateral and oblique of lumbar spine
 
Within 1 month

Clinodactyly of toe
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Evidence of failed conservative management
 
Within 1 month

Imaging: AP, lateral and oblique x-ray of foot in weight bearing
 
Within 1 month

Indication of functional impact and severity
 
Within 1 month
Management in the community should be considered first.

Consider a referral to a podiatrist: CONTACT US - College of Podiatric Physicians of Alberta (albertapodiatry.com)

Referral for a surgical intervention should follow an assessment by a community provider who has confirmed that surgery is an appropriate next step.

Clubfoot
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month
Refer to guidelines under Talipes Equino Varus (TEV)

Congenital anomaly of joint
< 9 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

x-ray and MRI of the involved joint(s)
 
Within 1 month

Congenital bowing of tibia and/or fibula
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

x-ray: AP/lateral of the tibia and/or fibula
 
Within 1 month
May have a genetic origin. Links to Neuofibromatosis.
Note: Can be linked to congenital psuedarthitis and risk of fracture.
RED FLAG: Increased bowing of the tibia. Late stage outcomes can be difficult to manage.

Curly toe
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Failed conservative management
 
Within 1 month

Indication of functional impact and severity
 
Within 1 month
Curley toes are usually asymptomatic and resolve spontaneously in 25% or more cases.
Surgery is not recommended until around age 6 unless the condition causes pain and changes in function. 
See: https://posna.org/Physician-Education/Study-Guide/Curly-Toe

Management in the community should be considered first.  CONTACT US - College of Podiatric Physicians of Alberta (albertapodiatry.com)

Deformity of toe
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Failed conservative management
 
Within 1 month

Indication of functional impact and severity
 
Within 1 month

x-ray: AP / lateral and Oblique in weight bearing
 
Within 1 month
Hammer toe and Mallet toe are toe deformities that occur due to an imbalance in the muscles, tendons or ligaments of the toes. Hammer toe affects the middle toe joint and mallet toe affects the distal toe joint.

Refer only for surgical management. see also: https://orthoinfo.aaos.org/en/diseases--conditions/hammer-toe/.
Claw toe: Claw Toe - OrthoInfo - AAOS

Degenerative disc disease
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented physiotherapy treatment. Outcome of facet blocks
 
Within 1 month

MRI of spine
 
Within 1 month
RED FLAGS: cauda equina signs (needs emergency care).
May be referred to a neurosurgeon.

Developmental dysplasia of the hip
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Children and youth: x-ray: Standing AP pelvis
 
Within 1 month

Infants and toddlers: x-ray: AP and frog lateral of the hips
 
Within 1 month
Also known as congenital dislocation of the hip or hip dysplasia

Infants
RED FLAG: hip click at new baby exams between 6-8 weeks

More information see: https://hipdysplasia.org

Children and Youth
Mild hip dysplasia may not be noticed until some children are older and become more active and a change in comfort or function results in testsing or imaging that shows the abnormality.
A standing AP pevis x-ray should accompany any refereral

Elbow joint instability
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine provider
 
Within 1 month

Document failed conservative management
 
Within 1 month

MRI of elbow
 
Within 1 month

x-ray: AP/lateral and oblique of the elbow
 
Within 1 month
NOTE: For acute elbow injury refer to an emergency or urgent care provider.

For more information see: https://orthoinfo.aaos.org/en/diseases--conditions/recurrent-and-chronic-elbow-instability/

Familial Scheuermann disease
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

AP and Lateral 3ft standing XR
 
Within 1 month
Scheuermann's kyphosis is caused by a structural abnormality in the spine. In patients with Scheuermann's kyphosis, a lateral x-ray will show that, rather than the normal rectangular shape, three or more consecutive vertebrae have a triangular shape.

Kyphosis of <55 deg and skeletally immature  -PCP to monitor. Refer to PT for core strengthing, ROM if sympomatic
Kyphosis of >55 deg - refer.  Bracing may be considered.

see also:
https://orthoinfo.aaos.org/en/diseases--conditions/kyphosis-roundback-of-the-spine/

Femoral acetabular impingement
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented functional impact of condition
 
Within 1 month

MRI -FAI protocol
 
Within 1 month

x-ray: AP and frog lateral of hip joint
 
Within 1 month
YOUTH AGED 9-16
This condition is not appropriate for surgical intervention until the child is more skeletally mature.

Conservative management should be attempted until symptoms or functional mobility are impactful.

Fracture of scaphoid bone
< 4 Weeks
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

X-ray of the fracture
 
Within 1 month
Only refer scaphoid fractures confirmed on X-ray
Age 14 and over refer to South Health Campus - bone and joint clinic
Age 13 and under refer to Alberta Children's Hospital  - orthopedic clinic 

Occult and unconfirmed fractures are not managed by ACH orthopedic clinic.

Genu valgus
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Developmental history
 
Within 1 month

Functional impact of the condition
 
Within 1 month

Neurological exam to rule out a neuromuscular cause
 
Within 1 month

x-ray: Standing 3ft AP of legs
 
Within 1 month
The clinic will accept referrals for pathlogical and severe physiological genu valgum.
For more information about differential diagnosis and treatment see: https://pubmed.ncbi.nlm.nih.gov/10795033/
Follow the required referral guidelines.

Some referrals may be re-directed to a community non surgical provider 

Idiopathic scoliosis
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

x-ray: 3 foot standing PA (Optional Lateral scoliosis series)
 
Within 1 month. Lateral scoliosis series may be requested depending on condition

Physical exam findings to include full neuro exam
 
Within 1 month

MRI of spine
 
May be required. Orthopedic surgeon will indicate if needed.
AGE 10 and under:
Cob angle > 20 degree and Risser score 0-2 or hand score/TOCI score 0-5 - refer to clinic.
 
Cob angles of <20 deg: If asymptomatic to neuro exam, monitor for progression. If progresses >5 degrees make a routine referral to clinic

Refer to the algorithm in this article for ongoing monitoring where clinic criteria is not met.
https://www.researchgate.net/publication/235659523_A_Quality_Improvement_Program_to_Reduce_Unnecessary_Referrals_for_Adolescent_Scoliosis

In-toeing
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month
In-toeing is frequently seen as a normal variant of devloping ambulators.
See: https://orthoinfo.aaos.org/en/diseases--conditions/flexible-flatfoot-in-children/

Surgery is usually not considered unless the child is older than 9 or 10 years and has a severe deformity that causes tripping and an unsightly gait

Mild or early develomental cases may be re-directed to a community non surgical provider for initial management

Injury of rotator cuff
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine specialist required
 
Within 1 month

Documented failed conservative management
 
Within 1 month

MRI of shoulder
 
Within 1 month

Instability of knee joint
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine provider
 
Within 1 month

MRI of knee
 
Within 1 month

x-ray: standing bilateral AP/lateral both knees to check alignment and rule out fracture
 
Within 1 month

Joint stiffness
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented failed conservative management, including outcome of splinting
 
Within 1 month

x-ray: AP/lateral of joint
 
Within 1 month

Kyphosis
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Physical exam findings to include full neurological exam to rule out neuro-muscular origin
 
Within 1 month

x-ray: 3 foot standing PA/lateral scoliosis series
 
Within 1 month

Legg-Calve-Perthes disease
< 6 Weeks
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Confirmed non-active disease
 
Within 1 month

Medical history including functional impact of condition
 
Within 1 month

x-ray: AP and frog lateral of hip
 
Within 1 month
Note: A new diagnosis of active disease should be sent as an urgent orthopedic referral.

For more information see: https://orthoinfo.aaos.org/en/diseases--conditions/perthes-disease/

Metatarsus adductus
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month
Metatarsus adductus improves by itself most of the time, usually over the first 4 to 6 months of life. Babies aged 6 to 9 months with severe deformity or feet that are very rigid may be treated with casts or special shoes with a high rate of success. Surgery to straighten the foot is seldom required. Metatarsus adductus is a different condition than clubfoot that requires treatment soon after birth.

For more information see: Metatarsus Adductus | Boston Children's Hospital (childrenshospital.org)

Muscle contracture
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Developmental history
 
Within 1 month

Document severity of contracture as determined by ROM and functional impact
 
Within 1 month

Outcome of conservative management
 
Within 1 month
NOTE: referrals for equinus contractures are not included in this referal grouping.
For tight heel cords and toe walking presentations, see below under 'additional information' and physiotherapy resources.

Depending on the condition referrals may be re-directed to an alternate service.

Nonunion of clavicle fracture
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

x-ray and clavicle CT scan
 
Within 1 month

Osgood Schlatter disease
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Failed conservative management
 
Within 1 month

Indication of pain and severity, including functional assessment
 
Within 1 month

x-ray - AP and Lateral of the knee
 
Within 1 month
Treatment for Osgood-Schlatter disease focuses on reducing pain and swelling. This can most often be achieved by assessment and treatment from a sports medicine of physiotherapy provider.

for more informationsee: https://orthoinfo.aaos.org/en/diseases--conditions/osgood-schlatter-disease-knee-pain/

Referral to an orthopedic clinic should only be considered where the condition limits daily function and where conservative management has failed.

Osteochondral fracture
< 1 Month
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Ankle: AP/lateral/mortice bilateral standing x-ray
 
Within 1 month

Elbow: AP/lateral/oblique elbow x-ray
 
Within 1 month

knee: full length, bilateral AP/lateral/oblique/notch and skyline x-ray of knee in standing. Plus MRI.
 
Within 1 month

Osteochondritis dissecans
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

X-ray of affected joint and MRI
 
Within 3 months

Osteochondroma
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented functional impact and severity as indicated by pain and restrictions to normal activity
 
Within 1 month

x-ray: AP and lateral of the affected bone
 
Within 1 month
Often discovered as an incidental finding during imaging. May develop in isolation or multiples.

RED FLAG: Pain, fracture, neurological problems, mechanical problems, deformity of a joint, pressure on a nerve or blood vessel

For more information see: Osteochondroma - OrthoInfo - AAOS

Out-toeing
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month
Out-toeing is frequently seen as a normal variant of lower extemity alignment in developing ambulators. Correction without treatment can occur up to the ages of 3-4. 
Out-toeing may be associated with long bone rotation or malaignment of the hips and/or knee joints. 

For more information see: https://www.chortho.com/common-conditions/out-toeing

Mild or early develomental cases may be re-directed to a commuhnity non surgical provider for initial management 

Overriding toes
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Description of functional disability resulting from overlapping toes
 
Within 1 month

Developmental history
 
Within 1 month

Documented failed conservative management
 
Within 1 month

Patellar instability
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine specialist
 
Within 1 month

Documented failed conservative management
 
Within 1 month

MRI
 
Within 1 month

x-ray: AP/lateral and Skyline of knee. Skyline to be ordered at the time of consult by the assessing physician
 
Within 1 month
Note: Acute dislocation of the patella should be referred to emergency or urgent care providers. Sebsequent care should be providered by a sports medicine specialist. Referra to orthopedics should come from sports medicine provider. 

For more information see: https://orthoinfo.aaos.org/en/diseases--conditions/patellar-dislocation-and-instability-in-children-unstable-kneecap/

Pes planus
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Evidence of conservative management
 
Within 1 month

Functional impact of condition
 
Within 1 month

x-ray: AP / Lateral and Oblique views of both feet in weight bearing
 
Within 1 month
Mild/moderate or early develomental cases may be re-directed to a commuhnity non surgical provider for initial management

Polydactyly
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

X-ray AP and lateral of affected foot/Feet
 
Within 1 month
Refer for symptomatic cases of polydactyly. Surgery is more appropriate when the patient is 1-2 years of age. This is usually consident with walking when the child may start wearing shoes and have difficulty with shoe fitting.
For conservative and surgical management see: 
https://pediatricfootankle.com/foot-conditions/polydactyly/

Also see:CONTACT US - College of Podiatric Physicians of Alberta (albertapodiatry.com)

Removal of internal fixation device
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Rational for removal
 
Within 1 month

x-ray: of area showing internal fixation hardware
 
Within 1 month

Shoulder dislocation
< 1 Month
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

MR arthrogram of shoulder
 
Within 1 month

x-ray: AP/lateral and axillary view
 
Within 1 month
First time dislocation - rule out fracture and refer to a sport medicine provider for treatment

Multiple dislocatons  - complete imaging and obtain comprehensive sport medicine assessment and ask sports medicine provider to refer to orthopedic clinic 

Shoulder joint instability
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine specialist is required
 
Within 1 month

Documented failed conservative management
 
Within 1 month

MR arthrogram of shoulder
 
Within 1 month

x-ray: AP/lateral and axillary view
 
Within 1 month
Instability of the shoulder joint refers to conditions affecting the glenohumoral joint 

NOTE: Acute shoulder injuries should be managed through emergent or urgent care providers. After initial acute management a sport medicine specialist should be consulted. Follow up may be provided through a sports medicine provider until referal to an orthopedic clinic is needed.

For more information see: https://orthoinfo.aaos.org/en/diseases--conditions/chronic-shoulder-instability/

Skeletal dysplasia
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

History including functional impact of condition
 
Within 1 month

X-ray of affected bone/joint
 
Within 1 month
Signs usually present in the first year of life and include abnormal growth in the spine and skull, and in the long bones of the arms and legs, which can result in the individual being short in stature.

Spondylolisthesis
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Physical exam findings to include full neurological exam
 
Within 1 month

x-ray: AP/lateral spine
 
Within 1 month
Unstable < 3 months
Stable < 6 months 

see: https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

RED FLAGS: Bowel and bladder signs, back pain, decreased straight leg raise, bow string sign, gait abnormalities, reduced participation in activity.

Low grade or mildly symptomatic cases may be referred to an associated community provider.

Spondylolysis
< 6 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Physical exam findings to include full neurological exam
 
Within 1 month

x-ray: AP/lateral spine
 
Within 1 month
https://orthoinfo.aaos.org/en/diseases--conditions/spondylolysis-and-spondylolisthesis/

RED FLAGS: Bowel and bladder signs, back pain, decreased SLR, bow string sign, gait abnormalities, reduced participation in activity

Low grade or mildly symptomatic cases may be referred to an associated community provider.

Subluxation of sternoclavicular joint
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented failed conservative management
 
Within 1 month

Dynamic ultra sound or dynamic CT to confirm instability
 
Within 1 month

x-ray: serendipity view bilateral sternoclavicular joint to rule out fracture
 
Within 1 month
For more information see: https://orthoinfo.aaos.org/en/diseases--conditions/sternoclavicular-sc-joint-disorders/

For acute sternoclavicular joint injury refer to emergency or urgent care providers.

Syndactyly
< 12 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Conservative management in the community
 
Within 1 month
Typically not seen for orthopedic assessment. Refer only where condition impacts function.
Management in the commuuty should be considered first.

Consider a referral to a podiatrist: CONTACT US - College of Podiatric Physicians of Alberta (albertapodiatry.com)

Referral for a surgical intervention should follow an assessment by a community provider who has confirmed that surgery is an appropriate next step.

Talipes equinovarus
< 2 Weeks
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Functional impact and indication of severity of condition
 
Within 1 month

History of previous treatment and outcomes
 
Within 1 month

Imaging: AP/lateral and oblique of foot/feet
 
Within 1 month
In utero: We do not provide pre-natal assessment. Plesae refer as soon as the baby is born

New born
: see urgent referal criteria

Recurrent TEV/club foot: send as a routine referral. This will be triaged for severity.

When not in an open episode of care/ treatment, patients should be referred based on assessed need/change of status. This service does not provide 'routine follow up'.

Tarsal coalition
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Document outcome of conservative management
 
Within 1 month

x-ray: standing AP/lateral and oblique bilateral feel
 
Within 1 month
RED FLAG: Pain on top or outside edge of foot.
Pain more common in ages 8-16 as foot matures.
For more information: https://orthoinfo.aaos.org/en/diseases--conditions/tarsal-coalition/
https://www.childrenshospital.org/conditions-and-treatments/conditions/t/tarsal-coalition

Tear of meniscus of knee
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Imaging: AP /lateral of knee
 
Within 1 month

MRI of the knee
 
Within 1 month
For more information see: Meniscus Tear - OrthoInfo - AAOS

Thoracic insufficiency syndrome
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Physical exam findings to include full neurological exam
 
Within 1 month
Primary and secondary TIS both seen within 3 months

Tibial hemimelia
< 3 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

x-ray: AP of tibia and fibula
 
Within 1 month

Toe-walking gait
< 4 Months
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Documented failed conservative management
 
Within 1 month

Physical exam findings to include full neurological exam
 
Within 1 month
Please also refer to this article for more information on diagnosing true ideopathic toe walking:
https://journals.lww.com/pedorthopaedics/fulltext/2018/03000/toe_walking__a_neurological_perspective_after.9.aspx

Torus fracture of radius
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Follow up and management by a community provider.
 
Within 1 month

x-ray for the fracture.
 
Within 1 month
BUCKLE FRACTURE - also known as a Torus fracture
Buckle fractures do not require a referral to an orthopedic fracture clinic.
Buckle fractures or impacted/incomplete fractures happen due to a compressive force caused by sudden pressure on a bone. Buckle fractures occur in 1 in 4 kids who break a bone. Approximately 50% of pediatric wrist fractures are buckle fractures. These fractures are usually treated with a splint which protects the child from reinjury and provides comfort and pain relief. Most children need to wear a splint for two to three weeks. Duration of splint use depends on how long it takes for their symptoms to improve. 
Urgent Reason for Referral
Access Targets convey the clinically appropriate timeframe patients should be seen within, by reason for referral and priority level.
Access Target
Required Information/Investigations
Investigation Timing
Additional Details
Acute injury of anterior cruciate ligament
< 7 Days
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Comprehensive evaluation by a sports medicine specialist
 
Within 7-10 days

Imaging: AP and lateral knee x-ray to rule out fracture
 
Within 7 days

Urgent MRI
 
Within 7 days
Initial management: Access an emergency or urgent care provider. This should be followed by a comprehesive evaluation from a sports medicine specialist.
Referral to orthopedic clinic should be made by the sports medicine provider.

For more information:https://orthoinfo.aaos.org/en/diseases--conditions/anterior-cruciate-ligament-acl-injuries/

Cavovarus deformity
< 1 Month
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Condition confirmed by ultrsound
 
With 1-3 weeks

Document any associated hip dysplasia
 
Within 1-3 weeks
INFANT
For more informtion about Infant foot deformity assessment and diagnosis:
https://www.aafp.org/afp/2004/0215/afp20040215p865.pdf

Clubfoot
< 1 Month
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Indications to rule out other diagnoses
 
Within 2 weeks

photos to confirm diagnosis
 
With 2 weeks
NEW BORN CLUB FOOT
New diagnoses of club foot will be be seen urgently for assessment and active corrective intervention as needed.

Developmental dysplasia of the hip
< 7 Days
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Condition confirmed by ultrasound
 
With 7 days

Fracture dislocation of joint
< 2 Weeks
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Imaging: X-ray and advanced imaging - call clinic for phone consult
 
Within 2 weeks

Hip unstable
< 7 Days
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

Condition confirmed by ultrasound
 
Within 7 days

Positive Ortolani test on exam
 
Within 7 days

Intra-articular fracture
< 2 Weeks
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

X-ray and advanced imaging - phone consult to confirm type of advanced imaging
 
Within 2 weeks

Legg-Calve-Perthes disease
< 1 Month
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

AP and frog lateral hip x-rays
 
With 1 week

Confirmation of active disease
 
Within 1 week
Active/ New diagnosis 
For more information:https://orthoinfo.aaos.org/en/diseases--conditions/perthes-disease
RED FLAGS: 
Changes in gait pattern - new limp
Limited range of motion at the hip
Pain in the groin
Referred pain in the leg

Spinal injury
< 1 Day
Medication List (dose, frequency, route)
 
Within 1 month

Past medical history
 
Within 1 month

MRI
 
Within 1 day
Spinal injuries affecting the spinal cord must be seen within 24 hours 

Spinal injuries not affecting the spinal cord must be seen in 1 week 
PATIENT APPOINTMENT INFORMATION
 
MISSED APPOINTMENT GUIDELINES
No-Show Policy
  • If you miss an appointment, you will have one month from the date of the missed appointment to call back and rebook; otherwise, your referral will be closed, and you will need a new referral.
  • If you miss a second appointment, you will be discharged from the clinic and will need a new referral to be seen. Missing an appointment also means that we miss the opportunity to see another patient who needs care.
No-Show Policy
  • If you miss an appointment, you will have one month from the date of the missed appointment to call back and rebook; otherwise, your referral will be closed, and you will need a new referral.
  • If you miss a second appointment, you will be discharged from the clinic and will need a new referral to be seen. Missing an appointment also means that we miss the opportunity to see another patient who needs care.
 
HOURS OF OPERATION
Monday: 8:00 am - 4:00 pm
Tuesday: 8:00 am - 4:00 pm
Wednesday: 8:00 am - 4:00 pm
Thursday: 8:00 am - 4:00 pm
Friday: 8:00 am - 4:00 pm
   
 
ADDRESS
Level 1, MSK Clinic
28 Oki Drive NW
Calgary Alberta
T3B 6A8
PATIENT APPOINTMENT INSTRUCTIONS

Important Information for Patients (handout)

Important Information to Know BEFORE Your Appointment

  • Many patients are waiting for an appointment. Please provide 24 hours' notice if you need to change or cancel your appointment, so we have time to fill the vacant slot. Appointments can only be rescheduled a maximum of two times. To make any changes to your appointment, please contact the ACH Orthopedics Clinic directly at 403-955-7877.
  • You will receive an automated call reminder approximately 7 days before your scheduled appointment. It is essential to press 1 to confirm your child's appointment. Additionally, please ensure that the contact information on file is accurate.
  • This is an extremely busy clinic, so it is crucial to arrive on time for your appointment. If you are more than 15 minutes late for your scheduled appointment, you may be asked to reschedule for another day.
  • Unaccompanied minors are not permitted to attend appointments. All minors must be accompanied by a responsible adult, such as a parent or legal guardian.
  • All adolescents must attend their initial appointment with a legal guardian. Follow-up appointments for these adolescents may be allowed without a legal guardian at the physician's discretion. Please call the clinic at least 24 to 48 hours before your scheduled appointment to confirm if this applies to you. This ensures proper management of consents and medical decisions, as well as appropriate support during the visit.


Preparation for the Clinic Day

  • If your child is sick on the day of the appointment, please call the clinic at 403-955-7877 for further advice before heading to the hospital.
  • Please bring your child’s Alberta Personal Health Card
  • Appropriate clothing for your child so an examination can be completed (i.e. shorts and/or a t-shirt)
  • Any equipment/devices that may be required for your clinic visit (i.e. wheelchair, braces, communication devices)
  • Any questions or concerns that you may have for your child’s medical or rehabilitation team.

Important Information for Patients (handout)

Important Information to Know BEFORE Your Appointment

  • Many patients are waiting for an appointment. Please provide 24 hours' notice if you need to change or cancel your appointment, so we have time to fill the vacant slot. Appointments can only be rescheduled a maximum of two times. To make any changes to your appointment, please contact the ACH Orthopedics Clinic directly at 403-955-7877.
  • You will receive an automated call reminder approximately 7 days before your scheduled appointment. It is essential to press 1 to confirm your child's appointment. Additionally, please ensure that the contact information on file is accurate.
  • This is an extremely busy clinic, so it is crucial to arrive on time for your appointment. If you are more than 15 minutes late for your scheduled appointment, you may be asked to reschedule for another day.
  • Unaccompanied minors are not permitted to attend appointments. All minors must be accompanied by a responsible adult, such as a parent or legal guardian.
  • All adolescents must attend their initial appointment with a legal guardian. Follow-up appointments for these adolescents may be allowed without a legal guardian at the physician's discretion. Please call the clinic at least 24 to 48 hours before your scheduled appointment to confirm if this applies to you. This ensures proper management of consents and medical decisions, as well as appropriate support during the visit.


Preparation for the Clinic Day

  • If your child is sick on the day of the appointment, please call the clinic at 403-955-7877 for further advice before heading to the hospital.
  • Please bring your child’s Alberta Personal Health Card
  • Appropriate clothing for your child so an examination can be completed (i.e. shorts and/or a t-shirt)
  • Any equipment/devices that may be required for your clinic visit (i.e. wheelchair, braces, communication devices)
  • Any questions or concerns that you may have for your child’s medical or rehabilitation team.
 
DIRECTIONS
ACH Orthopedic/Fracture Clinic is located on the main level of the Alberta Children's Hospital. From the main entrance go straight ahead until you pass the elevator (on your left side), turn left at the eagle statue, and go down the hallway – look for “Musculoskeletal Clinics” sign, this is first clinic on your left by the fist tank.

Please check in at the first reception desk.
ACH Orthopedic/Fracture Clinic is located on the main level of the Alberta Children's Hospital. From the main entrance go straight ahead until you pass the elevator (on your left side), turn left at the eagle statue, and go down the hallway – look for “Musculoskeletal Clinics” sign, this is first clinic on your left by the fist tank.

Please check in at the first reception desk.
 
PHONE
403-955-7877
 
PARKING INSTRUCTIONS
Rates apply 24 hours per day, and are in effect for all public parkers, including those with provincially issued placards for persons with disabilities.
Paystations accept Canadian coins, Canadian bills or credit card (Visa, MasterCard, and American Express).
Parking Office and Kiosk accept payment by cash, credit card, debit or cheque.
Rates apply 24 hours per day, and are in effect for all public parkers, including those with provincially issued placards for persons with disabilities.
Paystations accept Canadian coins, Canadian bills or credit card (Visa, MasterCard, and American Express).
Parking Office and Kiosk accept payment by cash, credit card, debit or cheque.
 
EMAIL
VIRTUAL APPOINTMENT INFORMATION
 
 
WHEELCHAIR ACCESSIBILITY
Yes

This facility is wheelchair accessible and has an elevator on site


The primary purpose of the All Locations list is to let the user easily access any location of a healthcare service without going back to the main search screen.

The locations listed have 3 background colors:
  • Green means the healthcare service@location has referral information attached to it.
  • Brown means the healthcare service@location never had referral information attached to it, or it has unpublished referral information.
  • Red means
    • IA changed the healthcare service@location's status to something other than Current
    • It was deleted if it is an ARD healthcare service@location.
Green  and Brown are always at the top of the list. These are the Healthcare Service@Locations with the status of Current.
The Red list at the bottom consists of non-current Healthcare Service@locations that once had Published referral information in the ARD.
If the referral information was never published in ARD the Healthcare Service@location will not show in the Red list.

The secondary purpose of the All Locations list is to allow ARD Administrators to recover (copy) referral information from the non-current Healthcare Service@Locations to ones that are current.

Common Scenario:
A Healthcare Service moves from one location to another. In this case the IA Healthcare Service@Location record will be made defunct (non-current) and a new Healthcare Service@Location record will be created with a current status. In this scenario the captured referral guidelines in ARD can become "orphaned" as they are not attached to any current IA healthcare service.

Categories of non-current or orphaned referral guidelines: INDIVIDUAL and COMMON.
The REFERRAL GUIDELINES section of the profile has the prefix INDIVIDUAL or COMMON to help you choose the method below when transferring referral guidelines from a non-current Healthcare Service@Location to a current healthcare service@location.

Individual referral process
  1. Click on a non-current (Red) Healthcare Service@Location at the bottom of the All Locations list.
  2. The non-current referral info is displayed with the link Copy this Referral Process to another Healthcare Service@Location link on the upper right hand corner. Click on the copy link.
  3. Choose a current location (Green or Brown) from the All Locations list. This will be the Healthcare Service@Location you are pasting the referral info into.
  4. The system will display the Edit Referral Info screen populated with the referral info from the non-current Healthcare Service@Location you viewed in the first step.
  5. Click Save and the referral info is transferred from the non-current Healthcare Service@Location to the current one.
  6. Repeat these steps for each Healthcare Service@Location that needs attention.

Common referral process - 2 sub cases.
Case 1: At least 1 current Healthcare Service@Location with common referral info is with current status for this healthcare service; One or more Healthcare Healthcare Service@Locations where replaced by new one.
  1. Click on any current Healthcare Service@Location whether it has referral info (Green) or not (Brown).
  2. The healthcare service location opens in the Edit Referral Info screen populated with the current common referral info.
  3. Save it. 
  4. All locations will be updated with the common referral information, including all the locations that don't have referral info yet (Brown). The non-current referrals (Red) will also be updated.
Case 2:  All Healthcare Healthcare Service@Locations for a healthcare service are set to a non-current status and replaced by new ones. In this case there is no current additional referral info to copy from, so the only alternative is to pick up the non-current common referral process (Red). Follow the steps described in the section Individual Referral Process above to copy/paste the non-current common referral info to the current healthcare service locations.
Generally we want to replicate current common referral info to new or replaced healthcare service locations. We only resort to copying non-current common referral info if there is no other option.

Remember: Some fields can be location specific with the common referral process:
Parking Instructions, Directions, Parking Map, Wait Time, Referral Phone or Referral Fax.
To update these items you have to edit each Healthcare Service@Location separately.

ADDITONAL NOTES:
  • The info icon after the All Locations drop down will be visible to ARD Administrators.
  • The system doesn't allow you to copy referral information from one non-current Healthcare Service@Location to another.

 

V6.5