Hand Surgery

The RNSH Department of Hand Surgery and Peripheral Nerve Surgery is a tertiary referral centre in NSW for injuries to and diseases of the hand, as well as nerve injuries affecting the upper limb. The Department provides care for both emergency and elective hand and upper limb conditions, with a 24 hour on-call service staffed at Consultant and Fellow/Registrar level.

The Department consists of six Hand Surgery consultants (of orthopaedic, plastic and general surgical backgrounds, with further training specifically in hand surgery), three Hand Surgery Fellows, two Orthopaedic Surgery Registrars, one Plastic Surgery Registrar and a Resident Medical Officer, along with a Research Officer and Department Secretary. Hand Therapists, Plaster Physiotherapists and nursing staff work in conjunction with the Department of Hand Surgery to provide a full range of services to patients.

Special areas of expertise within the department include:

  • mutilating hand injuries and replantations
  • congenital hand anomalies, including transition to adult care
  • spasticity and tetraplegic hand and upper limb surgery
  • brachial plexus injuries
  • free tissue transfer and flap coverage for upper limb injuries
  • Dupuytren's contracture management
  • complex wrist injuries
  • rheumatoid hand surgery

Lead

David Stewart

Senior lecturer, University of Sydney
Supervisor of Plastic Surgery Training, RNSH Department of Hand Surgery
Visiting Medical Officer at RNSH and the Children’s Hospital Westmead
Reviewer of the Journal of Hand Surgery (American)
Reviewer of the Journal of Hand Surgery (European)
Reviewer of the ANZ Journal of Surgery

Richard Lawson

Head of the RNSH Department of Hand Surgery
Lincoln Director of Hand Surgery Research at RNSH
Associate Editor of the Journal of Hand Surgery (American)
Reviewer of the Journal of Hand Surgery (European)

Brahman Sivakumar

Honorary senior lecturer, University of Sydney
Visiting Medical Officer at RNSH and Hornsby Ku-Ring-Gai Hospital
PhD candidate, University of Sydney

Belinda Smith - Research Officer

Anthony Beard - Visiting Medical Officer at RNSH

Mark Hile - Visiting Medical Officer at RNSH

James Ledgard - Visiting Medical Officer at RNSH

The RNSH Department of Hand Surgery and Peripheral Nerve Surgery is the tertiary referral hospital for the Northern Sydney Local Health District. It takes referrals from all of NSW, particularly for its special areas of expertise; brachial plexus injuries, tetraplegic hand reconstruction, upper limb spasticity, free tissue transfer and flap coverage of upper limb injuries.

Clinical Studies

  • Efficacy of XIAFLEX® (collagenase clostridium histolyticum) injection for Dupuytren’s contracture
  • Cost comparison of treatment of Dupuytren’s Disease: Collagenase injection vs fasciectomy
  • Congenital thumb hypoplasia: A retrospective review of results of surgical reconstruction of Grade 2 thumbs
  • Radiological assessment of the reconstructed thumb CMC joint following pollicisation
  • Outcomes of the Medial Femoral Condyle (MFC) Free Bone Flap Procedure
  • Donor site morbidity following the Medial Femoral Condyle (MFC) Free Bone Flap Procedure – Patient reported outcomes
  • Review of CMCJ arthroplasty: case series
  • Web position measurement: pre- and post-syndactyly release

Anatomical / Biomechanical studies

  • Intramuscular anatomy and innervation of the muscular components of the axillary nerve: Cadaveric study
  • Effect of the sagittal bands on metacarpophalangeal joint extension
  • Effect of extensor tendon adhesions on amplitude of finger joint movements: cadaveric study
  • Axonal count of the intercostal nerves
  • Biomechanical variation in headless compression screw fixation
  • Ligament of Struthers: Cadaveric study of comparative anatomy


Case studies/series

  • Neutrophilic dermatosis of the hand - a case series
  • Free medial femoral condyle flap for treatment of scaphoid nonunion with avascular necrosis in skeletally immature patients
  • One bone forearm procedure with medial femoral condyle osseous free flap
  • Recurrent cubital tunnel syndrome with ulnar nerve subluxation
  • The Austrian Flag: Severe carpal tunnel syndrome
  • Congenital hallucal hypoplasia equivalent to a grade 3 hypoplastic thumb in a patient with VACTERL association


Literature reviews

  • Treatment outcomes in congenital syndactyly release: a systematic review
  • Treatment outcomes of surgical reconstruction of congenital thumb hypoplasia, excluding pollicisation: a systematic review
  • Treatment outcomes of pollicisation for thumb hypoplasia: a systematic review

Cheng AMY, Cheng HS, Smith BJ, Stewart DA. Neutrophilic Dermatosis of the Hands: A review of 17 cases. J Hand Surg Am. 2018;43(2):185.e181-185.e185. doi: 10.1016/j.jhsa.2017.08.027.

Donald S, Niu R, Jones CW, Smith BJ, Clarke EC, Lawson RD. Effects of removal and reinsertion of headless compression screws. J Hand Surg Am. 2018; 43(2):139-145. doi: 10.1016/j.jhsa.2017.10.002. - Awarded “Editor’s Choice” status

Marshall TG, Sivakumar B, Smith BJ, Hile MS. Mechanics of metacarpophalangeal joint extension. J Hand Surg Am. 2018; 43(7):681.e1-681.e5. doi: 10.1016/j.jhsa.2017.12.010.

Sefton AK, Smith BJ, Stewart DA. Cost comparison of collagenase clostridium histolyticum and palmar fasciectomy for treatment of Dupuytren's contracture. J Hand Surg Asian Pac Vol. 2018; 23(3):336-341. doi: 10.1142/S2424835518500327.

Mende K, Tonkin MA. The Austrian Flag: Severe carpal tunnel syndrome. A case report. J Hand Surg Asian Pac Vol. 2018; 23(3):412-414. doi: 10.1142/S2424835518720268.

Rastogi P, Stewart DA, Lawson RD, Tremblay DM, Smith BJ, Tonkin MA. Cadaveric dissection of the axillary nerve: an investigation of extra-muscular and intra-muscular branching patterns. J Hand Surg Asian Pac Vol. 2018; 23(4):533-538. doi: 10.1142/S2424835518500546.

Graham DJ, Clitherow HDS, Singh HP, Smith BJ, Clarke EC, Tonkin MA. The effect of extensor tendon adhesions on finger motion. J Hand Surg Am. 2019; 44(10):903.e1-903.e5. doi: 10.1016/j.jhsa.2018.12.011.

Mende K, Tonkin MA. Congenital great toe hypoplasia equivalent to a grade 3 hypoplastic thumb in a patient with VACTERL association. J Hand Surg Asian Pac Vol. 2018; 23(4):605-606. doi: 10.1142/S2424835518720402.

Mende K, Suurmeijer JA, Tonkin MA. Surgical techniques for reconstruction of the hypoplastic thumb. J Hand Surg Eur Vol. 2019; 44(1):15-24. doi: 10.1177/1753193418793579.

Smith NC, Sivakumar B, Bellity JP, Tremblay DM, Lawson RD. Interosseous membrane reconstruction utilizing flexor digitorum superficialis autograft. Tech Hand Up Extrem Surg. 2019; 23(3):122-127. doi: 10.1097/BTH.0000000000000237.

Haines M, Baba M, Stewart DA. Iatrogenic femur fracture following medial femoral condyle flap harvest. J Hand Surg Am. 2020 Sep;45(9):885.e1-885.e3. doi: 10.1016/j.jhsa.2019.12.001.

Gschwind CR, Yeomans JL, Smith BJ. Upper limb surgery for severe spasticity after acquired brain injury improves ease of care. J Hand Surg Eur Vol. 2019; 44(9):898-904. doi: 10.1177/1753193419866595.

Ledgard JP, Gschwind CR. New developments in reconstructive upper limb surgery for tetraplegia: evidence for their efficacy. J Hand Surg Eur Vol. 2020;45(1):43‐50. doi:10.1177/1753193419886443

Vanhees M, Cardillo ND, Hile MS. The effect of knot position in Adelaide flexor tendon repair. J Hand Surg Eur Vol. J Hand Surg Eur Vol. 2020;45(3):303‐304. doi:10.1177/1753193419889297

Mende K, Watson A, Stewart DA. Surgical treatment and outcomes of syndactyly: A systematic review. J Hand Surg Asian Pac Vol. 2020;25(1):1‐12. doi:10.1142/S2424835520300017

Chahal H, Athreya P, Stewart DA. Acute Carpal Tunnel Syndrome as First Presentation of Amyloidosis. Australas J Plast Surg. [Accepted for publication, December 2020]

Hand Surgery related information

The RNSH Department of Hand and Peripheral Nerve Surgery runs a fellowship programme. The department has received more than 120 Australian and International fellows since 1987 when it commenced. Twelve month and six month positions are available, beginning in February and August of each year, with up to three paid positions available at any particular time.

More information can be found on the department website www.rnshhand.org

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