Capture the Fracture visits FLS at Nuffield Orthopaedic Centre

Valuable insights gained from visit to Nuffield Orthopaedic Centre (NOC) in Oxford, a globally renowned orthopaedic hospital with an outstanding Fracture Liaison Service.

The Nuffield Orthopaedic Centre (NOC) in Oxford is a globally renowned public orthopaedic hospital, managed by the Oxford University Hospitals NHS Foundation Trust.

The Fracture Liaison Service (FLS) at NOC is led by Assoc. Prof. Kassim Javaid, an academic rheumatologist at the University of Oxford, and the current Co-Chair of the Capture the Fracture (CTF) Steering Committee at IOF.

M. Fujita, Project Leader of CTF, recently visited the facility and met with Prof. Javaid and his fracture prevention team who are managing the FLS. The FLS team is supported by at least 4 full-time nurse practitioners who form the fracture prevention team. They identify at least 3000 patients a year, including hip fracture, inpatients, outpatients and vertebral fracture patients.

The team is responsible for identifying patients with fractures and performing post-fracture assessment for preventing secondary fractures. The assessment includes comprehensive falls risk assessment and interventions. Following these assessments, the team will then write a letter to the responsible GP advising commencement of drug treatment (including Ca/Vit D). A system is in place to ensure that the GP receives all the essential information on the patients, including the outcomes of post fracture assessment from the FLS team. A special feature of this FLS team is the use of an AI-based software to detect vertebral fractures on CT scans performed on patients who may have been scanned initially for different purposes. Vertebral fractures can be incidentally discovered in patients who received CT scans for pneumonia or cancer for instance.

The visit was an opportunity to see how an FLS functions in the clinical setting, patient care pathway in the NHS system, the roles of the FLS coordinators/nurse specialists, and various methods used to identify fractured patients.

On the same day, Dr Juan Carlos Viveros from Hospital Regional del ISSSTE, Leon, México, also visited the FLS. Dr Viveros established his FLS in April 2018, and is a specialist in internal medicine and geriatrics. His FLS is currently identifying around 70 hip fracture patients a year, and hopes to improve services so that patients in Leon will not suffer from second fractures. He stated:

"The visit to Oxford was very productive and interesting. The FLS led by Dr Javaid has an extraordinary level of performance, and the insights gained will help us to improve secondary fracture prevention in Mexico. It has helped generate ideas on how to improve the FLS in my hospital, as well as reaffirm the primary role that nurses play in this type of service. I am sure that their example and help will be invaluable for our FLS' improvement and growth.”