Mark Ross

The University of Queensland | UQ · School of Medicine

Background: Recalcitrant carpal tunnel syndrome (CTS) can present with persistent or recurrent symptoms after carpal tunnel release (CTR). A common aetiology for recurrent CTS is the development of perineural adhesions due to excess scarring. The hypothenar fat pad flap (HFPF) has been described to decrease the amount of scarring formed after revis...

Background Age and sex are known predictors of isometric shoulder strength and therefore must be accounted for when noting strength values or administering assessments such as the Constant Score. Given the popularity of the Constant Score, it is important to ensure protocols and values remain clinically relevant and are representative of the intend...

Introduction Winging of the scapula occurs due to dysfunction of its stabilising muscles, most commonly serratus anterior and/or trapezius, for example in facioscapulohumeral muscular dystrophy. Resultant loss of scapular control and abnormal kinematics can decrease shoulder function due to glenohumeral joint instability, loss of range of motion an...

Introduction: The treatment of shoulder osteoarthritis in the young patient remains challenging. The higher functional demands and higher expectations of the young patient cohort are often coupled with an increased failure and revision rate. Consequently, shoulder surgeons are faced with a unique challenge with implant selection. The aim of this s...

Background: Practice variation may indicate a lack of evidence to guide management. This study investigated the preferences of operative management of proximal phalangeal fractures in Australian hand surgeons, as well as factors that may account for variations. Methods: An electronic survey of all members of the Australian Hand Surgery Society was...

Introduction Various wrist arthroscopy techniques can be used in the management of scapholunate ligament (SLL) partial tears but their success has not been proven. Arthroscopic techniques including thermal shrinkage are becoming more popular in the management of partial SLL injuries. We hypothesized that arthroscopic ligament-sparing capsular tight...

Background Surgical options for osteoarthritis (OA) of the first carpometacarpal include excision, replacement arthroplasty, and arthrodesis. However, in pan trapezial OA, optimal management of residual scaphotrapezoidal articulation has remained unclear. Purpose The purpose of this study was to evaluate whether removing the proximal trapezoid from...

Background: Four-corner arthrodesis, which involves fusing four carpal bones while removing the scaphoid bone, is a standard surgery for the treatment of advanced stages of wrist arthritis. Nowadays, it can be performed using a dorsal approach by fixing a plate to the bones and a new radial approach is in development. To date, there is no consensus...

The challenges presented by pathology of the scapholunate ligament (SLL) complex require a thorough understanding of the anatomy and pathomechanics of the relevant structures. The history will not always yield the stereotypical acute high-energy traumatic insult to the wrist and cumulative injury needs to be considered.

Our understanding of carpal stability and kinematics continues to evolve through research and clinical experience. Conventional thinking relies on the belief that the interosseous ligaments of the proximal carpal row maintain stability primarily whilst other intercarpal and extrinsic structures act as secondary stabilisers.

Distal radius fractures are common injuries, and their management has progressed substantially over the last two decades. The most common operative management of these fractures is the volar locking plate. With the availability of multidirectional locking screws, which can target specific fragments, their indication for use has expanded. Rigid cont...

As discussed in the chapter 14, the role of the dorsal intercarpal ligament (DIC) and dorsal radiocarpal ligament (DRC) in the maintenance of carpal stability is becoming increasingly recognized. Modern imaging and arthroscopic techniques enable the assessment and treatment of injuries to the dorsal capsular ligaments. In this chapter, we describe...

Background Shoulder replacement is a reliable treatment for the relief of pain and improvement of function in patients with glenohumeral arthritis, rotator cuff arthropathy, osteonecrosis and fracture. Limited data is available comparing revision rates for the different types of shoulder replacement when used in younger patients. This study aims to...

Background: The optimal surgical management of glenohumeral osteoarthritis in young patients remains an unsolved problem. Humeral resurfacing hemiarthroplasty and stemmed hemiarthroplasty using metallic heads are two surgical options that avoid the complications of loosening or wear of the glenoid component seen in total shoulder arthroplasty. Des...

Background Advances in shoulder magnetic resonance imaging (MRI) and arthrography (MRA) have revolutionised musculoskeletal diagnosis and surgical planning. Despite this, the overall accuracy of MRI, with or without intra-articular contrast, can be variable. Methods In this prospective non-randomised analysis, 200 participants (74.5% males) with s...

Purpose: We report 8 cases of acute or subacute unilateral nondissociative carpal instability (CIND) in the context of nondisplaced scaphoid fractures. Methods: Eight patients from 3 centers developed abnormal volar intercalated segment instability (VISI) or dorsal intercalated segment instability (DISI) following the diagnosis of a nondisplaced...

This review describes the different possibilities for arthroplasties at the proximal interphalangeal joint, thumb carpometacarpal joint, distal radioulnar joint, metacarpophalangeal joint and the wrist. For each joint, the indication for arthroplasty is explained, the surgical technique with the suitable implant is described and a brief summary of...

Objective To demonstrate the utility of MRI in separating clinically relevant from minor or incidental lesions of the triangular fibrocartilage complex and the major interosseous ligaments in the wrist.Materials and methodsIn this retrospective study, we identified 89 patients and correlated MRI finding with subsequent arthroscopy. Triangular fibro...

Background Four-corner arthrodesis, which involves fusing four carpal bones while removing the scaphoid bone, is a standard surgery for the treatment of advanced stages of wrist arthritis. Nowadays, it can be performed using a dorsal approach by fixing a plate to the bones and a new radial approach is in development. To date, there is no consensus...

Background: Various rehabilitation treatments may be offered following surgery for flexor tendon injuries of the hand. Rehabilitation often includes a combination of an exercise regimen and an orthosis, plus other rehabilitation treatments, usually delivered together. The effectiveness of these interventions remains unclear. Objectives: To asses...

The goal of small joint arthroplasty is to relieve pain, optimise function and in doing so improve quality of life. Historically, arthrodesis has been used to relieve pain; however, the reduction in range of motion and function is unacceptable to many. Since the late 1950s there has been an evolution in the prostheses and techniques available, but...

Pyrolytic carbon (PyC) is a form of elemental carbon. Its favourable mechanical and biochemical properties mean it is well suited for a number of medical applications from cardiac valves to a bearing surface for joint arthroplasty. In this chapter we examine the material properties of PyC including its manufacture, safety profile and biocompatibili...

Volar wedge osteotomy and angle stable volar plating is now considered a standard approach for correction of distal radius malunion. In previous descriptions of the technique, soft tissue release has been performed with periosteal incision in line with the bony osteotomy. We present a technique whereby the dorsal periosteum is incised more proximal...

Objective Pyrocardan trapeziometacarpal interposition implant is a free intra-articular spacer composed of pyrocarbon. This biconcave resurfacing implant, both ligament and bone-stock sparing, is indicated for use in early-to-moderate stage trapeziometacarpal osteoarthritis. It was hypothesized that the postoperative outcome measures of the Pyrocar...

The emergence of the COVID-19 pandemic has severely affected medical treatment protocols throughout the world. While the pandemic does not affect hand surgeons at first glance, they have a role to play. The purpose of this study was to describe the different measures that have been put in place in response to the COVID-19 pandemic by hand surgeons...

Study Design This study is a descriptive survey. Introduction Health care providers (HCPs) are key stakeholders who facilitate workers’ return to work (RTW) following upper extremity surgery. Hand therapists play a major role in this process, yet we do not know if and/or how their perspectives differ from other HCPs. Purpose of the Study This stu...

Bone graft harvest from the distal radius, immediately proximal to the Lister’s tubercle, is a common technique in upper limb surgery. Here, we present a minimally invasive technique to harvest bone graft using a replaceable, well vascularized access trapdoor. The hinged trapdoor technique allows a small incision over Lister’s tubercle and does not...

Background Recessed mini-glenoid components provide an alternative to total shoulder replacement that may avoid some of the known shortcomings and complications associated with shoulder hemiarthroplasty or standard glenoid components in difficult cases. This study reports survivorship, radiological and clinical outcomes of a recessed mini-glenoid i...

Background There are concerns regarding glenoid erosion with metal shoulder hemiarthroplasty. PyroCarbon may offer an alternative because of favorable wear characteristics and preservation of the glenoid. The purpose of this study was to assess in vitro bone wear characteristics of PyroCarbon relative to cobalt chromium alloy hemiarthroplasty in a...

Purpose Return-to-work (RTW) stakeholders have varied roles and may therefore hold their own perspectives regarding factors that may influence outcomes. This study aimed to determine stakeholders’ perspectives on factors influencing RTW following surgery for non-traumatic upper extremity conditions. Methods A questionnaire was distributed to RTW s...

Aims: The aims of this study were: firstly, to investigate the influence of the thickness of cartilage at the sigmoid notch on the inclination of the distal radioulnar joint (DRUJ), and secondly, to compare the sensitivity and specificity of MRI with plain radiographs for the assessment of the inclination of the articular surface of the DRUJ in th...

Study design: Descriptive study. Introduction: A delayed return to work (RTW) is often associated with poorer outcomes after a workplace injury but is ill defined. Purpose of the study: To define delayed RTW after surgery for nontraumatic upper extremity conditions. Methods: Experts were consulted to define delayed RTW and whether a universa...

This is a protocol for a Cochrane Review (Intervention). The objectives are as follows: To assess the effects (benefits and harms) of diff erent rehabilitation inter ventions after surgery for flexor tendon injuries of the hand.

Kienböck’s disease is a painful condition that leads to progressive degeneration of the carpus, loss of grip strength and range of motion (ROM). Chondral loss is thought to start in the radiolunate articulation and progress to the capitolunate joint before globally affecting the wrist. In advanced Kienböck’s disease, where chondral loss and loss of...

Currently, there is no satisfactory treatment for Kienböck’s disease that provides excellent long-term results, in the context of macroscopic collapse of the lunate. Surgeons and scientists have been exploring multiple potential avenues of treatment with varying degrees of success over the decades. These have included the use of pyrolytic carbon (p...

This Delphi study aimed to reach consensus on important facilitators and barriers for return-to-work following surgery for non-traumatic upper extremity conditions. In Round 1, experts ( n = 42) listed 134 factors, which were appraised in Rounds 2 and 3. Consensus (⩾85% agreement) was achieved for 13 facilitators (high motivation to return-to-work;...

Background: Carpal tunnel syndrome (CTS) is a common problem, that can be effectively managed by surgery. Screening for prognostic factors is important to identify workers who are at a greater risk of a poor work outcome in order to implement tailored interventions to facilitate their return-to-work. Objective: To synthesize the best available e...

Plain language summary Rehabilitation following carpal tunnel release Carpal tunnel syndrome (CTS) is a condition in which a nerve that runs through a tunnel in the wrist is compressed. This leads to pain, numbness and tingling in the hand and sometimes into the forearm. In advanced stages, some patients experience weakness and muscle wasting in t...

Introduction Goniometric measurement of thumb range of motion is often used as an outcome measure in assessing patients with first carpometacarpal osteoarthritis. Despite common use and demonstrated construct validity, the reliability of this technique has not been well established. The Kapandji Index is an alternate functional measure of thumb mot...

Background: The purpose of this study was to evaluate whether removing the scaphotrapezoid joint (STj) for pantrapezial arthritis when performing a ligament reconstruction and tendon interposition (LRTI) resulted in any increase in carpal instability, compared with those patients who had an LRTI alone. We hypothesized that removing the proximal thi...

Background: Scaphoid nonunion advanced collapse (SNAC), scapholunate advanced collapse (SLAC), and Kienböck disease are some of the most common pathologies to result in arthritis of the carpus in the younger patient with a relative high functional demand. An option for treatment is to perform a proximal row carpectomy combined with resurfacing of t...

Distal radius fractures are common injuries of the upper extremity requiring treatment. In recent years, volar locking plate (VLP) fixation has become favored for operative treatment with the main goals being anatomic reduction and rigid fixation allowing for an early range of motion rehabilitation protocol. VLP fixation is excellent at correcting...

There are multiple surgical techniques to stabilize the bone in digital replantation. Various criteria need to be considered when choosing appropriate bony fixation including operative time, ease of exposure, stability, limitation of the area of dissection, and reproducibility. We describe our technique using internal fixation with a low-profile pl...

Introduction: Various conservative treatments for first carpometacarpal joint osteoarthritis have been reported. We aim to investigate the short-term effectiveness of conservative management interventions used to improve pain and function for adults with first carpometacarpal joint arthritis in a randomised controlled trial. Methods: A pragmatic 2...

The challenges presented by pathology of the Scapholunate Ligament (SLL) complex require a thorough understanding of the anatomy and pathomechanics of the relevant structures. The history will not always yield the stereotypical acute high-energy traumatic insult to the wrist and cumulative injury needs to be considered. Plain radiographs (static a...

The majority of shoulder surgery is performed via the anterior or anterolateral aspect of the shoulder joint. The deltopectoral approach is the workhouse approach to the shoulder for use in shoulder stabilisation, arthroplasty and fracture fixation. There are several modifications to this approach to increase exposure, such as coracoid or clavicle...

The primary goal in performing prosthetic arthroplasty in the small joints of the extremities remains pain relief; however, there is increasing interest in maximizing return of motion at the same time. During the past four decades, pyrolytic carbon (PyC) has been used successfully as a material for fabricating small joint implants for arthroplasty...

Available online at: http://wdpi2014.iwh.on.ca/program/presentation/T-P38 Background Workers undergoing carpal tunnel release (CTR) require time off work to recover from the surgery itself, and often to be rehabilitated back to work. The total time to return-to-work (RTW) following CTR can be highly variable. Differences in timeframes and outcomes...

Purpose To compare the inclination of the distal radioulnar joint (DRUJ) on computed tomography (CT) and plain radiography (XR) in order to assess the effect of narrowing the range of inclination used in the original Tolat classification system to identify potentially problematic reverse oblique DRUJs. Methods Two independent investigators compare...

Background: The purpose of this study was to review the survivorship, radiologic and clinical outcomes of reverse shoulder arthroplasty (RSA) used for the treatment of 3-part and 4-part proximal humeral fractures in the elderly. Methods: Between 2003 and 2009, 29 shoulders in 28 elderly patients (87% female) with a 3-part or 4-part fractures wer...

The purpose of this retrospective study was to evaluate the medium to longer-term results of type one displaced capitellar fractures treated with closed reduction. Retrospective case series PATIENTS:: Eight consecutive cases (seven adults; one child) with type one capitellar fractures. Closed reduction of type one capitellar fractures and four week...

Background: Distal radius fractures are among the most common fractures seen in the hospital emergency department. Of these, over 40% are considered unstable and require some form of fixation. 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...

Magnetic resonance imaging (MRI) is being increasingly utilized 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 sy...

Buy Article Permissions and Reprints Correction to Defining Residual Radial Translation of Distal Radius Fractures: A Potential Cause of Distal Radioulnar Joint InstabilityJnl Wrist Surg 2014; 03(01): 022-029 DOI: 10.1055/s-0033-1357758 The publisher regrets an error in the abstract of the above article in the Journal of Wrist Surgery, Volume 3,...

The aim of this paper is twofold: to raise awareness of the potential problems of leaving residual radial translation of the distal fragment in distal radius fracture fixation and to provide a reproducible, accurate and simple radiographic parameter to define this reduction. In this study, 100 normal wrist radiographs were reviewed by three fello...

Background: Various rehabilitation treatments may be offered following carpal tunnel syndrome (CTS) surgery. The effectiveness of these interventions remains unclear. Objectives: To review the effectiveness of rehabilitation following CTS surgery compared with no treatment, placebo, or another intervention. Search methods: On 3 April 2012, we...

Background Scapholunate reconstruction poses a challenge to orthopedic surgeons. Materials and Methods Prospective cohort. Description of Technique Our technique for scapholunate (SL) reconstruction involves ligament reconstruction utilizing a portion of the flexor carpi radialis tendon rerouted via transosseous tunnels across the scaphoid, lunate,...

Trapezium prosthetic arthroplasty has been utilized to treat basal joint arthritis for nearly five decades in an attempt to mitigate some of the potential disadvantages of trapeziectomy while preserving range of motion. Implant arthroplasty seeks to preserve joint biomechanics, avoids metacarpal subsidence, and should provide immediate stability. T...

The surgical treatment of post-traumatic radioulnar synostosis is difficult. Recurrence after resection alone is a concern with poor long-term maintenance of forearm rotation. We report on the use of pedicled adipofascial flaps to prevent recurrence and facilitate maintenance of movement in six adult patients with radioulnar synostosis. Five involv...

The objective of the systematic review is to synthesise the best available evidence on the effect of early prognostic factors on return to work outcomes in patients who have undergone carpal tunnel release surgery.

This paper reports the results of fixation of intraarticular fractures of the distal radius using the TriMed fragment-specific fixation system by surgeons early in their experience with the system. A consecutive series of 22 AO types C2 and C3 fractures in 21 patients were internally fixed with the system. Restoration of articular congruity to less...

The Sauvé-Kapandji procedure has been commonly performed in the setting of posttraumatic osteoarthritis of the distal radioulnar joint. A recognized complication is instability of the proximal ulnar stump, which may occur in up to 33% of cases. Salvage of the failed Sauvé-Kapandji procedure in this setting is difficult and can sometimes involve sac...

The Sauvé-Kapandji procedure has been commonly performed in the setting of posttraumatic osteoarthritis of the distal radioulnar joint. A recognized complication is instability of the proximal ulnar stump, which may occur in up to 33% of cases. Salvage of the failed Sauvé-Kapandji procedure in this setting is difficult and can sometimes involve sac...