Note: all referrals from non-UHB hospitals need to be assessed by the local trauma and orthopaedics (T&O) or plastics team first.
Birmingham Heartlands Hospital (UHB)
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Involve vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | Yes |
| Acute phalangeal fractures | Only if needs surgery |
| Acute metacarpal fractures | Only if needs surgery |
| Acute distal radius fractures | Discuss duty consultant |
| Acute scaphpoid fractures | Only if needs surgery |
| Acute other carpal fractures | Only if needs surgery |
| Malunions / Nonunions / >4 weeks old fracture |
No - elective referral |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
Yes |
| UL abscess proximal to wrist | No - T&O |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No - medics |
| Septic arthritis of the wrist | No - T&O |
| Paronychia | Yes if cannot be treated in A&E |
| Phalangeal dislocations | Only if needs surgery - reduce in A&E first |
Good Hope Hospital (UHB)
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Involve vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | Yes |
| Acute phalangeal fractures | Only if needs surgery |
| Acute metacarpal fractures | Only if needs surgery |
| Acute distal radius fractures | Discuss duty consultant |
| Acute scaphpoid fractures | Only if needs surgery |
| Acute other carpal fractures | Only if needs surgery |
| Malunions / Nonunions / >4 weeks old fracture |
No - elective referral |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
Yes |
| UL abscess proximal to wrist | No - T&O |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No - medics |
| Septic arthritis of the wrist | No - T&O |
| Paronychia | Yes if cannot be treated in A&E |
| Phalangeal dislocations | Only if needs surgery - reduce in A&E first |
City and Sandwell
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | No |
| Acute extensor tendon injury | No |
| Digital nerve injury | No |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | No |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | No |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Russels Hall - Dudley
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Walsall Manor
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Wolverhampton
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Worcester
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Redditch
| Amputation | Yes |
|---|---|
| Devascularised finger | Yes |
| Brachial artery/forearm or arm vessel injury |
Refer to vascular |
| Acute flexor tendon injury | Yes |
| Acute extensor tendon injury | Yes |
| Digital nerve injury | Yes |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | Yes |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | Discuss duty consultant |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Other hospitals
| Amputation | No |
|---|---|
| Devascularised finger | No |
| Brachial artery/forearm or arm vessel injury |
No |
| Acute flexor tendon injury | No |
| Acute extensor tendon injury | No |
| Digital nerve injury | No |
| Nail bed injury | No |
| Acute phalangeal fractures | No |
| Acute metacarpal fractures | No |
| Acute distal radius fractures | No |
| Acute scaphpoid fractures | No |
| Acute other carpal fractures | No |
| Malunions / Nonunions / >4 weeks old fracture |
No |
| Flexor sheath infections | No |
| Forearm / Arm wounds without tendon / nerve injury |
No |
| UL abscess proximal to wrist | No |
| UL abscess distal to wrist | No |
| Cellulitis proximal to the wrist | No |
| Septic arthritis of the wrist | No |
| Paronychia | No |
| Phalangeal dislocations | No |
Last reviewed: 26 January 2024