Periprosthetic fracture referral

Printed forms should be sent to:

Shoulder and Elbow Unit,
Muriel Sands Building
Royal National Orthopaedic Hospital NHS Trust
Brockley Hill, Stanmore
Middlesex, HA7 4LP

Referral Form

These forms are only for tertiary referrals from other hospitals. We will not accept referrals from GPs using the online referral form below.

If you are a GP referring to the RNOH please use the NHS e-referral system, e-RS.

Please select whether this is a shoulder or elbow periprosthetic fracture. For other conditions, please use the appropriate form.

Referrer’s details:

All correspondence will be sent to this email - please make sure it is correct!

Patient details:

History and Examination Findings
Co morbidities
Available imaging:

Please tick box

Available via:

Any other comments
Related Documents:Size
PDF version of the Periprosthetic fracture referral form.pdf176 KB
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Shoulder & Elbow Unit