Brisbane Hand & Upper Limb

Our current research includes:

All our research projects undergo ethical approval. Research is performed under the guidelines of the Australian National Health and Medical Research Council. 

Studies In Progress

Multi-Centre Clinical and Radiological Outcomes Study of the PyroTITAN™ HRA Shoulder Implant in Humeral Head Resurfacing

New Technique for Scapho-Lunate Ligament Reconstruction

Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a multi-centre randomised controlled trial

Clinical and Radiological Outcomes Study of the Trimed Ulnar Osteotomy Compression Plate: Retrospective Cohort Study in Australia and New Zealand

Clinical and Radiological Outcomes of Randelli and SMR TSR Replacements: Retrospective cohort study of 296 shoulders

Survivorship of the Metal-Backed Glenoid Platform in a Modular Total Shoulder Arthroplasty System

Measuring Ulnar Variance using Magnetic Resonance Imaging

Clinical and Radiological Outcomes of Pyrocarbon PIPJ Hemiarthroplasty

Magnetic Resonance Scan Findings in the Asymptomatic Wrist

Radiological and Clinical Outcomes Study Comparing Pyrocarbon Arthroplasty and LRTI for Osteoarthritis of the First CMC joint

Modified conservative management verses early surgical intervention amongst young people with anterior shoulder dislocation: a randomised controlled trial

Upper Extremity 3D Kinematics in the Dart-Throwing Motion of the Wrist

Development of a screening tool to predict delayed return-to-work following surgery of the upper extremity

A comparative study of two dynamometers in assessing shoulder strength used for calculating the Constant Score

Stakeholders’ perception of barriers to return to work for surgery for non-traumatic upper limb musculoskeletal conditions

Surgical interventions for treating scapholunate pathology in adults:  Systematic Review

Completed Studies

Clinical and Radiological Outcomes of an Embedded Polyethylene Mini-Glenoid Implant inTotal Shoulder Arthroplasty for Arthritis

The Influence of Cartilage Thickness at the Sigmoid Notch on Distal Radioulnar Joint Inclination

Distal radioulnar joint inclination – Computed Tomographic Validation of Plain Radiographs

Radial Translation Malunion – Defining Normal Parameters for Residual Radial Translation

Simplified technique for navigated central screw placement in fractured scaphoids utilizing ultra low dose computed tomography

Clinical and Radiological Outcomes Study of the Primary Management of 3- and 4-part Proximal Humeral Fractures using Reverse Total Shoulder Arthoplasty

A Multi-Centre Clinical and Radiological Outcomes Study of the PyroTITAN™ HRA Shoulder Implant in Humeral Head Resurfacing

Mark Ross, Phillip Duke, Kenneth Cutbush, Steve Andrews

Glenohumeral arthritis is a common shoulder problem, which increasingly affects young adults. These patients seek relief not only from pain but also require the ability to return to work, recreational and domestic activities. Total shoulder arthroplasty (TSA) is an effective solution for less active patients but has been associated with high rates of early glenoid wear, asceptic loosening, and the reduced return of full function. Hemiarthroplasty and humeral resurfacing  arthroplasty (HRA) are indicated in patients who have an intact rotator cuff, a congruent glenoid, and no history of instability or subluxation. However, persistent pain related to glenoid arthrosis after metal hemiarthroplasty or HRA is a limitation for many patients and surgeons. Pyrocarbon HRA provides an alternative to traditional TSA and metal HRA which hypothetically may allow earlier intervention, restoration of function and mobility, resulting in higher patient satisfaction and the ability to stage the intervention to meet the patient’s needs.The purpose of this study is to prospectively investigate the clinical and radiological outcomes over a ten year period of a cohort of patients who have received this implant.  

Recruitment of participants for this study commenced in 2010.  We are not recruiting any participants at this time.

A New Technique for Scapho-Lunate Ligament Reconstruction

Mark Ross, Greg Couzens

Our technique involves ligament reconstruction utilising a portion of the flexor carpi radialis tendon re-routed via trans-osseous tunnels across the scaphoid, lunate and triquetrum. The tendon graft is secured with interference screw fixation into the triquetrum. The philosophy of this new technique is to clamp the lunate between the scaphoid and the triquetrum by placing a graft through the centre of the scapho-lunate articulation and then augmenting the soft tissues such as the dorsal radiocarpal ligaments. These maintain the translational relationship between the scaphoid and the triquetrum and, therefore, augment stability of the scapho-lunate articulation.  This study is prospectively investigating the clinical and radiological outcomes of these new techniques.

This study has been published here and here.

Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a multi-centre randomised controlled trial

Gregory Couzens, Susan Peters, Mark Ross, Phillip Cheras

Distal radius fractures are among the most common fractures seen in the hospital emergency department. Historically these patients are managed either conservatively or surgically. Some surgical techniques have been associated with high complication rates and poor clinical and radiological outcomes. In recent years with the advent of low profile plating, open reduction and internal fixation (ORIF) using volar plates has become the surgical treatment of choice in many hospitals. However, it is currently unknown which plating systems have better clinical and radiological outcomes following surgery, and also the lowest complication rates. Few studies have compared different types of plates, which may have different plate and screw designs, features or may be manufactured from different materials (for example, stainless steel or titanium). This study will specifically investigate and compare the clinical and radiological outcomes of two commonly used volar plating systems for fixation of distal radius fractures: one made from stainless steel and the other made from titanium. This study will use a randomised double blind (participant and outcome assessor) clinical trial method to compare the effectiveness of stainless steel versus titanium volar plates used to surgically correct distal radius fractures in an adult population. A suite of outcome measures recommended for this patient group will be used. These measures include an assessment of range of movement, strength, function (QuickDASH and Patient Rated Wrist Evaluation), pain, complications,  quality of life, Radiological outcome (X-Ray) and patient satisfaction. These outcomes will be administered by a blinded assessor at seven time points: baseline, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years.

Data collection for this study has commenced. Recruitment of participants is anticipated to take 12 months.  Study completion is expected by December 2016.  The full protocol for this study has been published in BMC Musculoskeletal.

Conservative management of 1st CMC joint osteoarthritis: a single-blinded randomised controlled trial.

Mark Ross, Phillip Duke, Gregory Couzens, Susan Peters, Bhavana Jha, Wilma Walsh

Arthritis at the base of the thumb is common in ageing adults.  It can result in pain and impact on function and quality of life. There are many treatments available to help relieve pain and improve hand function. Currently, it is common practice in Australia and overseas for health care providers (such as General Practitioners, Surgeons, Rheumatologists and Hand Therapists) to initially recommend non-surgical/conservative treatments for their patients. Treatments can include splinting the joint to relieve pain and enable hand function; injection of corticosteroid into the joint to reduce inflammation and provide pain relief; and hand therapy to provide exercises and patient education to inform on strategies for protecting the joints, managing pain and improving function. Preliminary research on these types of treatments has had mixed results, yet, health care professionals continue to offer these as treatments. This study will compare the effectiveness of the following non-surgical treatments: Push BraceTM splint; corticosteroid injection; and hand therapy treatment in relieving symptoms and improving function in adults with osteoarthritis at the base of the thumb.

This study commenced recruitment in September 2015.  This study is supported by a research grant from the Queensland Hand Surgery Society.

If you have arthritis in your thumb and you want to participate in this trial, please contact the research institute.

The full protocol for this study has been published.

Clinical and Radiological Outcomes of Randelli and SMR TSR Replacements: Retrospective cohort study of 296 shoulders

Phillip Duke, Mark Ross, Kenneth Cutbush, Steve Andrews

The purpose of the study is to determine the post-operative survivorship, complication rate, levels of patient satisfaction, shoulder function, range of movement, radiographic alignment, and shoulder pain in patients receiving a Randelli or SMR Total Shoulder Replacement or Reverse Total Shoulder Replacement. This study is designed as a single site, unblinded, retrospective non-comparative cohort study evaluating the mid and long term performance of the Randellii and SMR TSR. The clinical performance of shoulder prosthesis implanted will be evaluated with respect to: clinical outcomes (ASES, QuickDASH, Constant Score and EQ-5D, VAS Pain Score, WOOS ); complications and adverse events; peri-operative clinical parameters; radiographic outcome; patient satisfaction.

This study has been completed. The results of this study have been presented at various national conferences.Results of this study will be for publication available in 2016.

Survivorship of the Metal-Backed Glenoid Platform in a Modular Total Shoulder Arthroplasty System

Phillip Duke, Mark Ross, Kenneth Cutbush, Steve Andrews

Total shoulder arthroplasty (TSA) has been established as an effective intervention for the management of degenerative and inflammatory arthropathies of the glenohumeral joint. There have been variable reports on the survivorship for metal-backed (MB) glenoids and some studies have shown that all-polyethylene glenoids seem to present fewer complications.  However, the key implant in a modular system is a MB glenoid platform, which is designed to be used as the bone interface in both anatomic and reverse shoulder arthroplasty. The purpose of this study was to evaluate the survivorship, radiological and clinical outcomes of a MB platform used in both reverse and anatomical TSR.

We have found that the MB platform can be equally or more effective than an all-polyethylene component when certain parameters are taken into account, specifically, the type of prosthesis, the clinical reasoning and the surgical intervention. The Randelli/SMR MB differs from other MB components because of its mechanism of fixation. It has a convex back for the bone interface and presents a concave surface for the convex back surface of the polyethylene liner. The main fixation is from a large central load-bearing peg. This implant was designed to function as a platform for a modular TSA system.

The results of this study have been presented at various national conferences. The results will be made available by publication in 2014.

Clinical and Radiological Outcomes of an Embedded Polyethylene Mini-Glenoid Implant inTotal Shoulder Arthroplasty for Arthritis

Mark Ross, Phillip Duke

Total shoulder arthroplasty gives the most predictable and satisfying results in centered arthritis with an intact rotator cuff. However, long term outcomes of the glenoid can be concerning to the surgeon. Embedded polyethylene mini-glenoid is an attractive alternative for shoulder arthroplasty for patients with shoulder arthritis. It allows quick pain relief and no concomitant glenoid erosion, which has been previously reported following metal hemiarthroplasty. The mini-glenoid implant is unobtrusive, secure and stable which makes it very reliable and interesting for humeral resurfacing arthroplasty. The purpose of this study was to retrospectively investigate the clinical and radiological outcomes of a cohort of patients who have received this implant over the past ten years.

This study has been completed. The results of this study have been presented at various national conferences. Results of this study will be available for publication in 2016.

Clinical and Radiological Outcomes of Pyrocarbon PIPJ Hemiarthroplasty

Mark Ross, Susan Peters

Unilateral joint destruction in small joints of the hand presents a difficult challenge, particularly in younger patients.  Many surgical techniques in an attempt to salvage motion whilst preserving the native joint following injury may be used and include: DIPJ to PIPJ transfer; hamate osteochondral graft; and, free vascularized toe joint transfer. Fusion and amputation are usually avoided as a surgical option. Nevertheless, there may be clinical circumstances where the joint cannot be salvaged with either normal fixation techniques or using these reconstructive techniques. Pyrocarbon hemiarthroplasty offers a viable alternative for the management of unilateral joint desctruction. Pyrocarbon has a number of material properties which may render it more suitable than metal for hemiarthroplasty. This study is investigating the clinical and radiological outcomes of an existing cohort of patients who have undergone surgery using a pyrocarbon hemiarthroplasty for the PIPJ using a retrospective study design.

 

Measuring Ulnar Variance using Magnetic Resonance Imaging

 

Mark Ross, Greg Couzens, Susan Peters

This study examined the anatomy of approximately 100 normal wrist MRIs and XRays and approximately 100 wrists with ulnar sided wrist pathology.  We examined the impact of cartilage (which can only be viewed on MRI) on the height or “variance” of the ulna. A normative study design was used to describe the normal standard values for the anatomy of the ulnar in normal wrists which will later be compared to the values of wrists with ulnar sided pathology. 

The study had been completed. The results of this study will be submitted for publication in 2014.

Upper Extremity 3D Kinematics in the Dart-Throwing Motion of the Wrist

 

Gregory Couzens, Mark Ross

Traditionally our understanding of carpal kinematics relates to the orthogonal sagittal (flexion/extension) and coronal (radial/ulnar deviation) planes of wrist motion. Nevertheless, most activities involving tool use are performed in an oblique plane from radial deviation-extension to ulnar deviation-flexion. This movement has been called the dart-throwing motion (DTM).

DTM also involves rotation of the forearm. In wrist radial deviation/extension, there is pronation of the forearm. In wrist ulnar deviation/flexion, there is supination of the forearm. This is a facilitatory motion of the forearm that maintains the grasped object in the vertical plane.

We proposed that the net effect of forearm rotational motion is to keep the oblique DTM axis aligned with the visual axis during wrist motion, which improves accuracy through visual control. Our hypothesis is that the default functional position of the forearm with regard to rotation is between 30° and 45° of pronation, in order to maintain alignment between the function axis and the visual axis during utilisation of the DTM.  We investigated DTM as a multiple-joint 3D motion in relation to the visual axis. We utilised an optical motion capture system (Optotrak® Certus™) with infrared emitting surface markers placed on definded landmarks.

This research is ongoing with new advances in DTM being made.  Please contact the investigators for more information on this exciting project.

A comparative study of two dynamometers in assessing shoulder strength used for calculating the Constant Score

Mark Ross, Phillip Duke, Susan Peters,  Bhavana Jha

The primary objective of this study is to examine the measurement properties of the IDO Isometer in comparison with that of the Chatillon Dynamometer in assessing the shoulder isometric strength as required for calculating the Constant Score;  to assess the intra-rater and inter-rater reliability of both the devices;  to collate normative data for an Australia populationl and to compare our collected data to the normative data published in other related studies.

This study requires 500 normal shoulders to be assessed.  We are currently recruiting participants.  Please contact the research institute if you would like to be involved. 

This study is supported by a research grant from Integra Life Sciences.

Modified conservative management verses early surgical intervention amongst young people with anterior shoulder dislocation: a randomised controlled trial

 

Mark Ross, Kenneth Cutbush, Andrew Johnson, Steve McPhail, Susan Peters, Steve Frederiksen, Michael Bourke, Wendy Potts, Grace Lam

Anterior shoulder dislocations are the most common type of joint dislocation, accounting for 50% of all joint dislocations presenting to Emergency Departments. Historically these patients were managed with a convention sling that holds the hand and arm close to the body (called an internal rotation sling). Unfortunately the dislocation recurrence rate for patients under the age of 30 who are managed this way is very high (up to 72%) and this form of immobilisation may offer no benefit other than early pain relief.    Arthroscopic shoulder stabilisation surgery has been shown to significantly lower the redislocation rate in the young high risk patient group and has less morbidity than older open surgical techniques.  For these reasons shoulder surgeons may offer surgery to young patients after their first dislocation especially those involved in sports or vocation that put them at future risk of shoulder instability.   However surgery has higher costs and more immediate clinical risk than a sling.  Some preliminary research has emerged to suggest that a different type of shoulder bracing (called external rotation bracing) may be substantially better than an internal rotation sling. External rotation bracing keeps the elbow by the side, but the hand out in front. It may help the soft tissues around the shoulder joint to heal with less ongoing shoulder instability. This may reduce or eliminate the need for surgery. However, there has been no previous randomised trial comparison of external rotation bracing to arthroscopic shoulder stabilisation surgery. This study will use a randomised trial method to compare the effectiveness (and cost-effectiveness) of the (cheaper and more conservative) external rotation bracing in comparison to arthroscopic shoulder stabilisation surgery amongst young patients (16-30 years) who have dislocated their shoulder for the first time.

This study is currently recruiting participants at Princess Alexandra Hospitals or QEII Hospitals.  If you have recently had a shoulder dislocation, and would like to participate in the trial, please contact the research institute.

Surgical interventions for treating scapholunate pathology in adults: Systematic Review

Lex Allen, Bhavana Jha, Susan Peters, Gregory Couzens, Mark Ross

Scapholunate (SL) dissociation is the most common carpal instability pattern. It is usually a result of a disruption in the SL ligament complex with the SL ligament having been shown to be the key structure in maintaining stability. Following this injury the abnormal kinematics of the wrist result in increased loading across the wrist joint which can lead to early arthritis, chronic instability, pain and reduced functional abilities. Surgical repair or reconstruction of the SL ligament aim to reduce pain and instability, maintain motion and quality of life and prevent development of early arthritis. Chronic disruption of the SL ligament results in progressive instability leading to advanced arthritis in the radiocarpal and midcarpal joints through a characteristic progression pattern termed “Scapholunate Advanced Collapse” (SLAC wrist). The abnormal distribution of forces across the wrist joint occurs with this injury pattern because the scaphoid and lunate create a deformity where the scaphoid remains in a flexed position and the lunate is extended thus altering wrist kinematics and leading to instability and early arthritis found in patients with SLAC wrist pathology. Many surgical techniques have been reported in the literature for management of SL dissociation. Due to the common nature of this injury, and it’s potential impact on quality of life and ability to perform functional tasks at home and work it is important to investigate the effects of these interventions. The objective of this review is to evaluate the effectiveness of various surgical interventions for treating scapholunate dissociations in adults.

Clinical and Radiological Outcomes Study of the Primary Management of 3- and 4-part Proximal Humeral Fractures using Reverse Total Shoulder Arthoplasty

Mark Ross, Benjamin Hope, Andy Stokes, Susan Peters, Iain MacLeod, Phillip Duke

Treatment of proximal humeral fractures involves a number of options, both operatively and non-operatively.  Within the literature there are virtually no well-constructed scientific trials which clearly demonstrate the best treatment options in displaced three and four part fractures of the proximal humerus. In this fracture pattern, treatment usually consists of hemi-arthroplasty with tuberosity reconstruction. Whilst this gives predictable results in middle-aged patients, the outcomes are variable in elderly patients. In addition to poor restoration of range of movement above chest level, there is also an incidence of persisting pain. The purpose of this study was to review the radiological and clinical outcomes of patients who had a reverse total shoulder arthroplasty performed for shoulder trauma.

Results of this study can be found here.

The Influence of Cartilage Thickness at the Sigmoid Notch on Distal Radioulnar Joint Inclination

 

Mark Ross, Martin, Wiemann, Susan Peters, Greg Couzens

The purpose of this study was to assess the influence of cartilage thickness at the sigmoid notch on the inclination of the distal radioulnar joint (DRUJ). In 100 dorso-palmar wrist x-rays and corresponding coronal MRI images (Proton density fat saturated, 3 Tesla) of the same patients, cartilage thickness at the sigmoid notch and DRUJ inclination were determined. Measuring against the long axis of the ulna, the DRUJ inclination angle was first evaluated using the cortical bone at the sigmoid notch (on both plain x-ray and MRI) and then using the cartilage at the sigmoid notch on MRI. For all measurement techniques, the prevalence of Tolat Type 1 (sigmoid notch inclination parallel to long axis of ulna), Type 2 (inclination oblique facing proximally) and Type 3 (inclination oblique facing distally), as well as the number of type shifts between the evaluations were noted.

Use of the cartilage at the sigmoid notch rather than the bone cortex for measuring the inclination at the DRUJ produces a significant shift in the prevalence of Tolat types 1 and 3. These findings call into question the conventional wisdom that ulnar shortening osteotomies are contraindicated in patients whose DRUJ demonstrates reverse oblique inclination (Tolat type 3) on plain x-ray. MRI should be considered in these Tolat types to better clarify the significance of DRUJ inclination in relation to ulnar shortening osteotomy or other procedures at the DRUJ.

This study has been completed. The results of this study have been presented at various national and international conferences, and has been submitted for publication.

Distal radioulnar joint inclination – Computed Tomographic Validation of Plain Radiographs

Wolfgang Heiss-Dunlop, Mark Ross, Susan E Peters, Karl Gadd, Livio di Mascio, Greg Couzens

The purpose of this study was to compare the inclination of the distal radio ulnar joint (DRUJ) on computer tomography and plain radiography in the coronal plane. Prevalence data for the different inclination types as defined by Tolat et al was calculated for our study population. A modified definition for DRUJ inclination types using computer tomography is proposed. These results regarding the DRUJ morphology are relevant when considering surgical procedures for the DRUJ including ulnar shortening osteotomy and DRUJ reconstruction and arthroplasty.

Two independent investigators compared the plain wrist radiographs (XR) and computed tomographs (CT) of patients with normal DRUJs measuring the angle of inclination in the coronal plane.  The degree of agreement between XR and CT measurements was determined, establishing mean differences, standard deviations and limits of agreement.  Inter- and intra-observer reliability was determined.  The prevalence of the three inclination types of the DRUJ, as described by Tolat et al was recorded. Their original definition was modified, by narrowing the inclination range that is included in the parallel Tolat Type 1 DRUJ. The resultant changes in prevalence of the different DRUJ types was noted and compared.

This study has been published in the American Journal of Hand Surgery. Results of this study can be found here.

Medium to Long term Outcomes of a Pyrocarbon Capitate Resurfacing Arthroplasty

 

Steve Andrews, Wisam Al Hakim, Greg Couzens, Bhavana Jha, Joel Lando, Mark Ross

The study is designed as a single-centre, retrospective, unblinded, case-series investigation to evaluate the short to longer-term outcomes of the Tornier™ RCPI.

This study has been completed.  The results of this study will be released in 2015.

Radiological and Clinical Outcomes Study Comparing Pyrocarbon Arthroplasty and LRTI for Osteoarthritis of the First CMC joint

 

Mark Ross, Greg Couzens

Osteoarthritis of the CMC joint of the thumb is common.  Various conservative and surgical options to relieve pain and imrpove function exist.   Ligament reconstruction tendon interposition (LRTI)  is the most common surgery used.  However, various types of joint replacement now exist.  The purpose of the study is to determine the difference between pre-and post-operative levels of function, pain, range of movement and strength in participants receiving a pyrocarbon CMC joint replacement or the convential surgery using a ligament reconstruction interposition technique. We are investigating the radiographic alignment of the joint and implant complications over a 24 month period. The Clinical Performance of the two different types of surgery will be evaluated with respect to: clinical response (Quick DASH, Patient Rated Wrist Evaluation, pain VAS score, range of motion, grip and pinch strength); radiographic  performance and complication rates.

This study is currently recruiting participants.

A Clinical and Radiological Outcomes Study of the Trimed Ulnar Osteotomy Compression Plate: Retrospective Cohort Study in Australia and New Zealand

 

Mark Ross, Mike Forster, Gregory Couzens, Steve Andrews

The study is designed as a single-centre non-randomised uncontrolled unblinded retrospective clinical investigation of the clinical and radiological outcomes of the Trimed Ulnar Osteotomy Compression Plate. This plate is used in the Ulnar Shortening Osteotomy surgical procedures. Specifically the study will investigate the plate with respect to participant’s functional abilities, pain, range of movement, strength and radiological status on xray.

This study has been completed. Results of this study will be available in 2016.

Stakeholders’ perception of barriers to return to work for surgery for non-traumatic upper limb musculoskeletal conditions

Susan Peters, Michel Coppieters, Mark Ross, Venerina Johnston

Work disability associated with non-traumatic work-related musculoskeletal disorders (MSDs) of the upper extremity (UE) is a significant and costly societal problem. Surgery is frequently offered to workers who have more severe symptoms or do not respond adequately to conservative management.  Despite the high reported success of surgery for conditions such as carpal tunnel syndrome, lateral epicondylalgia and rotator cuff tendinopathy, work disability associated with the inability to return to work (RTW) persists. Stakeholders involved in the RTW process have differing perspectives and priorities for recovery of the injured worker, which may be impacted by their perception of barriers to RTW.

This study aimed to examine key stakeholders’ perceptions of factors that influence RTW following surgery for non-traumatic MSDs of the UE. 

An Australian cross-sectional survey was administered to representatives of four key stakeholder groups including health care professionals, employers, insurer representatives and lawyers.   A comprehensive list of potential factors influencing a worker’s ability to RTW following surgery for non-traumatic MSDs were collated.  This list was developed based on a systematic review, scoping literature review and a piloting process with representative stakeholders. Stakeholders rated factors on a five point Likert scale from not at all influential to extremely influential.  Frequency data were calculated. Likert scale responses were also dichotomised and analysed to compare stakeholder groups. 

The majority of factors that stakeholders identified as being influential on a worker’s ability to RTW are modifiable and amenable to intervention.  These variables should be the focus of RTW research and should be considered in the management of workers who undergo surgery for non-traumatic MSDs of the UE.

Psychometric evaluation of the questionnaire used in the survey is currently being undertaken.

This study has been completed.
This study was supported by an AHTA Research Bursary.

Magnetic Resonance Scan Findings in the Asymptomatic Wrist

 

Greg Couzens, Nick Daunt, Mark Ross, Ross Crawford

MRI is being increasingly utilised to define pathology and guide treatment in patients presenting with wrist pain. The clinical relevance of MRI identified or confirmed pathology has not been established, and the prevalence of asymptomatic MRI pathology is not known.

Twenty volunteers with no previous wrist injury or symptoms underwent bilateral MRI wrist studies. The scans were reported by an experienced musculoskeletal radiologist and an experienced wrist surgeon, with a consensus reached on each report.

The results found that there were a significant number of positive MRI findings per wrist.  We concluded that MRI findings need to be correlated closely with clinical examination and history, before making recommendations for treatment.

This study has been published in the Australian and New Zealand Journal of Surgery. Results from this study can be found here.

Radial Translation Malunion – Defining Normal Parameters for Residual Radial Translation

 

Mark Ross, Gregory Couzens, Livio Di Mascio, Susan Peters

Distal radial fractures are one of the most common fractures of the upper extremity. Instability of the distal radio-ulnar joint (DRUJ) is a troubling complication that can occur following a radial fracture or malunion. The biomechanics of this joint is complex and the relative importance of each structure in the maintenance of stability remains controversial. In the past, importance has been placed on the status of the ulnar styloid. However subsequent interest has focused on soft tissue constraints and many surgical strategies have focused on these two factors in both the acute and reconstructive phase. Advances in the treatment of these fractures with internal fixation to gain anatomical reduction and early movement with fragment specific fixation of the distal radius in our experience decreases the incidence of instability of the DRUJ following these fractures. With the increasing popularity of internal fixation of distal radius fractures with volar locked plating systems, it has been hypothesised that instability of the DRUJ may also be caused by radial translation malunion.

Commonly used radiographic parameters that assess fracture reduction often do not take into account radial translation of the distal fragment (which effectively detentions the interosseous membrane and pronator quadratus) and thus leads to DRUJ instability. For this reason, we have studied the normal radiographic parameters of distal radial radiographs in an attempt to provide a simple and reproducible way of identifying and evaluating “residual radial translation”.   

Antero-posterior radiographs with no evidence of an acute fracture or dislocation or history of previous fracture or dislocation were identified. These radiographs were of skeletally mature individuals who had no history of distal radioulnar instability. Radial translation was measured by drawing a line along the ulnar aspect of the radius and into the proximal row of the carpus. This line intersects the lunate. The point of intersection was evaluated by drawing a second line along the transverse width of the lunate on the AP radiograph which was parallel with the distal radial articulation. The point of intersection was evaluated measuring from the radial side of the lunate. A single author repeated these measurements for all radiographs studied at two separate sittings to evaluate for intra-observed variability. In an attempt to evaluate for inter-observer variability, two fellowship trained upper limb surgeons took measurements on 25 of the radiographs each.

Our results propose a new parameter to measure radial translation, so that DRUJ instability can be minimised following distal radius fractures.

This study has been published in the Journal of Wrist Surgery.  Results of this study can be found here.

Simplified technique for navigated central screw placement in fractured scaphoids utilizing ultra low dose computed tomography

Greg Couzens, John Mills, Brad Gilpin

Central screw placement within the proximal pole of the scaphoid in non-displaced and minimally displaced scaphoid fractures has been correlated to improved biomechanical and clinical outcomes. Achieving this is challenging due to the complex anatomical shape of the scaphoid and the limitations of conventional imaging modalities. The use of navigation to guide screw placement intra-operatively has the potential to facilitate accurate central screw placement whilst also reducing the technical demands of existing surgical techniques. Recent literature has begun to explore the feasibility of using a navigation system intra-operatively to guide screw placement within fractured scaphoids. However, these studies have been limited in their design and selection of operative approach.

The purpose of this study was to develop and demonstrate the effectiveness of a simplified technique for navigated central screw placement in fractured scaphoids utilising ultra low dose computed tomography (CT). The hypothesise was that use of a navigation system with pre-operative ultra low dose CT imaging and a dorsal percutaneous operative technique would result in accurate and reproducible central screw placement.

This study was presented as a Poster at the American Hand Surgery Society Meeting in 2013.

The Institute enables collaboration between Researchers and Upper Limb Orthopaedic Surgeons.

The Brisbane Hand and Upper Limb Research Institute was established in 2010 to facilitate and coordinate upper limb clinical and basic science research across the private and public sector in Brisbane, Queensland Australia.

Brisbane Private Hospital
Level 9, 259 Wickham Terrace
Brisbane, QLD 4000

Brisbane Hand and Upper Limb Research Institute

From Left to Right:
Bhavana Jha
Dr Chris James
Carly Rankin
Dr Richard Benson
Susan Peters 
Dr Agus Kadir
Dr Bradley Gilpin 

Left to Right:
Dr Greg Couzens
Associate Professor Mark Ross
Dr Phillip Duke
Susan Peters
Dr Ben Hope
Dr Cameron Mackay