Easier, quicker, safer: an enhanced instrument count procedure

Andrea Szekretar, Theatre Scrub Team Leader and Advanced Scrub Practitioner, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust was runner up in the Innovation Award category of the BJN Awards 2021

P10 Rapid-access temporal artery ultrasound by vascular sonographers in suspected GCA: an audit during and after a training phase

Background Fast, same-day access ultrasound (US) of temporal (TA) and axillary (AxA) arteries has emerged as part of a gold standard of assessment for suspected giant cell arteritis (GCA). GCA is a rheumatological emergency but many rheumatology units lack expertise and capacity to provide such a service themselves. We audited US scanning for GCA by experienced vascular sonographers, but new to TA scanning, during and after a training phase. Methods Before the training audit a meeting between three vascular sonographers (LD, AO and MT), the radiology US Lead (KR) and an experienced rheumatologist sonographer (RK) took place to share the rationale, technique and evidence-base of TA/AXA scanning in suspected GCA. Early during the training period ad hoc co-scanning between technicians and RK/KR was performed and one technician attended the Vascular Scanning Unit at Nuffield Orthopaedic Centre in Oxford. Rheumatology medical staff was encouraged to refer all patients with suspected GCA to the Vascular US unit for scanning, with patients and clinicians being aware that the scan was for training purposes only. At the end of the training period, a sample review of images and reports was undertaken and diagnostic criteria and terminology rehearsed before service scanning commenced. Results Twenty-six subjects were scanned during the training period between July 2018 and May 2019: mean [range] 73 [53-89] years, 77% female. Of these 9 (35%) showed US changes reported as diagnostic of GCA in TAs, one equivocal and the remainder negative for GCA. Three of the 9 US-positive subjects underwent TA biopsy, which confirmed GCA in all cases. Of the 6 cases not undergoing biopsy, all were treated as GCA except one (3rd US training case, ESR 2). A total of 10 (38%) of all subjects underwent TA biopsy of which 7 showed a negative biopsy and negative TA US for GCA, thus resulting in a 100 % concordance of US and TA biopsy. In the first 4 months following the training phase, 23 subjects have been scanned for suspected GCA (mean [range] 69 [53-87] years, 65 % female): diagnostic, equivocal and negative changes for GCA were seen in 4, 2 and 17 subjects, respectively. No US-positive and 3 US-negative subjects underwent TA biopsy which showed negative histology for GCA in all three. Duration of steroid treatment before US and TA biopsy was a median 1 (IQR 0.75-4.0) and 6.5 (IQR 5.0-9.5) days, respectively, across both cohorts. Conclusion This audit suggests that experienced general vascular sonographers can achieve good proficiency in TA/AxA US for suspected GCA with excellent concordance with TA biopsy results to support a rapid-access clinical pathway for patients with suspected GCA. Furthermore, the audit suggests a reduction in biopsy rates in subjects whose US is positive for GCA. Disclosures L. Devonshire None. C. Koutsianas None. A. Ostrowski None. M. Trumper None. K. Randhawa None. R. Klocke None.

The Norman Capener Travelling Fellowship in complex spinal oncological surgery

I had been working as a consultant spine surgeon in Oxford (Nuffield Orthopaedic Centre and the John Radcliffe Hospitals) for approximately one year when I was given the opportunity to lead the spinal oncology department at the internationally known AOSpine centre of excellence in England, the Queens Medical Centre, Nottingham. Before starting my new post, I decided to embark on a travelling fellowship in complex spinal oncological surgery under the leadership of Professor Ziya Gokaslan at the Johns Hopkins Hospital, Baltimore, which is the number one ranked hospital in the US.

Treatment of Giant Cell Tumour of the Femoral Head and Neck

Giant cell tumours of the femoral head and neck treated at the Nuffield Orthopaedic Centre between 1970 and 1982 were reviewed to evaluate the effectiveness of primary treatment by curettage and bone grafting. All 4 cases recurred within two years, necessitating the likelihood of recurrence following curettage and bone grafting, particularly at this anatomical site, is stressed, and the possibility that hip replacement arthroplasty be considered the primary treatment of choice is discussed.